CAJ | 학술논문

目的：探讨肝炎肝硬化患者血清睾酮水平的变化规律及血清睾酮水平同中医常见病性证候要素的相关性，为肝炎肝硬化的临床干预及其中医病机的阐述提供一定依据。方法通过本课题组统一制定的《肝炎肝硬化临床信息采集表》，在全国多中心经过横断面流行病学调查，收集患者的一般情况、中医症状、体征等临床信息；同时采集血液标本并统一检测所需客观指标；参照现行的多个诊疗共识，结合前期文献回顾与临床调查结果，并经过两轮专家论证制订了《肝炎肝硬化常见证候要素辨识标准》，根据该标准，判定入组患者各自所属的病性类证候要素。利用 SPSS20.0软件对患者临床信息、客观指标及证候要素的数据结果进行存储及统计分析。结果（1）肝炎肝硬化患者血清睾酮水平同 Child - Pugh 得分及 MELD 评分之间均存在显著相关（P <0.01），且都为负相关（-1<r <0）；肝炎肝硬化代偿期患者的血清睾酮水平高于失代偿期患者的血清睾酮水平（ P <0.01）。（2）病性证候要素的分布情况为：血瘀（331）>气虚者（319）>水停者（299）>阳虚者（260）>阴虚者（257）>气滞者（254）>湿热者（168）。（3）肝炎肝硬化代偿期气虚组和水停组患者的血清睾酮水平分别低于非气虚组和非水停组，而血瘀组、湿热组、气滞组、阴虚组和阳虚组患者的血清睾酮水平分别高于非血瘀组、非湿热组、非气滞组、非阴虚组和非阳虚组的血清睾酮水平，但是这些差异均无统计学意义（P >0.05）。（4）肝炎肝硬化失代偿期患者中，气虚组患者的血清睾酮水平低于非气虚组患者的血清睾酮水平，且差异有统计学意义（P <0.01）；而血瘀组、气滞组、湿热组、水停组、阴虚组和阳虚组患者的血清睾酮水平分别同非血瘀组、非气滞组、非湿热组、非水停组、非阴虚组和非阳虚组之间的差异均无统计学意义（P >0.05）。结论肝炎肝硬化患者血清睾酮水平会随病情加重而呈下降趋势；中医病性证候要素对肝炎肝硬化代偿期患者的血清睾酮水平可能无影响，而气虚、水停及血瘀可能会对肝炎肝硬化失代偿期患者的血清睾酮水平产生影响。目的：探討肝炎肝硬化患者血清睪酮水平的變化規律及血清睪酮水平同中醫常見病性證候要素的相關性，為肝炎肝硬化的臨床榦預及其中醫病機的闡述提供一定依據。方法通過本課題組統一製定的《肝炎肝硬化臨床信息採集錶》，在全國多中心經過橫斷麵流行病學調查，收集患者的一般情況、中醫癥狀、體徵等臨床信息；同時採集血液標本併統一檢測所需客觀指標；參照現行的多箇診療共識，結閤前期文獻迴顧與臨床調查結果，併經過兩輪專傢論證製訂瞭《肝炎肝硬化常見證候要素辨識標準》，根據該標準，判定入組患者各自所屬的病性類證候要素。利用 SPSS20.0軟件對患者臨床信息、客觀指標及證候要素的數據結果進行存儲及統計分析。結果（1）肝炎肝硬化患者血清睪酮水平同 Child - Pugh 得分及 MELD 評分之間均存在顯著相關（P <0.01），且都為負相關（-1<r <0）；肝炎肝硬化代償期患者的血清睪酮水平高于失代償期患者的血清睪酮水平（ P <0.01）。（2）病性證候要素的分佈情況為：血瘀（331）>氣虛者（319）>水停者（299）>暘虛者（260）>陰虛者（257）>氣滯者（254）>濕熱者（168）。（3）肝炎肝硬化代償期氣虛組和水停組患者的血清睪酮水平分彆低于非氣虛組和非水停組，而血瘀組、濕熱組、氣滯組、陰虛組和暘虛組患者的血清睪酮水平分彆高于非血瘀組、非濕熱組、非氣滯組、非陰虛組和非暘虛組的血清睪酮水平，但是這些差異均無統計學意義（P >0.05）。（4）肝炎肝硬化失代償期患者中，氣虛組患者的血清睪酮水平低于非氣虛組患者的血清睪酮水平，且差異有統計學意義（P <0.01）；而血瘀組、氣滯組、濕熱組、水停組、陰虛組和暘虛組患者的血清睪酮水平分彆同非血瘀組、非氣滯組、非濕熱組、非水停組、非陰虛組和非暘虛組之間的差異均無統計學意義（P >0.05）。結論肝炎肝硬化患者血清睪酮水平會隨病情加重而呈下降趨勢；中醫病性證候要素對肝炎肝硬化代償期患者的血清睪酮水平可能無影響，而氣虛、水停及血瘀可能會對肝炎肝硬化失代償期患者的血清睪酮水平產生影響。
목적：탐토간염간경화환자혈청고동수평적변화규률급혈청고동수평동중의상견병성증후요소적상관성，위간염간경화적림상간예급기중의병궤적천술제공일정의거。방법통과본과제조통일제정적《간염간경화림상신식채집표》，재전국다중심경과횡단면류행병학조사，수집환자적일반정황、중의증상、체정등림상신식；동시채집혈액표본병통일검측소수객관지표；삼조현행적다개진료공식，결합전기문헌회고여림상조사결과，병경과량륜전가론증제정료《간염간경화상견증후요소변식표준》，근거해표준，판정입조환자각자소속적병성류증후요소。이용 SPSS20.0연건대환자림상신식、객관지표급증후요소적수거결과진행존저급통계분석。결과（1）간염간경화환자혈청고동수평동 Child - Pugh 득분급 MELD 평분지간균존재현저상관（P <0.01），차도위부상관（-1<r <0）；간염간경화대상기환자적혈청고동수평고우실대상기환자적혈청고동수평（ P <0.01）。（2）병성증후요소적분포정황위：혈어（331）>기허자（319）>수정자（299）>양허자（260）>음허자（257）>기체자（254）>습열자（168）。（3）간염간경화대상기기허조화수정조환자적혈청고동수평분별저우비기허조화비수정조，이혈어조、습열조、기체조、음허조화양허조환자적혈청고동수평분별고우비혈어조、비습열조、비기체조、비음허조화비양허조적혈청고동수평，단시저사차이균무통계학의의（P >0.05）。（4）간염간경화실대상기환자중，기허조환자적혈청고동수평저우비기허조환자적혈청고동수평，차차이유통계학의의（P <0.01）；이혈어조、기체조、습열조、수정조、음허조화양허조환자적혈청고동수평분별동비혈어조、비기체조、비습열조、비수정조、비음허조화비양허조지간적차이균무통계학의의（P >0.05）。결론간염간경화환자혈청고동수평회수병정가중이정하강추세；중의병성증후요소대간염간경화대상기환자적혈청고동수평가능무영향，이기허、수정급혈어가능회대간염간경화실대상기환자적혈청고동수평산생영향。
Objective To discuss the rule of serum testosterone level change the patients of hepati-tis cirrhosis and the correlative study with the common TCM pattern elements so as to provide the evidences for the clinical practice of hepatitis cirrhosis and the explanation of TCM pathogenesis.Methods In the research,the Clinical information form of hepatitis cirrhosis was drawn up for the national multi - central cross - sec-tional epidemiological survey and the collection of clinical information of patients,such as general condition, TCM symptoms and physical signs. Additionally,blood sample was collected and the required objective inde-xes were determined. In reference to the common recognition of different treatments,in associated with the lit-erature reviews and clinical investigation results and through two - round expert argument,the Standard of the identification of the common pattern elements of hepatitis cirrhosis was developed. According to this standard, the individual pattern elements were determined in the enrolled patients. Afterwards,using SPSS20. 0 soft-ware,the data on the clinical information,objective indexes and TCM pattern elements were recorded and an-alyzed statistically. Results 1. In the patients of hepatitis cirrhosis,the serum testosterone level was signifi-cantly correlative to either Child - Pugh score or MELD score(P < 0. 01)and presented the negative correla-tion( - 1 < r < 0). The serum testosterone level was not different significantly between the patients of hepatitis cirrhosis at compensatory stage and those at decompensatory stage(P < 0. 01). The level in the patients at compensatory stage was higher than that at decompensatory stage. 2. The distribution of TCM patterns:blood stagnation(331 cases)> qi deficiency(319 cases)> body fluid retention(299 cases)> yang deficiency (260 cases)> yin deficiency(257 cases)> qi stagnation(254 cases)> damp heat(168 cases). 3. The ser-um testosterone level in the patients at compensatory stage differentiated in qi deficiency group and body fluid retention group was lower that in the non - qi deficiency group and non - body fluid retention group. That in blood stagnation group,damp heat group,qi stagnation group,yin deficiency group and yang deficiency group was higher than that in the non - blood stagnation group,non - damp heat group,non - qi stagnation group, non - yin deficiency group and non - yang deficiency group separately. But the differences were not significant (P > 0. 05). 4. In the patients at decompensatory stage,the serum testosterone level in the qi deficiency group was lower than that in the non - qi deficiency group,indicating the significant difference(P < 0. 01). That in the blood stagnation group,qi stagnation group,damp heat group,body retention group,yin deficiency group and yang deficiency group was not different significant than that in the non - blood stagnation group,non - qi stagnation group,non - damp heat group,non - yin deficiency group and non - yang deficiency group(P >0. 05). Conclusion The serum testosterone level is reduced in tendency while the condition is getting worse in the patients of hepatitis cirrhosis. TCM pattern elements have not affect serum testosterone level in the case at compensatory stage. But,qi deficiency,body fluid retention and blood stagnation impact the serum testoster-one level in the patients at decompensatory stage.