【作者】 李亚萍；

【导师】 尹常健；

【作者基本信息】 山东中医药大学 ， 中西医结合临床， 2012， 博士

【摘要】 目的：观察肝胆湿热证证候特征，探讨慢性乙型肝炎肝胆湿热证与客观指标之间的关系，并确立治疗方案，初步建立慢性乙型肝炎肝胆湿热证规范化双重诊疗体系。方法：160例肝胆湿热证患者，随机分为治疗组100例（甲乙清解汤）和对照组60例（抗肝损伤辨病专方），拟定治疗组的治疗方案。一方面，对治疗组患者的临床表现进行频数分析、聚类分析、因子分析和Logistic回归分析等统计分析，观察肝胆湿热证的证候特征并确立辨证标准；同时，分析肝胆湿热证证候积分与肝功能、HBV-DNA、B超等指标变化的相关性。另一方面，观察治疗组治疗前后临床症状、体征的改善情况；治疗前后肝功能、B超、凝血酶原时间（PT）、肝纤维化四项、免疫学（CD4+、CD8+、CD4+/CD8+）等指标的变化，并比较治疗后治疗组与对照组组间的差异性，以确立肝胆湿热证的治疗方案。结果：1、辨证标准：主症：胁肋胀痛，急躁易怒；次症：小便黄赤、身目发黄、舌苔黄腻；兼症：口粘、口苦、口臭、大便粘腻、渴不欲饮、纳差、恶心厌油、失眠多梦、乏力、腹胀痛、舌红、脉弦滑；客观指标：ALT、AST、TBIL、DBIL、GLO轻度、中度升高；B超分度为轻度或中度。2、相关性分析：肝胆湿热证与ALT、AST、GLO、TBIL、DBIL、IBIL、B超分度、病情分度之间存在明显的直线正向相关关系（P<0.01）；与ALB、A/G之间存在明显的直线负向相关关系（P<0.01）。3、治疗方案：经临床观察，治疗组用甲乙清解汤可改善肝功能、肝脾B超、肝纤维化四项、凝血酶原时间、免疫功能（CD4+、CD8+、CD4+/CD8+）等相关指标，且疗效显著（P<0.05，P<0.01），从而确立甲乙清解汤为治疗主方；并根据不同兼证确立加减方。4、确立疗效评价体系。结论：慢性乙型肝炎肝胆湿热证与肝功能指标存在相关性，在此基础上，构建起慢性乙型肝炎肝胆湿热证双重诊疗体系。更多还原

【Abstract】 Objective: Through investigating the characteristic of the dampness-heat syndromeof liver and gallbladder,to explore the relationship between objective indicators andchronic hepatitis B,in order to establish clinical standardized therapeutical system of thesyndrome of Damp-heat in the liver and Gallbladder of chronic Hepatitis B.Methods:160patients diagnosed as Damp-heat in the liver and Gallbladder wererandomly assigned to two groups: the treated group(100cases) treated with Jiayi clearingdecoction and the control group (60cases)treated with prescription specialise for hepaticinjury. One side, clinical symptoms of the treated group were analyzed by, to establishstandardized differentiation of the syndrome of Damp-heat in the liver and Gallbladder. Atthe same time, to anlyze the relationship between symptome point and liver function、HBV-DNA and ultrasonic check. On the other side, clinical symptoms、physical sign、liverfunction、ultrasonic check、PT、four indexes of liver fibrosis and CD4+、CD8+、CD4+/CD8+were observed and compared before and after therapy in the treated groupand between the two groups after therapy.Results:1.Standard of the syndrome differentiation: main symptoms: distending painin hypochondrium、irritable and angry easily;secondary symptoms: deep-colored urine、yellow fur、yellow eyes、yellow tongue coating;thirdly symptoms: greasy and bitter taste、halitosis、viscous stool、thirst without desire to drink、anorexia、nausea、tiring greasy food、insomnia、dreaminess、weakness、abdominal distension and pain、red tongue、wiry androlling and rapid pulse; objective indicators: light or middle increase of ALT、AST、TBIL、 DBIL、GLO; light or middle change in ultrasound parameters.2. Proportional analysis: thesyndrome of Damp-heat in the liver and Gallbladder is apparently positively proportionalto ALT、AST、GLO、TBIL、DBIL、IBIL、ultrasound parameters、degree of illness（P<0.01）,and negatively proportional toALB、A/G（P<0.01）.3. Therapeutical program:Jiayi clearing decoction obviously improved liver function、liver and spleen’s ultrasoundparameters、four indexes for liver fibrosis、PT and CD4+、CD8+、CD4+/CD8+（P<0.05，P<0.01）. Jiayi clearing decoction is cardinal prescription for the syndrome of Damp-heatin the liver and Gallbladder of chronic Hepatitis B.4.Establish curative effection judgmentsystem.Conclusions: The syndrome of Damp-heat in the liver and Gallbladder of chronicHepatitis B have some correlation with liver function, on the basis of it, we can establishdouble therapeutical program of the syndrome of Damp-heat in the liver and Gallbladderof chronic Hepatitis B.更多还原