病毒性肝炎生化指标与中医证型关系的初步研究

【作者】 王琮；

【导师】 徐春军；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 第一部分文献研究本文就近二十年来国内病毒性肝炎的相关文献,从病因病机和发病机制研究、诊断方法研究、内治外治研究进展,三个方面进行了综合评述。第二部分临床研究目的：探讨病毒性肝炎患者实验室指标与中医辨证分型之间的关系,初步建立病毒性肝炎的指标辨证体系,以辅助对无症状型患者的辨证。方法：选择270例诊断明确、有突出症状的病毒性肝炎患者,记录其主要实验室指标,并根据症状、舌脉对患者进行中医辨证分型,统计不同证型患者的实验室指标变化及不同节段实验室指标的证型分布规律。结果：肝胆湿热证的ALT、AST水平显著高于其余4型,分别为258.06U/L、171.29U/L,肝肾阴虚证次之,肝郁脾虚证患者ALT、AST水平最低；各证型GGT均值由大到小的排列顺序与AST组相同；TBIL的升高以脾肾阳虚证异常最为明显,且均值(31.25umol/L)远高于其他证型；ALT、 AST、 GGT升高不同节段各证型出现百分比差异显著(P<0.01),ALT、 AST正常时(<40U/L),均以肝郁脾虚证为主,升高2倍以内时,以肝郁脾虚证、肝肾阴虚证两型为主,升高至5倍以上时以肝胆湿热证占绝大多数；各证型在GGT升高不同节段的分布部分特征与AST相符,但瘀血阻络证患者出现GGT升高的概率较高；各证型在TBIL升高不同节段分布情况较复杂,各节段间无显著差异(P>0.05),不具有统计学意义。结论：病毒性肝炎患者ALT、 AST、 GGT在不同程度异常时辨证分型的分布规律差异显著,具有重要临床意义。本研究可从临床工作者的角度出发,通过已知的实验室指标,辅助判断症状不显、舌脉如常患者的辨证分型,此外还可通过对证型分布规律的分析可指导临床用药。更多还原

【Abstract】 Part One SummaryThis article summarizes the research of viral hepatitis in etiology and pathogenesis, diagnosis method and therapeutic method in the last20years.Part Two Clinical ResearchObjective:Through exploring the relationship between laboratory parameters and Chinese medicine diagnosis of viral hepatitis patient, finding assistant evidences to judge the TCM syndrome type.Methods:Collecting270cases with outstanding symptoms who are also clearly diagnosised of viral hepatitis. Record their main laboratory index, while judge their Chinese medicine diagnosis and classification according to the symptoms, tongue meridian. Analyze the distribution regularities of different TCM syndrome types.Results:ALT, AST level of damp-heat syndrome are significantly higher than the rest of the4types,they are258.06U/L and171.29U/L, liver and kidney Yin deficiency follows, ALT, AST level of liver depression and spleen deficiency are close to normal; GGT of every syndrome type are similar to AST group. The rise of TBIL in spleen-kidney yang deficiency is the most obvious, and the mean (31.25umol/L) is far higher than other types. Some of the groups have significant differences in ALT, AST and GGT (P<0.05), but other indicators’difference is invalid (P>0.05). A moderately elevated liver function in liver depression and spleen deficiency and kidney Yin deficiency pattern see more, moderate to severe rise see more in damp and hot disease. Liver depression and spleen deficiency is the commonist pattern when ALT or AST is normal (<40U/L); after rising to more than five times,the most probably pattern is damp-heat syndrome; syndrome types in different segments of increased GGT is also similar with AST, but blood stasis syndrome is more probability to see an increased GGT; statistics of TBIL is more complex, each segment has no significant differences between each other (P>0.05).Conclusion:Laboratory index rising degree and TCM syndrome type distribution rule are of closely relation. This study can be from clinical workers’ angle, through the known laboratory index, helping to analyze of the TCM type of patients.更多还原