酒精性肝硬化的中医证候特点研究

【作者】 何玲燕；

【导师】 李军祥；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 中医药在防治酒精性肝病方面具有潜在的优势和鲜明的特点,本课题旨在中医理论指导下,运用临床流行病学的方法和原则,从中医四诊角度对酒精性肝硬化的临床症状进行证候学分类,探讨酒精性肝硬化的中医证候特点,并以此归纳现阶段酒精性肝硬化在中医病名、证型上的分布,以达到为临床诊断及治疗起到一定的支持作用,为进一步的分析性研究和试验性研究奠定基础。本研究二部分组成:理论研究部分,一部分内容总结了中医对酒精性肝病病因病机的认识,对当前国内有关中药方剂和有效成分治疗酒精性肝病以及酒精性肝病流行病学的研究进展进行了综述;另一部分系统论述了酒精性肝病现代理论研究及其临床治疗成果。临床研究部分,为多中心前瞻性研究。以符合临床流行病学要求的全国5家医院病例资料为基础,对酒精性肝硬化患者的临床资料进行调查,探讨酒精性肝硬化患者中医证候分布的特点;应用熵聚堆统计分析方法,研究了120例酒精性肝硬化患者中医证候特点的分布以及发病特点。研究结果:实验一:男性为主要的饮酒和酒精性肝硬化患病人群;酒精性肝硬化的发病高峰年龄在50岁左右。不同职业人群酒精性肝硬化发生率有所不同,干部、商人最高,分别为29%和43%;日饮酒量160g/d,饮酒年限20年,累计酒精摄入量1500kg左右时,具有较高的患病率。酒精性肝硬化患者中谷氨酰转肽酶(γ-GT)值(100～250U/L)、AST/ALT比值＞2、碱性磷酸酶(ALP)值(220～550U/L)、总胆红素(TBIL)(34～51umol/1)、白蛋白(ALB)(28～35g/l)、凝血酶原百分活动度PTA(50%～70%)的出现率较高。实验二:酒精性肝硬化患者中医证候特点为虚实夹杂;中医病位主要在肝胆脾肾;病机主要为气滞、血瘀、湿(热)浊内蕴,兼有肝肾阴虚,脾肾阳虚。证型主要分为:肝郁脾虚、脾虚湿盛、湿热内蕴、气滞血瘀、肝肾阴虚、脾肾阳虚。更多还原

【Abstract】 Chinese medicine in the prevention and treatment of alcohol-induced liver disease has the potential advantages and distinctive features, TCM aims at the issue under the principle of theoretical guidance,the use of clinical epidemiology methods and principles,from the perspective of Chinese medicine clinic four to alcohol sclerosis clinical symptoms of the syndrome classification study to explore the alcohol-induced cirrhosis of the characteristics of TCM Syndrome,As summarized in alcoholic liver cirrhosis stage disease in Chinese medicine,evidence-based on the distribution,so as to achieve for the clinical diagnosis and treatment play a supporting role for the further analysis of the research and lay the foundation for pilot studies.In this study,two parts:Theoretical study of the concluding part of traditional Chinese medicine on alcohol-induced liver disease etiology and pathogenesis of understanding on the current home of the active ingredients of Chinese medicine prescriptions and treatment of alcoholic liver disease alcoholic liver disease,as well as epidemiological Studies were reviewed;another part of the system on the modern theory of alcohol-induced liver cirrhosis and its clinical results.Part of clinical research for the multi-center prospective study。To comply with the requirements of clinical epidemiology 5 national hospital-based clinical data on patients with alcoholic liver cirrhosis to investigate clinical data to explore traditional Chinese medicine in patients with alcoholic cirrhosis of the characteristics of Syndrome Distribution;application heap Poly entropy statistical analysis, studied 120 cases of alcoholic cirrhosis in patients with the characteristics of TCM Syndrome distribution,the characteristics of the incidence.Study Results:1:men as the main drinking and the prevalence of alcohol-induced liver cirrhosis group;alcoholic cirrhosis the peak age of incidence around the age of 50.Different occupational groups the incidence of alcoholic cirrhosis is different cadres,businessmen highest 29%and 43%;Alcohol day 160g / d,drinking age 20 years,cumulative alcohol intake of around 1500kg,has a high prevalence rate.Patients with alcoholic liver cirrhosis glutamyltranspeptidase enzyme(γ-GT) values (100 ~ 250U / L),AST / ALT ratio> 2,alkaline phosphatase(ALP) values (220 ~ 550U / L),total bilirubfn(TBIL)(34 ~ 51umol / 1),albumin(ALB) (25 ~ 31g / 1),percentage of prothrombin activity PTA(50%~ 70%) the emergence of a higher rate.2:The TCM syndromes’ feature of the ALC patients is the inclusion of excess and deficiency,In the TCM theory,ALC is mainly located at liver,gallbladder,spleen and kidney.Pathogenesis are qi-stagnancy and blood stasis,dampness and turbid things inside,besides yin deficiency of liver and spleen,yang vacuity of spleen and kidney.Syndromes include stagnation of liver-QI with deficiency of the spleen damp abundance,qi-stagnancy and blood stasis and hepatic and renal yin deficiency,asdthenic splenonephro-yang.更多还原