108例肝炎肝硬化患者瞬时弹性成像检测值变化规律及与病性类证候要素的相关性
|
摘要
目的分析肝炎肝硬化患者瞬时弹性成像(FibroScan,简称FS值)在不同疾病分期、分级中的变化规律及其与病性类证候要素的相关性。方法纳入肝炎肝硬化患者108例,其中代偿期69例,失代偿期39例。制定证候要素辨识标准,判定每位患者的病性类证候要素;同时采集患者信息,对患者进行ChildPugh评分,并根据评分进行分级,以及终末期肝病模型(MELD)评分,检测FS值。比较不同分期及不同Child-Pugh分级患者的FS值,并分析患者FS值与病性类证候要素的相关性。结果代偿期患者FS值明显低于失代偿期患者(P <0. 01);患者FS值与Child-Pugh得分、Child-Pugh分级及MELD评分之间呈正相关(P <0. 01)。代偿期患者常见证候要素为阴虚(45例)、气滞(43例)、阳虚(39例);失代偿期常见证候要素为水停(34例)、阴虚(30例)、血瘀(29例),其中血瘀、阳虚、气虚、水停分布两期比较差异有统计学意义(P <0. 05)。代偿期患者血瘀、阴虚、湿热、阳虚、水停患者FS值均高于未出现相应证素者;气滞患者FS值低于未出现者(P <0. 05)。失代偿期患者中气滞患者FS值低于未出现者,血瘀、阴虚、湿热、气虚、阳虚、水停患者FS值均高于未出现相应证素者,其中是否出现血瘀、水停、阳虚比较差异有统计学意义(P <0. 05)。结论肝炎肝硬化患者FS检测值随着病情的加重而呈上升趋势;中医证候要素与患者FS检测值有一定相关性,出现血瘀、水停、阳虚时病情较重。
Objective To analyze the change rules of FibroScan detection value( FS value) of patients with hepatitis cirrhosis in different disease stages and levels,and its correlation with traditional Chinese medicine( TCM) disease syndrome elements. Methods A total of 108 patients with hepatitis cirrhosis were included,of which 69 were compensated and 39 were decompensated. The syndrome identification criteria were developed,and the disease syndrome elements of each patient were determined. The patient information was collected,and Child-Pugh scores on patients were performed. Then grade according to scores,and model for end-stage liver disease( MELD) scores were evaluated. FS value was detected. The FS values of patients with different stages and different Child-Pugh grades were compared,and the correlation between FS values and disease syndrome elements were analyzed. Results FS value in patients with compensated liver cirrhosis was significantly lower than that in patients with decompensation( P <0. 01). There was a positive correlation between FS value and Child-Pugh score,Child-Pugh grade as well as MELD score( P < 0. 01). The distribution of common syndrome elements in compensatory hepatitis cirrhosis patients was as follows: yin deficiency( 45 cases),qi stagnation( 43 cases),and yang deficiency( 39 cases). The distribution of common syndromes in patients with liver cirrhosis in decompensated stage was as follows: water retention( 34 cases),yin deficiency( 30 cases),and blood stasis( 29 cases). The distribution frequency of blood stasis,yang deficiency,qi deficiency and water retention was significantly different between the two groups( P < 0. 05). In the patients with liver cirrhosis at compensatory stage,the FS values of the patients with blood stasis,yin deficiency,damp-heat,yang deficiency and water retention were higher than those of non-appearance patients without above syndromes. The FS value of patients with qi stagnation was lower than that of patients without qi stagnation( P < 0. 05). In the decompensated patients,the FS value of patients with qi stagnation syndrome was lower than that of patients without qi stagnation. The FS values of patients with blood stasis,yin deficiency,damp-heat,qi deficiency,yang deficiency,and water retention were higher than those of patients without above syndromes. Among them,the comparison of whether or not blood stasis,water retention,and yang deficiency were statistically significant( P < 0. 05). Conclusion The FS detection value of patients with hepatitis and cirrhosis increase with the aggravation of the disease. There is a certain correlation between TCM syndrome elements and the FS detection value of the patients with liver cirrhosis. The patients with blood stasis,water retention,yang deficiency syndrome are more serious.
Objective To analyze the change rules of FibroScan detection value( FS value) of patients with hepatitis cirrhosis in different disease stages and levels,and its correlation with traditional Chinese medicine( TCM) disease syndrome elements. Methods A total of 108 patients with hepatitis cirrhosis were included,of which 69 were compensated and 39 were decompensated. The syndrome identification criteria were developed,and the disease syndrome elements of each patient were determined. The patient information was collected,and Child-Pugh scores on patients were performed. Then grade according to scores,and model for end-stage liver disease( MELD) scores were evaluated. FS value was detected. The FS values of patients with different stages and different Child-Pugh grades were compared,and the correlation between FS values and disease syndrome elements were analyzed. Results FS value in patients with compensated liver cirrhosis was significantly lower than that in patients with decompensation( P <0. 01). There was a positive correlation between FS value and Child-Pugh score,Child-Pugh grade as well as MELD score( P < 0. 01). The distribution of common syndrome elements in compensatory hepatitis cirrhosis patients was as follows: yin deficiency( 45 cases),qi stagnation( 43 cases),and yang deficiency( 39 cases). The distribution of common syndromes in patients with liver cirrhosis in decompensated stage was as follows: water retention( 34 cases),yin deficiency( 30 cases),and blood stasis( 29 cases). The distribution frequency of blood stasis,yang deficiency,qi deficiency and water retention was significantly different between the two groups( P < 0. 05). In the patients with liver cirrhosis at compensatory stage,the FS values of the patients with blood stasis,yin deficiency,damp-heat,yang deficiency and water retention were higher than those of non-appearance patients without above syndromes. The FS value of patients with qi stagnation was lower than that of patients without qi stagnation( P < 0. 05). In the decompensated patients,the FS value of patients with qi stagnation syndrome was lower than that of patients without qi stagnation. The FS values of patients with blood stasis,yin deficiency,damp-heat,qi deficiency,yang deficiency,and water retention were higher than those of patients without above syndromes. Among them,the comparison of whether or not blood stasis,water retention,and yang deficiency were statistically significant( P < 0. 05). Conclusion The FS detection value of patients with hepatitis and cirrhosis increase with the aggravation of the disease. There is a certain correlation between TCM syndrome elements and the FS detection value of the patients with liver cirrhosis. The patients with blood stasis,water retention,yang deficiency syndrome are more serious.
引文
[1]熊益群,周大桥.肝硬化[M].北京:中国医药科技出版社,2007:38.
[2]ZIOL M,HANDRA-LUCA A,KETTANEH A,et al. Noninvasiveassessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C[J]. Hepatology,2005,41(1):48-54.
[3]AL-GHAMDI AS. Fibroscan:a noninvasive test of liver fibrosis assessment[J]. Saudi J Gastroenterol,2007,13(3):147-149.
[4]中华医学会传染病与寄生虫病学会和肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志,2001,19(1):55-61.
[5]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2011,27(1):113-128.
[6]夏德全,王吉耀.实用内科学[M]. 10版.北京:人民卫生出版社,1997:1673.
[7]刘成海,危北海,姚树坤.肝硬化中西医结合诊疗共识[J].中国中西医结合消化杂志,2011,19(4):277-279.
[8]中华中医药学会.中医内科常见病诊疗指南:西医疾病部分[M].北京:中国中医药出版社,2008:130-140.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:143-150.
[10]中华中医药学会内科肝胆病学组,世界中医药学会联合联合会肝病专业委员会,中国中西医结合学会肝病分组.慢性乙型肝炎中医诊疗专家共识(2012年1月)[J].临床肝胆病杂志,2012,28(3):164-168.
[11]薛冬云,韩涛. MELD-Na模型预测失代偿期肝硬化患者短期预后价值的评估[J].中国肝脏病杂志(电子版),2008,1(2):18-21.
[12]刘昌江,王莉,谢冬莲,等.终末期肝病模型评分标准临床应用的研究进展[J].医学综述,2013,19(13):2406-2408.
[13]韩怡,胡乃中. MELD、MESO、iMELD对失代偿期肝硬化患者短期预后的评估价值[J].中国现代医学杂志,2018,28(16):113-116.
[14]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:257-288.
[15]赵丽红,王天芳,薛晓琳,等. 801例肝炎肝硬化患者常见病性类证候要素在代偿期及失代偿期的分布特点[J].北京中医药大学学报,2015,38(4):260-265.
[16]杨波. MELD、CLD和Child-Pugh肝功能分,在肝细胞癌术前风险评估中的对比分析[D].桂林:桂林医学院,2012.
[17]姚向波.肝炎肝硬化患者肝功能生化指标检测的临床意义[J].检验医学与临床,2014,11(19):2741.
[18]MALINCHOC M,KAMATH PS,GORDON FD,et al. A model to predict poorsurvival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology,2000,31(4):864-871.
[19]王静. FibroScan在慢性肝病中的临床应用及与中医证型相关性研究[D].太原:山西省中医药研究院,2015.
[20]吴秀艳,王天芳,李永纲,等. 108例肝炎肝硬化患者FibroScan检测值与面色变化的相关性分析[J].中医杂志,2014,55(16):1401-1404.
[21]朱先女,陈启红,李贵华. 182例慢性乙型肝炎患者各中医证型的肝脏Fibroscan结果分析[J].新中医,2010,42(7):39-40.
[22]王奕.乙型慢性病毒性肝炎Fibroscan检测与中医辨证分型的关系[C]//中华中医药学会内科分会肝胆病专业委员会.中华中医药学会全国第十四次肝胆病学术会议论文汇编.北京:中华中医药学会内科分会肝胆病专业委员会,2010:3.
[23]谭春雨,刘平.肝硬化“虚损生积”病机理论溯源及其临床意义[J].上海中医药大学学报,2010,24(4):25-28.
[2]ZIOL M,HANDRA-LUCA A,KETTANEH A,et al. Noninvasiveassessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C[J]. Hepatology,2005,41(1):48-54.
[3]AL-GHAMDI AS. Fibroscan:a noninvasive test of liver fibrosis assessment[J]. Saudi J Gastroenterol,2007,13(3):147-149.
[4]中华医学会传染病与寄生虫病学会和肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志,2001,19(1):55-61.
[5]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2011,27(1):113-128.
[6]夏德全,王吉耀.实用内科学[M]. 10版.北京:人民卫生出版社,1997:1673.
[7]刘成海,危北海,姚树坤.肝硬化中西医结合诊疗共识[J].中国中西医结合消化杂志,2011,19(4):277-279.
[8]中华中医药学会.中医内科常见病诊疗指南:西医疾病部分[M].北京:中国中医药出版社,2008:130-140.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:143-150.
[10]中华中医药学会内科肝胆病学组,世界中医药学会联合联合会肝病专业委员会,中国中西医结合学会肝病分组.慢性乙型肝炎中医诊疗专家共识(2012年1月)[J].临床肝胆病杂志,2012,28(3):164-168.
[11]薛冬云,韩涛. MELD-Na模型预测失代偿期肝硬化患者短期预后价值的评估[J].中国肝脏病杂志(电子版),2008,1(2):18-21.
[12]刘昌江,王莉,谢冬莲,等.终末期肝病模型评分标准临床应用的研究进展[J].医学综述,2013,19(13):2406-2408.
[13]韩怡,胡乃中. MELD、MESO、iMELD对失代偿期肝硬化患者短期预后的评估价值[J].中国现代医学杂志,2018,28(16):113-116.
[14]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:257-288.
[15]赵丽红,王天芳,薛晓琳,等. 801例肝炎肝硬化患者常见病性类证候要素在代偿期及失代偿期的分布特点[J].北京中医药大学学报,2015,38(4):260-265.
[16]杨波. MELD、CLD和Child-Pugh肝功能分,在肝细胞癌术前风险评估中的对比分析[D].桂林:桂林医学院,2012.
[17]姚向波.肝炎肝硬化患者肝功能生化指标检测的临床意义[J].检验医学与临床,2014,11(19):2741.
[18]MALINCHOC M,KAMATH PS,GORDON FD,et al. A model to predict poorsurvival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology,2000,31(4):864-871.
[19]王静. FibroScan在慢性肝病中的临床应用及与中医证型相关性研究[D].太原:山西省中医药研究院,2015.
[20]吴秀艳,王天芳,李永纲,等. 108例肝炎肝硬化患者FibroScan检测值与面色变化的相关性分析[J].中医杂志,2014,55(16):1401-1404.
[21]朱先女,陈启红,李贵华. 182例慢性乙型肝炎患者各中医证型的肝脏Fibroscan结果分析[J].新中医,2010,42(7):39-40.
[22]王奕.乙型慢性病毒性肝炎Fibroscan检测与中医辨证分型的关系[C]//中华中医药学会内科分会肝胆病专业委员会.中华中医药学会全国第十四次肝胆病学术会议论文汇编.北京:中华中医药学会内科分会肝胆病专业委员会,2010:3.
[23]谭春雨,刘平.肝硬化“虚损生积”病机理论溯源及其临床意义[J].上海中医药大学学报,2010,24(4):25-28.