108例肝炎肝硬化患者FibroScan检测值与舌象的相关性分析
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摘要
目的分析肝炎肝硬化患者的舌象与瞬时弹性成像技术(Fibro Scan)检测值(FS值)的相关性,为中医通过望舌判断病情严重程度提供客观依据。方法运用肝炎肝硬化临床信息采集表收集患者的一般病情资料、舌象、FS值等,并用Excel进行数据录入,将数据根据舌象有无出现分组,并运用SPSS 20. 0软件对患者临床信息、FS值及舌象进行描述性统计分析,采用t检验、卡方检验、秩和检验等。结果 (1)108例肝炎肝硬化患者,FS值最小值4. 1 k Pa,最大值75 k Pa,平均(24. 07±18. 43) k Pa,其中代偿期(16. 18±10. 06) k Pa,失代偿期(38. 03±21. 50) k Pa,2期比较差异有统计学意义(P <0. 01);(2)108例患者不同舌象FS值的比较发现:舌色上,红绛舌组FS值最高;舌形上,瘦舌组FS值最高;苔质上,燥苔组FS值最高;苔色上,黄苔组FS值最高。所有分组中,只有胖舌组、裂纹舌组以及燥苔组差异比较有统计学意义(P <0. 05),其余各组间差异比较无统计学意义。结论舌象表现为瘦舌、裂纹舌和燥苔患者的FS值较高,说明当肝炎肝硬化患者出现以上3种舌象时,病机主要以热证、阴虚、血虚和津伤为主,提示肝硬化病情越严重。由此可以看出,作为判断病情严重程度的FS值与舌象变化有一定的相关性。
Objective To investigate the correlation of tongue manifestations and FibroScan value in patients with post-hepatitic cirrhosis and provide objective evaluation of illness severity and pathogenesis.Methods The clinical information extraction table of hepatitis cirrhosis was used to collect the general information of the patient's condition,the FS value of the tongue image and etc. The data were inputted into Excel,and grouped according to whether there was any tongue picture or not. SPSS 20. 0 software was used to analyze the clinical information of patients with descriptive statistical analysis,including t test,chi-square test,and rank sum test. Results In 108 patients with post-hepatitic cirrhosis,the minimum value of FS was 4. 10 kPa and the maximum value was 75. 00 kPa. The mean value was( 24. 07 ± 18. 43) k Pa; compensatoed stage( 16. 18 ± 10. 06) k Pa,decompensated stage( 38. 03 ±21). There was significant difference between the two stages( P < 0. 05). FS of the crimson tongue was highest in the color of tongue. In tongue shape,Fs of thin tongue was higher than other tongues. In tongue coating,dry and yellow coating were higher than others. Among all the groups,only the bulgy tongue group,the cracked tongue group and the dry fur group had significant differences( P < 0. 05),but there was no significant difference between other groups. Conclusion FS value appears to ke higher in the patients with thin tongue,fissured tongue and dry coating. It shows that the higher the FS value of heat syndrome,yin deficiency,blood deficiency and injury,the more serious the condition of liver cirrhosis is when the above three tongue signs appear in the patients with hepatitis and liver cirrhosis. This indicates that FS value has a certain correlation with tongue changes.
Objective To investigate the correlation of tongue manifestations and FibroScan value in patients with post-hepatitic cirrhosis and provide objective evaluation of illness severity and pathogenesis.Methods The clinical information extraction table of hepatitis cirrhosis was used to collect the general information of the patient's condition,the FS value of the tongue image and etc. The data were inputted into Excel,and grouped according to whether there was any tongue picture or not. SPSS 20. 0 software was used to analyze the clinical information of patients with descriptive statistical analysis,including t test,chi-square test,and rank sum test. Results In 108 patients with post-hepatitic cirrhosis,the minimum value of FS was 4. 10 kPa and the maximum value was 75. 00 kPa. The mean value was( 24. 07 ± 18. 43) k Pa; compensatoed stage( 16. 18 ± 10. 06) k Pa,decompensated stage( 38. 03 ±21). There was significant difference between the two stages( P < 0. 05). FS of the crimson tongue was highest in the color of tongue. In tongue shape,Fs of thin tongue was higher than other tongues. In tongue coating,dry and yellow coating were higher than others. Among all the groups,only the bulgy tongue group,the cracked tongue group and the dry fur group had significant differences( P < 0. 05),but there was no significant difference between other groups. Conclusion FS value appears to ke higher in the patients with thin tongue,fissured tongue and dry coating. It shows that the higher the FS value of heat syndrome,yin deficiency,blood deficiency and injury,the more serious the condition of liver cirrhosis is when the above three tongue signs appear in the patients with hepatitis and liver cirrhosis. This indicates that FS value has a certain correlation with tongue changes.
引文
[1]吴秀艳,王天芳,李永纲,等. 108例肝炎肝硬化患者Fibro Scan检测值与面色变化的相关性分析[J].中医杂志,2014,55(16):1401-1404.Wu XY,Wang TF,Li YG,et al. The correlation analysis between Fibro Scan detection value and facial color change in 108 patients with hepatitis cirrhosis[J]. Journal of Chinese Medicine,2014,55(16):1401-1404.
[2]Degos F,Perez P,Roche B,et al. Diagnostic accuracy of Fibro Scan and comparison to liver fibrosis biomarkers in chronic viral hepatitis:a multicenter prospective study(the FIBOSTIC study)[J]. J Hepatol,2010,53(6):1013-1021.
[3]张宁,周双男,宫嫚,等. Fibro Scan评价复方鳖甲软肝片抗纤维化的疗效[J].临床肝胆病杂志,2013,29(10):760-763.Zhang N,Zhou SN,Gong M,et al. Fibro-Scan was used to evaluate the effect of compound Biejia Ruangan tablet on anti-fibrosis[J]. Journal of Clinical Hepatology,2013,29(10):760-763.
[4]王仲霞,王立福,王葽,等.益气破血行气通络中药对乙型肝炎代偿期肝硬化患者的治疗作用[J].中西医结合肝病杂志,2012,22(1):5-7.Wang ZX,Wang LF,Wang L,et al. The therapeutic effect of traditional Chinese medicine for nourishing qi and breaking blood and regulating qi and dredging collaterals on patients with compensatory liver cirrhosis of hepatitis B[J]. Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases,2012,22(1):5-7.
[5]Kim SU,Kim do Y,Park JY,et al. How can we enhance the performance of liver stiffness measurement using Fibro Scan in diagnosing liver cirrhosis in patients with chronic hepatitis B[J]. J Clin Gastroenterol,2010,44(1):66-71.
[6]罗子华,邹健,宓林,等. Fibroscan评价慢性病毒性肝炎肝纤维化(≥F2)的Meta分析[J].世界华人消化杂志,2013,21(33):3724-3735.Luo ZH,Zou J,Mi L,et al. Fibroscan in the evaluation of liver fibrosis(≥F2)in chronic viral hepatitis[J]. World Chinese Journal of Digestology,2013,21(33):3724-3735.
[7]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.Chinese Medical Association Infectious Diseases and Parasitology Society,liver Science Branch. A program for the prevention and treatment of viral hepatitis[J]. Chinese Journal of Hepatology,2000,8(6):324-329.
[8]贾继东,李兰娟.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.Jia JD,Li LJ. Guidelines for prevention and treatment of chronic hepatitis B(2010 ed.)[J],Journal of Clinical Hepatology,2011,27(1):113-128.
[9]李宁,薛晓琳,吴秀艳,等.代偿期、失代偿期肝炎肝硬化患者的舌象比较分析[J].世界中西医结合杂志,2014,9(4):371-374.
[10] Li N,Xue XL,Wu XY,et al. Comparative analysis of tongue picture in patients with liver cirrhosis in compensatory and decompensated stage[J]. World Journal of Integrated Traditional and Western Medicine,2014,9(4):371-374.
[11]孙澄清. 63例肝硬化患者的舌象观察[J].苏州大学学报(医学版),2003,23(6):657.Sun CQ. Tongue observation of 63 patients with cirrhosis[J]. Journal of Soochow University(Medical Science ed.),2003,23(6):657.
[12]毛永森,彭中强.肝硬化100例舌脉观察[J].青海医学院学报,1996,17(3):198-199.Mao YS,Peng ZQ. Observation on tongue vein of 100 patients with liver cirrhosis[J]. Journal of Qinghai Medical College,1996,17(3):198-199.
[13]李凤陈,李萍,李凯,等.舌诊在肝硬化中的应用[J].中医药学报,2001,29(4):60-61.Li FC,Li P,Li K,et al. Application of tongue diagnosis in liver cirrhosis[J]. Acta Chinese Medicine and Pharmacology,2001,29(4):60-61.
[14]胡兴昌.舌诊与肝病辨治[J].当代医学,2009,15(3):153-154.Hu XC. Tongue diagnosis and treatment of liver diseases[J]. Contemporary Medicine,2009,15(3):153-154.
[15]谢旭善.舌象与肝病辨治[J].山东中医杂志,1998,17(1):7-9.Xie XS. Differential treatment of tongue and liver disease[J]. Shandong Journal of Traditional Chinese Medicine,1998,17(1):7-9.
[16]戴芳,唐亚平,周艳,等.裂纹舌与病性证素相关性的研究[J].辽宁中医杂志,2010,37(11):2200-2201.Dai F,Tang YP,Zhou Y,et al. A study on the correlation between cracked tongue and diseased syndromes[J].Liao Ning Journal of Traditional Chinese Medicine,2010,37(11):2200-2201.
[17]贾微,唐亚平,黄浩,等.燥苔与病性证候要素相关性的研究[J].时珍国医国药,2014,25(3):671-672.Jia W,Tang YP,Huang H,et al. Study on the correlation between dryness moss and essential factors of disease syndrome[J]. Lishizhen Medicine and Materia Medica Research,2014,25(3):671-672.
[18]李灿东,吴承玉.中医诊断学[M].北京:中国中医药出版社,2012:15-16.Li CD,Wu CY. Chinese Medicine Diagnostics[M]. Beijing:China press of Traditional Chinese Medicine,2012:15-16.
[2]Degos F,Perez P,Roche B,et al. Diagnostic accuracy of Fibro Scan and comparison to liver fibrosis biomarkers in chronic viral hepatitis:a multicenter prospective study(the FIBOSTIC study)[J]. J Hepatol,2010,53(6):1013-1021.
[3]张宁,周双男,宫嫚,等. Fibro Scan评价复方鳖甲软肝片抗纤维化的疗效[J].临床肝胆病杂志,2013,29(10):760-763.Zhang N,Zhou SN,Gong M,et al. Fibro-Scan was used to evaluate the effect of compound Biejia Ruangan tablet on anti-fibrosis[J]. Journal of Clinical Hepatology,2013,29(10):760-763.
[4]王仲霞,王立福,王葽,等.益气破血行气通络中药对乙型肝炎代偿期肝硬化患者的治疗作用[J].中西医结合肝病杂志,2012,22(1):5-7.Wang ZX,Wang LF,Wang L,et al. The therapeutic effect of traditional Chinese medicine for nourishing qi and breaking blood and regulating qi and dredging collaterals on patients with compensatory liver cirrhosis of hepatitis B[J]. Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases,2012,22(1):5-7.
[5]Kim SU,Kim do Y,Park JY,et al. How can we enhance the performance of liver stiffness measurement using Fibro Scan in diagnosing liver cirrhosis in patients with chronic hepatitis B[J]. J Clin Gastroenterol,2010,44(1):66-71.
[6]罗子华,邹健,宓林,等. Fibroscan评价慢性病毒性肝炎肝纤维化(≥F2)的Meta分析[J].世界华人消化杂志,2013,21(33):3724-3735.Luo ZH,Zou J,Mi L,et al. Fibroscan in the evaluation of liver fibrosis(≥F2)in chronic viral hepatitis[J]. World Chinese Journal of Digestology,2013,21(33):3724-3735.
[7]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.Chinese Medical Association Infectious Diseases and Parasitology Society,liver Science Branch. A program for the prevention and treatment of viral hepatitis[J]. Chinese Journal of Hepatology,2000,8(6):324-329.
[8]贾继东,李兰娟.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.Jia JD,Li LJ. Guidelines for prevention and treatment of chronic hepatitis B(2010 ed.)[J],Journal of Clinical Hepatology,2011,27(1):113-128.
[9]李宁,薛晓琳,吴秀艳,等.代偿期、失代偿期肝炎肝硬化患者的舌象比较分析[J].世界中西医结合杂志,2014,9(4):371-374.
[10] Li N,Xue XL,Wu XY,et al. Comparative analysis of tongue picture in patients with liver cirrhosis in compensatory and decompensated stage[J]. World Journal of Integrated Traditional and Western Medicine,2014,9(4):371-374.
[11]孙澄清. 63例肝硬化患者的舌象观察[J].苏州大学学报(医学版),2003,23(6):657.Sun CQ. Tongue observation of 63 patients with cirrhosis[J]. Journal of Soochow University(Medical Science ed.),2003,23(6):657.
[12]毛永森,彭中强.肝硬化100例舌脉观察[J].青海医学院学报,1996,17(3):198-199.Mao YS,Peng ZQ. Observation on tongue vein of 100 patients with liver cirrhosis[J]. Journal of Qinghai Medical College,1996,17(3):198-199.
[13]李凤陈,李萍,李凯,等.舌诊在肝硬化中的应用[J].中医药学报,2001,29(4):60-61.Li FC,Li P,Li K,et al. Application of tongue diagnosis in liver cirrhosis[J]. Acta Chinese Medicine and Pharmacology,2001,29(4):60-61.
[14]胡兴昌.舌诊与肝病辨治[J].当代医学,2009,15(3):153-154.Hu XC. Tongue diagnosis and treatment of liver diseases[J]. Contemporary Medicine,2009,15(3):153-154.
[15]谢旭善.舌象与肝病辨治[J].山东中医杂志,1998,17(1):7-9.Xie XS. Differential treatment of tongue and liver disease[J]. Shandong Journal of Traditional Chinese Medicine,1998,17(1):7-9.
[16]戴芳,唐亚平,周艳,等.裂纹舌与病性证素相关性的研究[J].辽宁中医杂志,2010,37(11):2200-2201.Dai F,Tang YP,Zhou Y,et al. A study on the correlation between cracked tongue and diseased syndromes[J].Liao Ning Journal of Traditional Chinese Medicine,2010,37(11):2200-2201.
[17]贾微,唐亚平,黄浩,等.燥苔与病性证候要素相关性的研究[J].时珍国医国药,2014,25(3):671-672.Jia W,Tang YP,Huang H,et al. Study on the correlation between dryness moss and essential factors of disease syndrome[J]. Lishizhen Medicine and Materia Medica Research,2014,25(3):671-672.
[18]李灿东,吴承玉.中医诊断学[M].北京:中国中医药出版社,2012:15-16.Li CD,Wu CY. Chinese Medicine Diagnostics[M]. Beijing:China press of Traditional Chinese Medicine,2012:15-16.