801例肝炎肝硬化患者病性类证候要素与常见脉象的相关性分析
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摘要
目的基于病证结合分析肝炎肝硬化患者病性类证候要素与常见脉象的相关性,为丰富常见脉象的临床意义以及探讨其形成机理提供依据。方法运用课题组统一制订的《肝炎肝硬化临床信息采集表》,进行全国多中心的横断面流行病学调查,收集肝炎肝硬化患者的中医症状、舌象、脉象(包括深浅、至数、宽细、长短、硬度、流利度等)信息,制订《肝炎肝硬化常见证候要素辨识标准》,依此判定患者的病性类证候要素类型;统计学方法采用频数、频率等描述性分析、卡方检验与简单相关分析的方法。结果 801例患者中,选取出现频率大于20%的作为常见脉象,其中弦脉602例(75.2%),细脉279例(34.8%),沉脉232例(29.0%),滑脉185例(23.1%)。弦脉与血瘀、气滞呈正相关关系,相关系数r分别为0.141、0.166(P<0.05);滑脉与阴虚、湿热呈正相关关系,相关系数r分别为0.093、0.131(P<0.05);沉脉与气虚、阳虚呈正相关关系,相关系数r分别为0.099、0.111(P<0.05);细脉与阴虚、气虚、阳虚、水停呈正相关关系,相关系数r分别为0.089、0.109、0.105、0.075(P<0.05)。结论肝炎肝硬化患者病性类证候要素与常见脉象间存在一定的相关性。
Objective To enrich the clinical meanings of common pulse manifestations,and to explore mechanisms of those pulses by analyzing the correlation between pattern elements of disease nature and common pulse manifestations in patients with viral hepatitis or cirrhosis based on the combination of pattern and diseases. Methods A national multicenter cross-sectional epidemiological survey was conducted to collect TCM symptoms,tongue manifestations and pulse conditions( including depth,frequency,width,length,hardness,and frequency of pulse) of patients with viral hepatitis or cirrhosis. The survey questionnaire used the Information Collection form of Vital Hepatitis Cirrhosis drafted by the research group. Standard of Hepatitis Cirrhosis Pattern Elements Differentiation was made to identify patterns and pattern elements. Descriptive statistics such as frequency and rate,Chi-square test,and correlation analysis were used. Results Pulses of 801 patients were collected. Pulses with occurrence rate above 20%was defined as common pulse manifestations,in which wiry pulse accounted for 75. 2%( n = 602);thready pulse,29. 0 %( n = 279); deep pulse 29%( n = 232); and slippery pulse,23. 1%( n = 185).There was positive correlation between wiry pulse and blood stasis and qi stagnation( correlation coefficient was 0. 141 and 0. 166 respectively,P < 0. 05). There was positive correlation between slippery pulse and yin deficiency and damp heat( correlation coefficient were 0. 093 and 0. 131 respectively,P < 0. 05). There was positive correlation between deep pulse and qi deficiency and yang deficiency( correlation coefficient was0. 099 and 0. 111 respectively,P < 0. 05). There was positive correlation between thready pulse pulse and yin deficiency,qi deficiency,yang deficiency and water retention( correlation coefficient was 0. 089,0. 109,0. 105 and 0. 075 respectively,P < 0. 05). Conclusion There is a certain correlation between pattern elements and common pulse manifestations in viral hepatitis cirrhosis patients.
Objective To enrich the clinical meanings of common pulse manifestations,and to explore mechanisms of those pulses by analyzing the correlation between pattern elements of disease nature and common pulse manifestations in patients with viral hepatitis or cirrhosis based on the combination of pattern and diseases. Methods A national multicenter cross-sectional epidemiological survey was conducted to collect TCM symptoms,tongue manifestations and pulse conditions( including depth,frequency,width,length,hardness,and frequency of pulse) of patients with viral hepatitis or cirrhosis. The survey questionnaire used the Information Collection form of Vital Hepatitis Cirrhosis drafted by the research group. Standard of Hepatitis Cirrhosis Pattern Elements Differentiation was made to identify patterns and pattern elements. Descriptive statistics such as frequency and rate,Chi-square test,and correlation analysis were used. Results Pulses of 801 patients were collected. Pulses with occurrence rate above 20%was defined as common pulse manifestations,in which wiry pulse accounted for 75. 2%( n = 602);thready pulse,29. 0 %( n = 279); deep pulse 29%( n = 232); and slippery pulse,23. 1%( n = 185).There was positive correlation between wiry pulse and blood stasis and qi stagnation( correlation coefficient was 0. 141 and 0. 166 respectively,P < 0. 05). There was positive correlation between slippery pulse and yin deficiency and damp heat( correlation coefficient were 0. 093 and 0. 131 respectively,P < 0. 05). There was positive correlation between deep pulse and qi deficiency and yang deficiency( correlation coefficient was0. 099 and 0. 111 respectively,P < 0. 05). There was positive correlation between thready pulse pulse and yin deficiency,qi deficiency,yang deficiency and water retention( correlation coefficient was 0. 089,0. 109,0. 105 and 0. 075 respectively,P < 0. 05). Conclusion There is a certain correlation between pattern elements and common pulse manifestations in viral hepatitis cirrhosis patients.
引文
[1]熊益群,周大桥.肝硬化[M].北京:中国医药科技出版社,2008.XIONG YQ,ZHOU DQ.Liver cirrhosis[M].Beijing:China Medical Science Press,2008.
[2]王思颖.肝炎肝硬化脉象、脉图的特征及其与症状、实验室指标的相关性研究[D].北京:北京中医药大学,2013.WANG SY.Study on the characteristics of pulse manifestations and pulsograph parameters in patients with viral hepatitis cirrhosis and its correlation with the symptoms and laboratory indicators[D].Beijing:Beijing University of Chinese Medicine,2013.
[3]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.ZHAO LH,WANG TF,XUE XL,et al.Distribution of common syndrome elements of disease nature in 801 patients with viral hepatitis cirrhosis:a comparison between compensation stage and discompensation stage[J].Journal of Beijing University of Traditional Chinese Medicine,2015,38(4):260-265.
[4]中华医学会传染病与寄生虫病学分会,中华医学会肝病学分会.病毒性肝炎防治方案[J].传染病信息,2000,13(4):141-150.Infectious Diseases and Parasitic Diseases Branch Association,Liver disease Branch Association,Chinese Medical Association.Viral hepatitis prevention and treatment protocd[J].Infections Disease Information,2000,13(4):141-150.
[5]中华医学会肝病学分会,中华医学会感染病分会.慢性乙型肝炎防治指南(2010版)[J].中国肝脏病杂志(电子版),2011,3(1):40-56.Liver Disease Branch Association,Infectious Disease Branch Association,Chinese Medical Association.Guidelines for prevention and treatment of chronic hepatitis B(2010)[J].Chinese Journal of Liver Diseases(Electronic Version),2011,3(1):40-56.
[6]中国中西医结合学会消化系统疾病专业委员会.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.Expert Consensus of Digestive System Diseases,Chinese Association of Integrative Medicine.Treatment of liver cirrhosis with traditional Chinese and Western medicine[J].Chinese Journal of Integrated Traditional and Western Medicine on Digestion,2011,19(4):277-279.
[7]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.China Association of Chinese Medicine.Guidelines for diagnosis and treatment of common internal diseases in Chinese medicine·diseases of modern medicine[M].Beijing:China Press of Traditional Chinese Medicine,2008.
[8]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.ZHENG XY.Guiding principles of clinical research on traditional chinese medicine(trial)[M].Beijing:China Medical Science Press,2002.
[9]中华中医药学会内科肝胆病学组、世界中医药联合学会肝病专业委员会、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[J].临床肝胆病杂志,2012,28(3):164-168.Hepatobiliary Disease Group,Internal Medicine of Traditional Chinese,China Association of Traditional Chinese Medicine;Expert Consensus of Hepatology,World Federation of Chinese Medicine Societies;Hepatology Group,Chinese Association of the Integration of Traditional and Western Medicine.Guidelines for traditional Chinese medical diagnosis of chronic hepatitis B[J].Journal of Clinical Hepatology,2012,28(3):164-168.
[10]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.TAN CY,LIU P.Theoretical origin of pathogenesis on accumulation due to deficiency of liver cirrhosis and clinical significance[J].Shanghai University of Traditional Chinese Medicine,2010,24(4):25-28.
[11]张琴,王磊,都广礼,等.肝炎后肝硬化患者舌诊、脉诊信息在中医证候判识中的作用与意义[J].中国中医基础医学杂志,2007,13(6):416-417.ZHANF Q,WANG L,DU GL,et al.The role and significance of tongue diagnosis and pulse diagnosis information of patients with hepatitis cirrhosis in TCM syndrome identification[J].Chinese Journal of Basic Medicine in Traditional Chinese Medicine,2007,13(6):416-417.
[2]王思颖.肝炎肝硬化脉象、脉图的特征及其与症状、实验室指标的相关性研究[D].北京:北京中医药大学,2013.WANG SY.Study on the characteristics of pulse manifestations and pulsograph parameters in patients with viral hepatitis cirrhosis and its correlation with the symptoms and laboratory indicators[D].Beijing:Beijing University of Chinese Medicine,2013.
[3]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.ZHAO LH,WANG TF,XUE XL,et al.Distribution of common syndrome elements of disease nature in 801 patients with viral hepatitis cirrhosis:a comparison between compensation stage and discompensation stage[J].Journal of Beijing University of Traditional Chinese Medicine,2015,38(4):260-265.
[4]中华医学会传染病与寄生虫病学分会,中华医学会肝病学分会.病毒性肝炎防治方案[J].传染病信息,2000,13(4):141-150.Infectious Diseases and Parasitic Diseases Branch Association,Liver disease Branch Association,Chinese Medical Association.Viral hepatitis prevention and treatment protocd[J].Infections Disease Information,2000,13(4):141-150.
[5]中华医学会肝病学分会,中华医学会感染病分会.慢性乙型肝炎防治指南(2010版)[J].中国肝脏病杂志(电子版),2011,3(1):40-56.Liver Disease Branch Association,Infectious Disease Branch Association,Chinese Medical Association.Guidelines for prevention and treatment of chronic hepatitis B(2010)[J].Chinese Journal of Liver Diseases(Electronic Version),2011,3(1):40-56.
[6]中国中西医结合学会消化系统疾病专业委员会.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.Expert Consensus of Digestive System Diseases,Chinese Association of Integrative Medicine.Treatment of liver cirrhosis with traditional Chinese and Western medicine[J].Chinese Journal of Integrated Traditional and Western Medicine on Digestion,2011,19(4):277-279.
[7]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.China Association of Chinese Medicine.Guidelines for diagnosis and treatment of common internal diseases in Chinese medicine·diseases of modern medicine[M].Beijing:China Press of Traditional Chinese Medicine,2008.
[8]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.ZHENG XY.Guiding principles of clinical research on traditional chinese medicine(trial)[M].Beijing:China Medical Science Press,2002.
[9]中华中医药学会内科肝胆病学组、世界中医药联合学会肝病专业委员会、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[J].临床肝胆病杂志,2012,28(3):164-168.Hepatobiliary Disease Group,Internal Medicine of Traditional Chinese,China Association of Traditional Chinese Medicine;Expert Consensus of Hepatology,World Federation of Chinese Medicine Societies;Hepatology Group,Chinese Association of the Integration of Traditional and Western Medicine.Guidelines for traditional Chinese medical diagnosis of chronic hepatitis B[J].Journal of Clinical Hepatology,2012,28(3):164-168.
[10]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.TAN CY,LIU P.Theoretical origin of pathogenesis on accumulation due to deficiency of liver cirrhosis and clinical significance[J].Shanghai University of Traditional Chinese Medicine,2010,24(4):25-28.
[11]张琴,王磊,都广礼,等.肝炎后肝硬化患者舌诊、脉诊信息在中医证候判识中的作用与意义[J].中国中医基础医学杂志,2007,13(6):416-417.ZHANF Q,WANG L,DU GL,et al.The role and significance of tongue diagnosis and pulse diagnosis information of patients with hepatitis cirrhosis in TCM syndrome identification[J].Chinese Journal of Basic Medicine in Traditional Chinese Medicine,2007,13(6):416-417.