肝豆状核变性伴肝纤维化中医证型分布及其相关临床因素分析
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摘要
目的:通过大样本临床前瞻性研究,探讨肝豆状核变性(Wilson disease,WD)的肝纤维化临床常见中医证型分布,以及与性别、发病年龄、病程关系,以期为以后合理的中医临床诊疗提供依据。方法:在文献研究的基础上,设计《肝豆状核变性肝纤维化中医辨证表》,收集WD患者的中医证候资料,对WD患者运用中医八纲及脏腑气血辨证理论进行辨证分型;建立数据库,运用频数分析及Kruskal-Wallis H秩和检验等统计学方法进行统计分析,总结WD的临床常见中医证型分布,以及与性别、发病年龄、病程的关系。结果:在247例WD肝纤维化患者中,性别及病程在中医证型分布构成(P>0.05)均无统计学意义。发病年龄在中医证型分布构成(P<0.05)有统计学意义,且在湿热内蕴证与脾肾阳虚证之间比较有统计学意义(P=0.05)。结论:WD肝纤维化好发于儿童、青少年,其中医证型的分布在不同性别之间及病程表现无明显差异,在发病年龄上表现有明显差异。在不同发病年龄上,儿童多以肝肾不足、湿热内蕴为主,青少年以痰瘀互结、湿热内蕴为主,中年多以脾肾阳虚、湿热内蕴、肝肾不足为主。在病程上,湿热内蕴、痰瘀互结、肝肾不足始终贯穿在病程的不同时期,早中期尤以实证突出,晚期更是虚实夹杂。
Objectives:To investigate the distribution of common clinical traditional Chinese medicine(TCM)syndromes of hepatolenticular degeneration(Wilson disease,WD)with hepatic fibrosis,as well as the relationship with sex,age of onset and course of disease,in order to provide a basis for the rational clinical diagnosis and treatment of TCM in the future,through the clinical prospective study of large samples. Methods:On the basis of literature research,Dialectical Table of TCM for Hepatic Fibrosis of Hepatolenticular Degeneration was designed to collect the TCM syndromes of WD patients,the syndrome differentiation was conducted for WD patients by applying TCM eight principles and syndrome differentiation theory of viscera,Qi and blood;The database was set up,and the frequency analysis and Kruskal-Wallis H rank test were used for statistical analysis,which summarized the distribution of common TCM syndromes in WD,as well as the relationship with sex,age of onset and course of disease. Results:In 247 patients with WD hepatic fibrosis,the sex and course of disease were not statistically significant in the distribution composition(P>0.05)of TCM syndromes. The age of onset was statistically significant in the distribution of TCM syndromes(P<0.05),and there was a statistically significant(P=0.05)between dampness-heat accumulation syndrome and spleen-kidney Yang deficiency syndrome. Conclusion:WD hepatic fibrosis is common in children and adolescents,and there is no significant difference in the distribution of TCM syndromes between different sexes and in the course of disease,but there are significant differences in the age of onset. In different age of onset,children are mostly spleen-kidney Yin deficiency syndrome,dampness-heat accumulation syndrome,adolescents with phlegm and blood stasis syndrome,dampnessheat accumulation syndrome,mainly in middle age to spleen-kidney Yang deficiency syndrome,dampnessheat accumulation syndrome,spleen-kidney Yin deficiency syndrome. In the course of the disease,dampness-heat accumulation syndrome,phlegm and blood stasis syndrome,spleen-kidney Yin deficiency syndrome always run through the different periods of the course of the disease,especially in the early and middle period,the late stage is a virtual inclusions.
Objectives:To investigate the distribution of common clinical traditional Chinese medicine(TCM)syndromes of hepatolenticular degeneration(Wilson disease,WD)with hepatic fibrosis,as well as the relationship with sex,age of onset and course of disease,in order to provide a basis for the rational clinical diagnosis and treatment of TCM in the future,through the clinical prospective study of large samples. Methods:On the basis of literature research,Dialectical Table of TCM for Hepatic Fibrosis of Hepatolenticular Degeneration was designed to collect the TCM syndromes of WD patients,the syndrome differentiation was conducted for WD patients by applying TCM eight principles and syndrome differentiation theory of viscera,Qi and blood;The database was set up,and the frequency analysis and Kruskal-Wallis H rank test were used for statistical analysis,which summarized the distribution of common TCM syndromes in WD,as well as the relationship with sex,age of onset and course of disease. Results:In 247 patients with WD hepatic fibrosis,the sex and course of disease were not statistically significant in the distribution composition(P>0.05)of TCM syndromes. The age of onset was statistically significant in the distribution of TCM syndromes(P<0.05),and there was a statistically significant(P=0.05)between dampness-heat accumulation syndrome and spleen-kidney Yang deficiency syndrome. Conclusion:WD hepatic fibrosis is common in children and adolescents,and there is no significant difference in the distribution of TCM syndromes between different sexes and in the course of disease,but there are significant differences in the age of onset. In different age of onset,children are mostly spleen-kidney Yin deficiency syndrome,dampness-heat accumulation syndrome,adolescents with phlegm and blood stasis syndrome,dampnessheat accumulation syndrome,mainly in middle age to spleen-kidney Yang deficiency syndrome,dampnessheat accumulation syndrome,spleen-kidney Yin deficiency syndrome. In the course of the disease,dampness-heat accumulation syndrome,phlegm and blood stasis syndrome,spleen-kidney Yin deficiency syndrome always run through the different periods of the course of the disease,especially in the early and middle period,the late stage is a virtual inclusions.
引文
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[15]周宜轩,李泽庚.安徽国医名师临证精粹[M].合肥:安徽科学技术出版社,2017:641.
[16]杨文明,陈彪,鲍远程,等.肝豆状核变性病中医临床思考[J].中国实验方剂学杂志,2004,10(6):66-69.
[17]方芳,杨文明.基于肝豆状核变性不同临床表型的分型论治探析[J].中医药临床杂志,2013,25(3):202.
[2]中国中西医结合学会肝病专业委员会.肝纤维化中西医结合诊疗指南[J].中国肝脏病杂志,2010,2(4):54
[3]国家技术监督局.中医临床诊疗术语证候部分[M].北京:中国标准出版社,1997:2-37.
[4]朱文峰.中医诊断学[M].2版.北京:中国中医药出版,2011:139-205.
[5]王永炎,张伯礼.中医脑病学[M].北京:人民卫生出版社,2007:727.
[6]沈斌,鲍远程.鲍远程辨证治疗肝风(肝豆状核变性)经验[J].河南中医,2017,37(2):227-229.
[7]杨文明,韩辉,鲍远程,等.中医对肝豆状核变性病因病机及辨证论治的探索[J].北京中医药大学学报(中医临床版),2012,19(4):6-8.
[8]韩辉,杨文明,张娟,等.肝豆状核变性中医证候特征[J].中医药临床杂志,2014,26(1):16.
[9]王殿华,陈金亮.中医论治肝豆状核变性的思路与方法[J].中医杂志,2010,51(2):172.
[10]王共强,王伟,薛本春,等.Wilson病中医证候文献分析[J].安徽中医学院学报,2011,30(4):5.
[11]廉龙江,施宗生,汪瀚.从脾论治肝豆状核变性探析[J].辽宁中医药大学学报,2016,18(9):140.
[12]汪瀚,杨文明,鲍远程.从铜毒论治肝豆状核变性初探[J].安徽中医学院学报,2009,28(5):4.
[13]谌宁生.肝豆状核变性的中医药治疗[J].江西中医药,1997,28(3):21-22.
[14]韩永升,饶娆,薛本春,等.肝豆状核变性患者中医证型的临床客观指标研究[J].安徽中医药大学学报,2015,34(6):26.
[15]周宜轩,李泽庚.安徽国医名师临证精粹[M].合肥:安徽科学技术出版社,2017:641.
[16]杨文明,陈彪,鲍远程,等.肝豆状核变性病中医临床思考[J].中国实验方剂学杂志,2004,10(6):66-69.
[17]方芳,杨文明.基于肝豆状核变性不同临床表型的分型论治探析[J].中医药临床杂志,2013,25(3):202.