Zhang Qin, Liu Ping, Cheng Hui-Fen, Chen Liang, Cao Su-Hua, Liu Ying, Wei Jian-Jun, Fang Zhi-Hong, Wu Ding-Zhong
Department of Integrated Traditional Chinese and Western Medicine, Shanghai Municipal Infectious Disease Hospital, Shanghai 200083, China.
Zhong Xi Yi Jie He Xue Bao. 2003 Jul;1(2):108-12. doi: 10.3736/jcim20030207.
To explore the characteristics of traditional Chinese medical syndrome (TCM syndrome) of hepatocirrhosis.
Clinical information from the four diagnosis methods of traditional Chinese medicine (TCM) and related laboratorial indexes were systematically collected from 223 hepatocirrhosis cases, and the multi-statistical methods including systematic cluster analysis, principal component analysis, stepwise discrimination and variance analysis were made with the software SAS 6.11.
Multi-analysis showed that there were 3 categories of syndrome characteristics. Type 1 (134 cases): damp heat, blood stasis, deficiency of liver and spleen Qi; Type 2 (62 cases): deficiency of both Qi and Yin with severe deficiency of Qi, heat with severe dampness, blood stasis; Type 3 (27 cases): deficiency of both Qi and Yin with severe deficiency of Yin, stasis and heat or dampness. Analysis of the changes of the related laboratorial indexes among the three types of syndrome showed that Type 1 mainly manifested asthenia syndrome with sthenia syndrome, and its indexes of AST, ALT, GGT levels were markedly higher than those of Type 2 and Type 3, both of which mainly showed sthenia syndrome with asthenia syndrome, and that Type 3 was in active inflammation, deficiency of both Qi and Yin (deficiency of Yin > deficiency of Qi), and its FN, Alb, FV, FVII, PLT, PCT levels were obviously reduced.
The multi-statistical methods can reveal the characteristics and regularity of TCM syndrome of hepatocirrhosis, and the 3 categories of syndrome characteristics basically conform to clinical manifestations. The result of TCM syndrome distribution and laboratorial indexes infer that damp heat is the pathological basis of hepatocirrhosis, and the degree of liver function disorder and liver damage may be the pathological basis of deficiency of Yin of both liver and kidney.
探讨肝硬化中医证候特点。
系统收集223例肝硬化患者的中医四诊临床资料及相关实验室指标,运用SAS 6.11软件进行系统聚类分析、主成分分析、逐步判别分析及方差分析等多种统计方法。
多元分析显示有3类证候特点。1型(134例):湿热、血瘀、肝脾气虚;2型(62例):气阴两虚且气虚偏重、热重湿盛、血瘀;3型(27例):气阴两虚且阴虚偏重、瘀热或瘀湿。对3类证候相关实验室指标变化分析显示,1型以虚中夹实证为主,其谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)水平显著高于2型和3型,2型和3型均以实中夹虚证为主,且3型处于炎症活动期,气阴两虚(阴虚>气虚),其纤维连接蛋白(FN)、白蛋白(Alb)、因子Ⅴ(FV)、因子Ⅶ(FVII)、血小板(PLT)、血小板压积(PCT)水平明显降低。
多种统计方法可揭示肝硬化中医证候特点及规律,3类证候特点基本符合临床表现。中医证候分布结果及实验室指标推断,湿热是肝硬化的病理基础,肝功能障碍及肝损伤程度可能是肝肾阴虚的病理基础。