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乙型肝炎肝硬化异型增生结节患者中医体质类型分布及临床特点分析

方梦冰 刘诚 张玉 曾嘉旖 陈智恒 黎胜 池晓玲 萧焕明

引用本文:
Citation:

乙型肝炎肝硬化异型增生结节患者中医体质类型分布及临床特点分析

DOI: 10.12449/JCH240515
基金项目: 

国家“十三五”重大传染病专项课题 (2018ZX10725506-003);

国家“十三五”重大传染病专项课题 (2018ZX10725505-004);

广东省中医院院内专项 (YN10101903);

广东省中医院院内专项 (YN2016XP03);

广东省中医院院内专项 (YN2022DB04);

省部共建中医湿证国家实验室开放课题 (SZ2022KF02);

广东省中医院优势病种项目 ([2020] No.37);

池晓玲国家中医药管理局名老中医药专家传承工作室项目 (Guozhong Pharmaceutical Human Education Letter [2022] No.‍75);

第五批全国中医临床优秀人才研修项目 (Guozhong Pharmaceutical Human Education Letter [2022] No.1)

伦理学声明: 本研究方案于2023年3月7日经由广东省中医院伦理委员会批准同意,批号:YE2023-055-01。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:方梦冰负责资料收集及分析,撰写论文;刘诚、张玉、曾嘉旖、陈智恒参与数据收集,修改论文;黎胜、池晓玲、萧焕明负责课题设计,指导撰写论文并最后定稿。
详细信息
    通信作者:

    萧焕明, xiaohuanming@163.com (ORCID: 0000-0002-8739-0720)

TCM constitution distribution and clinical features of patients with hepatitis B cirrhosis and dysplastic nodules

Research funding: 

The Thirteenth Five-Year Plan for Major and Special Programs of the National Science and Technologyof China (2018ZX10725506-003);

The Thirteenth Five-Year Plan for Major and Special Programs of the National Science and Technologyof China (2018ZX10725505-004);

the Clinical Research Projects of Guangdong Provincial Hospital of Chinese Medicine (YN10101903);

the Clinical Research Projects of Guangdong Provincial Hospital of Chinese Medicine (YN2016XP03);

the Clinical Research Projects of Guangdong Provincial Hospital of Chinese Medicine (YN2022DB04);

Open Project of State Key Laboratory of Dampness Syndrome of Chinese Medicine (SZ2022KF02);

Advantage Disease Project of Guangdong Provincial Hospital of Traditional Chinese Medicine ([2020] No.37);

Chi Xiaoling of Project of Inheritance Workshop of Famous Old Chinese Medicine Experts of State Administration of Traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter [2022] No.‍75);

The Fifth Batch of National Research and Training Programs for Clinical Talents of Traditional Chinese Medicine (Guozhong Pharmaceutical Human Education Letter [2022] No.1)

More Information
  • 摘要:   目的  探讨乙型肝炎肝硬化异型增生结节(DN)患者中医体质分布特征,为肝癌癌前病变的防治提供依据。  方法  选取2015年5月—2023年3月在广东省中医院住院治疗的乙型肝炎肝硬化DN患者113例、乙型肝炎肝硬化再生结节(RN)患者105例、乙型肝炎肝硬化小肝癌(sHCC)患者70例。收集患者的年龄、性别、肝功能Child-Pugh分级、中医体质类型、实验室指标等资料。正态分布的计量资料多组间比较采用单因素方差分析及LSD-t法;非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验;计数资料组间比较采用χ2检验,进一步两两比较采用Bonferroni校正法。  结果  乙型肝炎肝硬化DN患者以气虚质(27例,23.89%)、血瘀质(26例,23.01%)、痰湿质(23例,20.35%)为主。3组患者在痰湿质、湿热质占比方面比较差异有统计学意义(χ2值分别为6.822、6.383,P值均<0.05),从肝硬化RN患者、肝硬化DN患者到sHCC患者,痰湿质占比逐渐降低(30.48% vs 20.35% vs 14.29%),而湿热质占比逐渐升高(12.38% vs 16.81% vs 27.14%)。部分中医体质类型肝硬化DN患者在性别、Child-Pugh分级、前白蛋白、Alb、AST、TBil、总胆汁酸、甲胎蛋白上差异均有统计学意义(P值均<0.05),其中女性肝硬化DN患者气虚质占比高于男性患者(χ2=4.895,P=0.027);气虚质患者Child-Pugh A级占比低于Child-Pugh B级(χ2=6.380,P=0.012),而痰湿质患者Child-Pugh A级占比高于Child-Pugh B级(χ2=8.515,P=0.004);痰湿质患者前白蛋白、Alb水平高于其他4种体质患者(P值均<0.05),同时痰湿质患者TBil、总胆汁酸水平低于湿热质患者(P值均<0.05);阴虚质患者Alb水平低于气虚质、血瘀质、痰湿质患者(P值均<0.05);阴虚质患者甲胎蛋白异常比例显著高于非阴虚质患者(χ2=4.448,P=0.035)。  结论  乙型肝炎肝硬化DN患者以气虚质、血瘀质、痰湿质多见,痰湿质患者癌变可能性小,而湿热质、阴虚患者癌变风险较大。

     

  • 图  1  不同中医体质肝硬化DN患者AFP异常比例

    Figure  1.  Proportion of abnormal AFP in patients with cirrhosis DN of different TCM constitutions

    表  1  3组患者基线特征比较

    Table  1.   Comparison of baseline characteristics among the three groups of patients

    指标 肝硬化RN(n=105) 肝硬化DN(n=113) sHCC(n=70) 统计值 P
    性别[例(%)] χ2=4.505 0.105
    75(71.43) 78(69.03) 58(82.86)
    30(28.57) 35(30.97) 12(17.14)
    年龄段[例(%)]
    青年 20(19.05) 16(14.16) 7(10.00) χ2=2.794 0.247
    中年 44(41.90)1) 66(58.41) 24(34.29)1) χ2=11.528 0.003
    老年 41(39.05) 31(27.43) 39(55.71) χ2=3.341 0.188
    Child-Pugh分级[例(%)]
    A级 59(56.19) 62(54.87) 42(60.00) χ2=0.475 0.789
    B级 38(36.19) 36(31.86) 24(34.29) χ2=0.458 0.795
    C级 8(7.62) 15(13.27) 4(5.71) χ2=3.507 0.173
    PA(mg/L) 150.00(90.00~200.00) 139.00(82.50~203.00) 151.00(78.75~208.50) H=0.090 0.956
    Alb(g/L) 37.56±7.25 37.47±7.32 37.27±6.56 F=0.035 0.966
    ALT(U/L) 30.00(17.50~47.00) 29.00(19.00~44.00) 31.00(20.00~50.75) H=1.185 0.553
    AST(U/L) 34.00(26.00~48.00) 35.00(25.00~50.00) 38.00(28.00~56.00) H=1.522 0.467
    ALP(U/L) 88.00(70.00~116.50) 86.00(66.50~132.50) 82.50(69.50~119.50) H=0.467 0.792
    GGT(U/L) 47.00(24.50~94.50) 48.00(27.50~76.50) 40.50(31.00~89.00) H=0.097 0.953
    TBil(μmol/L) 18.10(12.45~26.30) 19.30(12.85~31.65) 19.00(11.75~31.33) H=1.019 0.601
    TBA(μmol/L) 12.40(6.15~35.80) 21.60(6.10~50.50) 15.70(7.00~37.38) H=1.983 0.371
    PLT(×109/L) 95.00(67.00~151.50) 94.00(64.00~140.50) 110.50(79.75~155.50) H=4.261 0.119
    AFP(ng/mL) 4.82(2.45~12.42) 2) 4.52(2.87~10.81) 2) 8.92(3.92~51.75) H=11.655 0.003
    注:1)与肝硬化DN比较,P<0.05;2)与sHCC比较,P<0.05。年龄段:青年,<45岁;中年,45~59岁;老年,≥60岁。
    下载: 导出CSV

    表  2  3组患者体质分布及构成比

    Table  2.   Physical distribution and composition ratio of three groups of patients

    体质类型 肝硬化RN(n=105) 肝硬化DN(n=113) sHCC(n=70) χ2 P
    气虚质[例(%)] 29(27.62) 27(23.89) 13(18.57) 1.888 0.389
    血瘀质[例(%)] 21(20.00) 26(23.01) 14(20.00) 0.372 0.830
    痰湿质[例(%)] 32(30.48)1) 23(20.35) 10(14.29) 6.822 0.033
    湿热质[例(%)] 13(12.38)1) 19(16.81) 19(27.14) 6.383 0.041
    阴虚质[例(%)] 9(8.57) 16(14.16) 11(15.71) 2.427 0.297
    气郁质[例(%)] 1(0.95) 2(1.77) 1(1.43)
    阳虚质[例(%)] 0(0.00) 0(0.00) 2(2.86)
    注:1)与sHCC比较,P<0.05。
    下载: 导出CSV

    表  3  不同性别、年龄的肝硬化DN患者体质分布及构成比

    Table  3.   Physical distribution and composition ratio of patients with cirrhosis DN in different genders and ages

    体质类型 例数 性别 年龄
    男(n=78) 女(n=35) χ2 P 青年(n=16) 中年(n=66) 老年(n=31) χ2 P
    气虚质[例(%)] 27 14(17.95) 13(37.14) 4.895 0.027 4(25.00) 13(19.70) 10(32.26) 1.843 0.398
    血瘀质[例(%)] 26 21(26.92) 5(14.29) 2.178 0.140 2(12.50) 17(25.76) 7(22.58) 1.282 0.527
    痰湿质[例(%)] 23 17(21.79) 6(17.14) 0.323 0.570 4(25.00) 17(25.76) 2(6.45) 5.098 0.078
    湿热质[例(%)] 19 15(19.23) 4(11.43) 1.051 0.305 4(25.00) 10(15.15) 5(16.13) 0.907 0.635
    阴虚质[例(%)] 16 9(11.54) 7(20.00) 1.423 0.233 1(6.25) 8(12.12) 7(22.58) 2.858 0.240
    下载: 导出CSV

    表  4  不同Child-Pugh分级肝硬化DN患者体质分布及构成比

    Table  4.   Physical distribution and composition ratio of patients with cirrhosis DN in different Child-Pugh grades

    体质类型 例数 Child-Pugh A(n=62) Child-Pugh B(n=36) Child-Pugh C(n=15) χ2 P
    气虚质[例(%)] 27 10(16.13)1) 14(38.89) 3(20.00) 6.632 0.036
    血瘀质[例(%)] 26 15(24.19) 9(25.00) 2(13.33) 0.922 0.631
    痰湿质[例(%)] 23 19(30.65)1) 2(5.56) 2(13.33) 9.370 0.009
    湿热质[例(%)] 19 11(17.74) 4(11.11) 4(26.67) 1.916 0.384
    阴虚质[例(%)] 16 6(9.68) 6(16.67) 4(26.67) 3.141 0.208
    注:与Child-Pugh B比较,P<0.05。
    下载: 导出CSV

    表  5  不同中医体质类型肝硬化DN患者生化指标比较

    Table  5.   Comparison of biochemical indicators in patients with cirrhosis DN of different TCM constitution types

    指标 气虚质(n=27) 血瘀质(n=26) 痰湿质(n=23) 湿热质(n=19) 阴虚质(n=16) 统计值 P
    PA(mg/L) 122.00 (83.00~179.00)1) 146.00 (70.75~189.00)1) 220.00 (176.00~296.00) 113.00 (67.00~166.00)1) 125.50 (48.25~146.00)1) H=21.665 <0.001
    Alb(g/L) 36.42±7.291)2) 38.62±5.551)2) 40.86±8.06 35.84±6.021) 33.88±7.621) F=3.032 0.021
    ALT(U/L) 25.00 (18.00~33.00) 27.00 (14.75~39.00) 29.00 (18.00~45.00) 29.00 (19.00~74.00) 36.00 (19.50~69.00) H=4.764 0.312
    AST(U/L) 31.00 (22.00~45.00) 35.00 (23.00~50.00) 30.00 (20.00~40.00) 38.00 (29.00~88.00) 42.50 (33.00~84.75) H=10.986 0.027
    ALP(U/L) 82.00 (67.00~123.00) 88.00 (77.75~150.75) 74.00 (64.00~107.00) 98.00 (68.00~145.00) 108.00 (77.50~157.25) H=5.066 0.281
    GGT(U/L) 43.00 (18.00~70.00) 60.00 (36.50~125.00) 39.00 (21.00~73.00) 55.00 (40.00~129.00) 50.00 (37.75~65.75) H=7.132 0.129
    TBil(μmol/L) 19.60 (12.10~26.70) 19.40 (15.73~31.20) 14.10 (10.20~17.90) 31.70 (19.50~46.50) 1) 24.30 (12.28~41.78) H=14.586 0.006
    TBA(μmol/L) 17.30 (8.10~39.60) 28.90 (10.30~53.33) 5.80 (3.20~15.30) 30.50 (17.80~68.10) 1) 25.95 (8.75~46.88) H=13.265 0.010
    PLT(×109/L) 90.00 (63.00~116.00) 98.50 (48.75~139.25) 134.00 (92.00~180.00) 86.00 (56.00~122.00) 88.00 (63.50~106.50) H=8.838 0.065
    AFP(ng/mL) 3.58 (2.65~5.08) 4.38 (3.04~24.52) 3.11 (2.49~8.62) 10.07 (3.02~42.80) 8.50 (4.01~20.32) H=12.967 0.011
    注:1)与痰湿质比较,P<0.05;2)与阴虚质比较,P<0.05。
    下载: 导出CSV
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  • 收稿日期:  2023-08-20
  • 录用日期:  2023-09-25
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