本文關(guān)鍵詞： 病情程度 病毒性肝炎肝硬化 血脂 證候要素 藏象　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：病毒性肝炎肝硬化是由肝炎病毒長期作用于肝臟引起的一種慢性、進(jìn)行性、彌漫性肝病,隨病情發(fā)展,不同程度的影響肝臟的正常生理功能。肝臟是人體脂質(zhì)代謝的主要臟器,同時參與內(nèi)源性與外源性脂質(zhì)的代謝。故病毒性肝炎肝硬化的發(fā)生發(fā)展所導(dǎo)致的肝臟生理功能受損,可能影響人體脂質(zhì)的正常代謝。從中醫(yī)學(xué)理論角度來說,一般將本病歸屬于黃疸、脅痛等范疇,其發(fā)生與肝藏血主疏泄功能失調(diào)密切相關(guān)。本研究基于流行病學(xué)橫斷面調(diào)查,分別從現(xiàn)代醫(yī)學(xué)角度分析不同病情程度,病毒性肝炎肝硬化患者的血脂水平特點(diǎn),從中醫(yī)學(xué)角度分析不同病性類證候要素,患者血脂水平的特點(diǎn),目的在于探討肝臟在血脂代謝中的地位與作用。第一章病毒性肝炎肝硬化患者不同病情程度的血脂水平特點(diǎn)目的比較病毒性肝炎肝硬化患者不同病情程度的血脂水平特點(diǎn)。方法采用流行病學(xué)橫斷面調(diào)查方法,收集來自9所合作醫(yī)院的門診或住院的病毒性肝炎肝硬化患者的臨床信息,檢測患者血脂、肝功能指標(biāo),運(yùn)用SPSS統(tǒng)計(jì)軟件分析代償期、失代償期,不同Child-Pugh分級,患者血脂水平的差異;分析肝功能指標(biāo)與血脂水平的相關(guān)性。總結(jié)肝實(shí)質(zhì)功能受損時,血脂水平的特點(diǎn)。結(jié)果1.代償期患者TC、TG、HDL、LDL指標(biāo)的檢測值均高于失代償期,其中兩期患者的HDL水平都低于正常值。代償期、失代償期患者的四項(xiàng)血脂指標(biāo)的差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2.隨Child-Pugh分級評分的升高,病毒性肝炎肝硬化患者TC、TG、HDL、LDL指標(biāo)的均值都降低,結(jié)果顯示A、B、C三級間血脂指標(biāo)的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.相關(guān)性分析結(jié)果顯示,14項(xiàng)肝功能指標(biāo)中,TP、ALB、PA、TBIL、GGT、CHE六項(xiàng)指標(biāo)與血脂指標(biāo)相關(guān)性較高。比較肝功能指標(biāo)異常時血脂水平的特點(diǎn),發(fā)現(xiàn)TP、ALB、PA、CHE降低時,TC、TG、HDL、LDL均值都低于TP、ALB、PA、CHE未降低組(P0.05);TBIL升高時,四項(xiàng)血脂指標(biāo)均值都低于TBIL未升高組(P0.05)。結(jié)論病毒性肝炎肝硬化患者隨病情程度加重,肝實(shí)質(zhì)功能受損也加重,可導(dǎo)致血脂降低,且肝功能受損程度越重,血脂降低越明顯。第二章病毒性肝炎肝硬化患者病性類證候要素與血脂水平的關(guān)系目的分析病毒性肝炎肝硬化患者肝藏血主疏泄生理功能失調(diào)時,不同病性類證候要素的血脂水平特點(diǎn)。方法采用流行病學(xué)橫斷面調(diào)查方法,收集來自9所合作醫(yī)院的門診或住院的病毒性肝炎肝硬化患者的臨床信息,檢測患者血脂指標(biāo)。參照病毒性肝炎肝硬化患者常見病性類證候要素的辨識標(biāo)準(zhǔn)及課題組專家意見,判定患者所屬病性類證候要素。運(yùn)用SPSS統(tǒng)計(jì)軟件分析不同病性類證候要素的血脂水平特點(diǎn)并比較組間差異。結(jié)果1.比較病毒性肝炎肝硬化患者不同病性類證候要素的血脂水平,發(fā)現(xiàn)血瘀組、濕熱組、陽虛組、氣虛組患者TC、HDL、LDL的均值分別低于非血瘀組、非濕熱組、非陽虛組、非氣虛組的患者,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);陰虛組患者的TG均值低于非陰虛組患者,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);氣滯組患者TC、LDL的均值都高于非氣滯組的患者,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);水停組患者TC、TG、HDL、LDL的均值都低于非水停組的患者,且四項(xiàng)血脂指標(biāo)的差異都有統(tǒng)計(jì)學(xué)意義(P0.05)。2.比較病毒性肝炎肝硬化患者不同血脂水平病性類證候要素的構(gòu)成比,結(jié)果顯示TC水平降低的患者在氣虛組中所占的比例(43.2%)高于非氣虛組(25.0%),在水停組中所占的比例(50.4%)明顯高于非水停組(17.6%);TG水平降低的患者在血瘀組中所占的比例(15.6%)高于非血瘀組(8.5%),在陰虛組中所占的比例(15.2%)高于非陰虛組(10.2%),在水停組所占的比例(18.5%)高于非水停組(6.0%);HDL水平降低的患者在血瘀組中所占的比例(66.0%)高于非血瘀組(56.4%),在陽虛組中所占的比例(68.0%)高于非陽虛組(56.1%),在水停組所占的比例(69.4%)高于非水停組(53.5%);LDL水平降低的患者在水停組所占的比例(45.6%)高于非水停組(32.0%)。以上差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論病毒性肝炎肝硬化患者病性類證候要素的判定對血脂水平有影響,研究結(jié)果顯示氣虛、水停這兩類病性類證候要素的患者相對于非氣虛、非水停的患者更易出現(xiàn)TC水平降低;血瘀、陰虛、水停這三類病性類證候要素的患者相對于非血瘀、非陰虛、非水停的患者,更易出現(xiàn)TG水平降低;血瘀、陽虛、水停這三類病性類證候要素的患者相對于非血瘀、非陽虛、非水停的患者,更易出現(xiàn)HDL水平降低;水停這一病性類證候要素的患者相對于非水停的患者更易出現(xiàn)LDL水平降低。
[Abstract]:Viral hepatitis cirrhosis is a chronic hepatitis virus, by the long-term effects on the liver caused by progressive, diffuse liver disease, with the progression of the disease, affect the normal physiological function of the liver in different degree. The liver is the main organ of body lipid metabolism, and participate in the endogenous and exogenous lipid metabolism. Liver function caused by the occurrence of the development of the viral hepatitis and cirrhosis of the damage may affect the normal metabolism of the body lipid. From the theory of traditional Chinese medicine perspective, the disease belongs to the category of jaundice, hypochondriac pain, and the liver storing blood disorders are closely related. This study based on the investigation of epidemiology, respectively, analysis of different severity from the angle of modern medicine, lipid levels in patients with viral hepatitis and cirrhosis, from the analysis of the different nature of syndrome factors of TCM, characteristics of blood lipid level, Objective to investigate the status and role of the liver in lipid metabolism. To compare the lipid levels in the first chapter of viral hepatitis in patients with liver cirrhosis of different severity of lipid levels in patients with different severity of viral hepatitis cirrhosis. Methods using cross-sectional survey methods, clinical information collected from 9 cooperative hospital outpatient or inpatient viral in patients with liver cirrhosis, detection blood lipid, liver function index, analysis of compensation period using SPSS statistical software, decompensation, the levels of Child-Pugh, blood lipid level in patients with difference; correlation analysis of liver function indexes and blood lipids levels. Summarize the liver function damage, the characteristics of blood lipid level. Results of 1. patients with decompensated TC TG, HDL, LDL, detection index values were higher than the decompensated, which two patients with HDL levels were lower than normal value. The compensatory stage of decompensation Four blood lipids of patients with statistically significant difference (P0.05) of.2. increased with the Child-Pugh score, TC, TG in patients with viral hepatitis and cirrhosis, HDL, mean LDL index was lower, the result shows that A, B, the difference was statistically significant between the three levels of blood fat index C (P0.05).3. correlation analysis results show that the 14 indexes of liver function, TP, ALB, PA, TBIL, GGT, CHE six and blood lipid indexes have high correlation. Liver function index, abnormal blood lipid levels found in TP, ALB, PA, CHE, TC, TG decreased, HDL, LDL, TP and ALB are lower than the average. PA, CHE, did not reduce the group (P0.05); TBIL elevated, four blood lipids are lower than the mean TBIL (P0.05). The group did not increase with the severity of patients with viral hepatitis cirrhosis, liver function damage also increased, can lead to lowering blood lipids, and the degree of liver function damage is heavier, more reducing blood lipid the second chapter is obvious. Objective to analyze the relationship between viral hepatitis cirrhosis patients with the syndrome elements of disease nature and blood lipid level in patients with viral hepatitis and cirrhosis liver Tibet blood function physiological disorders, lipid levels in different disease nature syndrome elements. Using the method of cross-sectional survey method, clinical information collected from 9 cooperative hospital outpatient or hospitalization the hepatitis B virus in patients with liver cirrhosis, serum lipids were detected. The identification standard of viral hepatitis cirrhosis patients with common syndrome elements of disease nature and research group of experts, determining the patients belong to the syndrome elements of disease nature. Blood lipid level analysis of different characteristics of nature of syndrome factors were compared between the groups using the the SPSS statistical software. The results of 1. viral hepatitis cirrhosis patients with different syndrome elements of disease nature found that the level of serum lipid, blood stasis group, damp heat group, Yang deficiency, Qi Deficiency Patients 鑰匱C,HDL,LDL鐨勫潎鍊煎垎鍒綆浜庨潪琛，

本文編號：1505251