本文關(guān)鍵詞：基于循證醫(yī)學(xué)中醫(yī)診治自身免疫性肝炎的臨床證據(jù)分析研究　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 中醫(yī)藥 自身免疫性肝炎 循證醫(yī)學(xué) 德爾菲法

【摘要】：研究目的：針對(duì)中醫(yī)藥診治自身免疫性肝炎,系統(tǒng)查找證據(jù),整理、挖掘、提煉中醫(yī)藥治療自身免疫性肝炎的有效方法、手段,并通過(guò)德爾菲法專家問(wèn)卷調(diào)查進(jìn)一步凝練,以期為中醫(yī)藥診治自身免疫性肝炎臨床診療方案、臨床路徑、中醫(yī)指南的制定提供依據(jù)。研究方法：在全面了解自身免疫性肝炎中西醫(yī)研究現(xiàn)狀的基礎(chǔ)上,以“自身免疫性肝炎”、“病名”、“臨床表現(xiàn)”、“臨床特點(diǎn)”、“名中醫(yī)”、“經(jīng)驗(yàn)”、 “中醫(yī)”、“中西醫(yī)”等為主題詞,利用檢索工具,檢索、查閱相關(guān)文獻(xiàn),并運(yùn)用“改良Jadad量表”、"MINORS評(píng)價(jià)條目”、“中醫(yī)文獻(xiàn)依據(jù)分級(jí)標(biāo)準(zhǔn)”對(duì)相關(guān)文獻(xiàn)進(jìn)行文獻(xiàn)評(píng)價(jià),運(yùn)用頻數(shù)統(tǒng)計(jì)、聚類分析、復(fù)雜網(wǎng)絡(luò)技術(shù)等對(duì)相關(guān)文獻(xiàn)進(jìn)行分析,得出自身免疫性肝炎中醫(yī)病名、中國(guó)患者臨床特點(diǎn)、中醫(yī)證治等方面文獻(xiàn)信息。對(duì)文獻(xiàn)調(diào)研結(jié)果進(jìn)行比較、分析、篩選,并經(jīng)院內(nèi)專家小組討論,按照德爾菲專家調(diào)查方法,制定《中醫(yī)藥診治自身免疫性肝炎專家問(wèn)卷調(diào)查表》,向全國(guó)范圍內(nèi)26位中醫(yī)或中西醫(yī)結(jié)合臨床肝病學(xué)專家進(jìn)行問(wèn)卷調(diào)查,根據(jù)問(wèn)卷結(jié)果進(jìn)行統(tǒng)計(jì)分析,凝練中醫(yī)藥診治自身免疫性肝炎證據(jù)。研究結(jié)果：1.文獻(xiàn)研究結(jié)果：通過(guò)中醫(yī)病名文獻(xiàn)研究,對(duì)出現(xiàn)的中醫(yī)病名進(jìn)行頻數(shù)統(tǒng)計(jì)分析,結(jié)果顯示涉及18個(gè)中醫(yī)病名稱謂,出現(xiàn)頻次較高的中醫(yī)病名有：黃疸、脅痛。通過(guò)對(duì)自身免疫性肝炎中國(guó)患者臨床特點(diǎn)文獻(xiàn)研究發(fā)現(xiàn),中國(guó)患者女性比率較高；常見癥狀為乏力、黃疸、納差、腹脹；常見體征為黃疸、慢性肝病體征。通過(guò)對(duì)自身免疫性肝炎相關(guān)病案中醫(yī)證治分析發(fā)現(xiàn),涉及中醫(yī)病位5個(gè),主要位于肝、脾、腎；涉及中醫(yī)病性13種,但以血瘀、濕、熱、氣滯、氣虛、陰虛為多見；涉及中醫(yī)證型13種,但常見的中醫(yī)證型為瘀血阻絡(luò)證、濕熱內(nèi)蘊(yùn)證、肝郁脾虛證、肝腎陰虛證、肝氣郁滯證；涉及169味中藥,28首中藥方劑,通過(guò)頻數(shù)分析發(fā)現(xiàn)常用方劑為茵陳蒿湯、自擬方、柴胡疏肝散、逍遙散、小柴胡湯、一貫煎,通過(guò)聚類分析后發(fā)現(xiàn)藥物構(gòu)成以茵陳蒿湯、逍遙散為主方；通過(guò)頻數(shù)分析發(fā)現(xiàn)常用中藥為茵陳、甘草、赤芍、柴胡、白術(shù)、茯苓、丹參、黃芩、白芍、黃芪、當(dāng)歸、大黃、茜草、桃仁、牡丹皮；通過(guò)聚類分析發(fā)現(xiàn)常用中藥分類以補(bǔ)虛藥、清熱藥、利水滲濕藥、活血化瘀藥為主；通過(guò)復(fù)雜網(wǎng)絡(luò)分析發(fā)現(xiàn)治療不伴有黃疸的自身免疫性肝炎的核心藥物為柴胡、白術(shù)、白芍、茯苓、甘草、當(dāng)歸、黃芪等；治療伴有黃疸的自身免疫性肝炎的核心藥物為茵陳、大黃、赤芍、黃芩等。2.專家問(wèn)卷調(diào)查結(jié)果：運(yùn)用德爾菲法進(jìn)行專家咨詢發(fā)現(xiàn)：①中醫(yī)病名：被咨詢專家建議最多的中醫(yī)病名為脅痛、黃疸,但專家意見滿分較低,提示專家意見集中程度不高,有待于進(jìn)一步研究。②中醫(yī)病因：先天不足在中醫(yī)病因中貢獻(xiàn)度大,專家意見集中程度、協(xié)調(diào)程度高,七情所傷、飲食失宜作為本病常見中醫(yī)病因,雖然專家意見集中程度較高,但專家意見協(xié)調(diào)程度較低,需進(jìn)一步研究。⑧臨床表現(xiàn)：本病常見癥狀為精神疲倦、乏力、納差；常見體征為脾大；常見舌脈為舌有瘀斑、苔薄、苔黃、脈弦。④中醫(yī)辨證：臟腑辨證為本病常用中醫(yī)辨證方法；主要中醫(yī)病位在肝、脾、腎；中醫(yī)病性以虛實(shí)夾雜多見,虛則常見氣虛、陰虛,實(shí)則常見氣滯、血瘀、濕熱、痰濁；血瘀質(zhì)、濕熱質(zhì)、氣郁質(zhì)、氣虛質(zhì)、陰虛質(zhì)為本病常見中醫(yī)體質(zhì),而痰濕質(zhì)、特稟質(zhì)作為本病中醫(yī)體質(zhì),雖專家意見集中程度較高,但專家意見協(xié)調(diào)程度較低,專家意見分歧較大,有待于進(jìn)一步研究。⑤治療：中醫(yī)藥治療本病具有一定的優(yōu)勢(shì),主要在于縮短激素使用療程或減少激素劑量,激素禁忌癥或不耐受激素患者的治療,個(gè)體化治療,減輕激素副作用,護(hù)肝降酶,減少?gòu)?fù)發(fā),改善臨床不適癥狀,提高患者生活質(zhì)量；對(duì)于不同病情的患者推薦輕度患者單純中醫(yī)藥治療,中度、重度患者中西醫(yī)結(jié)合治療；本病常見中醫(yī)證型為肝郁脾虛、肝腎陰虛,而瘀血阻絡(luò)、濕熱蘊(yùn)結(jié)、痰濕內(nèi)蘊(yùn)證雖然專家意見集中程度較高,但專家意見協(xié)調(diào)程度低,有待進(jìn)一步研究；肝郁脾虛證常用方劑為柴芍六君子湯、逍遙散、柴胡疏肝散,肝腎陰虛證常用方劑為一貫煎。研究結(jié)論：1.自身免疫性肝炎可歸屬于中醫(yī)學(xué)“脅痛”、“黃疸”范疇,但目前尚無(wú)接受度高、普遍認(rèn)可的自身免疫性肝炎中醫(yī)病名,有待于進(jìn)一步研究。2.自身免疫性肝炎中醫(yī)病因復(fù)雜,先天不足為本病常見中醫(yī)病因。3.自身免疫性肝炎臨床表現(xiàn)多樣,乏力、精神疲倦、納差、脾大為常見癥狀、體征,舌有瘀斑、苔薄、苔黃、脈弦為常見舌脈。4.自身免疫性肝炎中醫(yī)辨證以臟腑辨證為宜,中醫(yī)病位主要位于肝、脾、腎,中醫(yī)病性復(fù)雜,以虛實(shí)夾雜多見,虛則常見氣虛、陰虛,實(shí)則以氣滯、血瘀、濕熱、痰濁為主。5.血瘀質(zhì)、濕熱質(zhì)、氣郁質(zhì)、氣虛質(zhì)、陰虛質(zhì)為自身免疫性肝炎常見的中醫(yī)體質(zhì)類型。6.肝郁脾虛證、肝腎陰虛證為自身免疫性肝炎常見中醫(yī)證型。
[Abstract]:Objective: To study TCM diagnosis and treatment of autoimmune hepatitis, find evidence system, consolidation, mining, means, extraction of traditional Chinese medicine in the treatment of autoimmune hepatitis, and Delphy Fa through the questionnaire survey of experts in order to further refine, plan, clinical diagnosis and treatment of Chinese medicine for the treatment of autoimmune hepatitis, clinical pathway, provide a guide to Chinese medicine on the basis of making. Methods: Based on a thorough knowledge of Western Medicine Research of autoimmune hepatitis on "autoimmune hepatitis", "disease", "clinical", "clinical characteristics", "traditional Chinese medicine", "experience", "Chinese medicine" and "western medicine" etc. subject headings, use of retrieval tools, retrieval, access to relevant literature, and using the modified Jadad scale "," MINORS "evaluation items, according to the classification standard of Chinese Literature" literature evaluation of relevant literature, the use of frequency system Meter, clustering analysis, analysis of complex network technology and so on the related literature, the autoimmune hepatitis TCM clinical characteristics of China patients, TCM treatment and other aspects of literature information. Literature research results were compared, analysis, screening, expert group and scholastic discussions, according to Delphy expert investigation method, making "Chinese medicine medicine for the treatment of autoimmune hepatitis expert questionnaire", to a nationwide 26 TCM or combining traditional Chinese and Western Medicine Clinical Hepatology experts conducted a questionnaire survey, statistical analysis was carried out according to the questionnaire results, concise Chinese medicine for the treatment of autoimmune hepatitis evidence. Results: 1. literature research results: through the TCM literature research, frequency statistical analysis of the TCM results involving 18 TCM terms, high frequency TCM disease name: jaundice, hypochondriac pain. The free The clinical features of patients with hepatitis China disease literature study found that women with higher China ratio; the common symptoms were fatigue, anorexia, jaundice, abdominal distension; common signs of jaundice, signs of chronic liver disease. The autoimmune hepatitis related medical records of TCM analysis found that relates to traditional Chinese medicine disease 5, mainly in the liver and spleen. Renal disease; TCM relates to 13, but in the wet, heat, blood stasis, qi stagnation, Qi deficiency, yin deficiency is more common; relates to TCM syndrome type 13, but for the common TCM Syndromes of blood stasis syndrome, damp heat syndrome, liver stagnation and spleen deficiency, liver kidney yin deficiency, liver qi stagnation syndrome involves 169 kinds of; 28 the first prescription of traditional Chinese medicine, traditional Chinese medicine, through frequency analysis we found that the commonly used prescription for Yinchenhao Decoction, decoction, CHSGS, Xiaoyaosan, Xiaochaihutang, Yiguanjian, through cluster analysis found that the drug composition with Yinchenhao Decoction of Xiaoyao Powder, mainly through frequency analysis we found that the party; The commonly used Chinese medicine wormwood, Radix Glycyrrhizae, radix paeoniae rubra, Radix Bupleuri, Atractylodes, Poria, radix salviae miltiorrhizae, Radix Scutellariae, Radix Paeoniae Alba, Radix Astragali, angelica, rhubarb, peach kernel, madder, cortex moutan; through cluster analysis found that the commonly used Chinese medicine classification to tonic, antipyretic, diuretics for eliminating dampness, promoting blood circulation and removing blood stasis; through the analysis of the complex network to find the core of drug treatment without jaundice of autoimmune hepatitis for bupleurum, Atractylodes, Radix Paeoniae Alba, Poria, licorice, angelica, Astragalus and other drugs in the treatment of jaundice; core of autoimmune hepatitis wormwood, rhubarb, radix paeoniae rubra, Radix Scutellariae and.2. expert questionnaire survey results: the use of Delphy Fa to consult the experts found the Chinese the illness: by consulting experts recommend the most TCM for chest pain, jaundice, but expert opinion out of low, suggesting that the concentration of expertise is not high, need to be further studied. The etiology of Chinese medicine: Chinese medicine in congenitally deficient The cause of large contribution, the concentration of expertise, coordination degree is high, hurt by seven emotions, improper diet as the common disease of TCM etiology, although expert opinion the high degree of concentration, but the expert opinion coordination degree is low, need further study. The clinical manifestations of this disease: common symptoms of mental fatigue, fatigue, anorexia; common signs of splenomegaly; common tongue, tongue with ecchymosis, moss thin, yellow moss, pulse string. The TCM syndrome: syndrome differentiation is commonly used in TCM for the disease; TCM disease in the liver, spleen and kidney disease; traditional Chinese medicine mixed with the actual situation of rare, deficiency of Qi Yin deficiency, in common, common qi stagnation damp heat, phlegm, blood stasis, blood stasis;, dampness heat, qi stagnation, Qi deficiency, yin deficiency is the commonest constitution of traditional Chinese medicine, and phlegm, intrinsic quality as the TCM Constitution, although the concentration of expertise is high, but the expert opinion coordination degree is low, specially A large differences of opinion, needs further study. The treatment: Chinese medicine in the treatment of this disease has certain advantages, mainly is to shorten the hormone treatment or reducing the dose of hormone, hormone or hormone therapy in patients with contraindications to intolerance, individualized treatment, reduce the side effects of hormone, liver protection, reduce recurrence, improve the clinical the symptoms, improve the quality of life of patients with moderate disease; for different patients is recommended in patients with mild pure Chinese medicine treatment, patients with severe combined treatment of TCM and Western medicine; Common TCM Syndromes of this disease is liver stagnation and spleen deficiency, liver kidney yin deficiency, and blood stasis, phlegm dampness syndrome of damp heat accumulation, although expert opinion the high degree of concentration, but the coordination degree of expert opinion is low, need to be further studied; liver stagnation and spleen deficiency syndrome prescriptions for Chaishao Decoction of six noble, Xiaoyaosan, CHSGS, liver kidney yin deficiency syndrome common party agent Yiguanjian on. Theory: 1. autoimmune hepatitis can be attributed to the traditional Chinese medicine "hypochondriac pain", "jaundice" category, but there is no high degree of acceptance, autoimmune hepatitis of TCM diseases generally recognized, needs further study in TCM autoimmune hepatitis.2. complicated etiology, clinical manifestations of this disease are congenitally deficient common etiology of Chinese Medicine.3. a variety of autoimmune hepatitis, fatigue, mental fatigue, anorexia, splenomegaly is common symptoms, signs, tongue with ecchymosis, moss thin, yellow moss, pulse string for TCM common tongue vein.4. autoimmune hepatitis with TCM syndrome differentiation is appropriate, the disease mainly in the liver, spleen, kidney disease, TCM complex, to deficiency of rare, deficiency of Qi Yin deficiency, but in common, qi stagnation, blood stasis, phlegm heat, blood stasis based.5., damp heat, qi stagnation, Qi deficiency, yin deficiency is a common autoimmune hepatitis of TCM Constitution Types in.6. of liver stagnation and spleen deficiency syndrome, yin deficiency of liver and kidney It is a common TCM syndrome type of autoimmune hepatitis.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 趙鴻,斯崇文,王勤環(huán);自身免疫性肝炎的診斷——附一例報(bào)告[J];臨床肝膽病雜志;2001年02期

2 趙鴻,斯崇文;自身免疫性肝炎一例[J];中華兒科雜志;2001年11期

3 沈雪林;自身免疫性肝炎10例分析[J];中華醫(yī)學(xué)雜志;2001年23期

4 闞甸華,程曉秋;自身免疫性肝炎一例[J];國(guó)外醫(yī)學(xué)(兒科學(xué)分冊(cè));2001年01期

5 張春平;老年人自身免疫性肝炎[J];國(guó)外醫(yī)學(xué)(內(nèi)科學(xué)分冊(cè));2002年06期

6 李超;中藥治療自身免疫性肝炎7例[J];實(shí)用中醫(yī)內(nèi)科雜志;2002年04期

7 趙鳳娥,王炳元;自身免疫性肝炎的治療[J];中國(guó)冶金工業(yè)醫(yī)學(xué)雜志;2002年04期

8 蔡中起,高鳳金;自身免疫性肝炎[J];臨床肝膽病雜志;2002年05期

9 管繼如;自身免疫性肝炎1例臨床分析[J];中國(guó)工業(yè)醫(yī)學(xué)雜志;2003年03期

10 戚務(wù)芳,蔣明;自身免疫性肝炎[J];中國(guó)實(shí)用內(nèi)科雜志;2003年01期

相關(guān)會(huì)議論文 前10條

1 張帆;趙曉燕;張光華;;自身免疫性肝炎21例診治分析[A];第十八次全國(guó)中西醫(yī)結(jié)合肝病學(xué)術(shù)會(huì)議論文匯編[C];2009年

2 王艷波;戴穎;蘇麗琴;;自身免疫性肝炎的診斷與治療[A];齊齊哈爾市首屆學(xué)術(shù)年會(huì)論文匯編[C];2004年

3 湯雯;賈繼東;;17例自身免疫性肝炎臨床特點(diǎn)及療效觀察[A];中華醫(yī)學(xué)會(huì)第十二次全國(guó)病毒性肝炎及肝病學(xué)術(shù)會(huì)議論文匯編[C];2005年

4 姚希賢;;自身免疫性肝炎的診斷治療[A];第二十一屆全國(guó)中西醫(yī)結(jié)合消化系統(tǒng)疾病學(xué)術(shù)會(huì)議暨國(guó)家級(jí)中西醫(yī)結(jié)合消化系統(tǒng)疾病新進(jìn)展學(xué)習(xí)班論文匯編[C];2009年

5 向代軍;閆惠平;夏晴;盧鋒;陳德喜;趙艷;劉妍;馮霞;;3-磷酸甘油酸脫氫酶的克隆表達(dá)及其抗體對(duì)自身免疫性肝炎的診斷意義[A];全國(guó)臨床免疫檢驗(yàn)研討會(huì)暨第六屆全國(guó)臨床免疫學(xué)術(shù)會(huì)議論文匯編[C];2009年

6 馬雄;邱德凱;;自身免疫性肝炎診斷和治療進(jìn)展[A];第九次全國(guó)消化系統(tǒng)疾病學(xué)術(shù)會(huì)議專題報(bào)告論文集[C];2009年

7 劉小玲;;自身免疫性肝炎的診療現(xiàn)狀[A];中華醫(yī)學(xué)會(huì)第七次全國(guó)感染病學(xué)術(shù)會(huì)議論文匯編[C];2001年

8 王融冰;孫鳳霞;江宇泳;劉軍民;;慢性自身免疫性肝炎的臨床研究[A];2002全國(guó)中西醫(yī)結(jié)合肝病學(xué)術(shù)會(huì)議論文匯編[C];2002年

9 張芳;唐采白;劉金秀;;自身免疫性肝炎的臨床分析[A];中華醫(yī)學(xué)會(huì)全國(guó)風(fēng)濕病學(xué)年會(huì)論文匯編[C];2003年

10 邵鳳珍;張俊富;崔麗安;劉文全;施伯安;趙遠(yuǎn)紅;;自身免疫性肝炎新療法的探討[A];第十三次全國(guó)中西醫(yī)結(jié)合肝病學(xué)術(shù)會(huì)議論文匯編[C];2004年

相關(guān)重要報(bào)紙文章 前8條

1 中南大學(xué)湘雅醫(yī)院教授 羅學(xué)宏;自身免疫性肝炎易誤診[N];湖南科技報(bào);2007年

2 王振坤;什么是自身免疫性肝炎[N];家庭醫(yī)生報(bào);2007年

3 ;何為自身免疫性肝炎[N];醫(yī)藥養(yǎng)生保健報(bào);2006年

4 羅學(xué)宏;自身免疫性肺炎易被誤診[N];大眾衛(wèi)生報(bào);2007年

5 加拿大衛(wèi)生部網(wǎng)站;青少年用米諾環(huán)素或致藥物性紅斑狼瘡和自身免疫性肝炎[N];中國(guó)醫(yī)藥報(bào);2012年

6 郭利民　 徐道振;重型自身免疫性肝炎的誤診教訓(xùn)[N];中國(guó)中醫(yī)藥報(bào);2003年

7 科文;中科大肝臟天然免疫研究獲新成果[N];中國(guó)醫(yī)藥報(bào);2006年

8 孫文兵;再說(shuō)自身免疫性胰腺炎[N];健康報(bào);2006年

相關(guān)博士學(xué)位論文 前7條

1 曾建宗;金實(shí)教授肝病診治經(jīng)驗(yàn)探析[D];南京中醫(yī)藥大學(xué);2015年

2 蘇海燕;自身免疫性肝炎診斷標(biāo)準(zhǔn)的比較及遺傳易感性的初步研究[D];天津醫(yī)科大學(xué);2010年

3 曹金;自身免疫性肝炎發(fā)病機(jī)制研究及TNF-α拮抗劑治療初探[D];中國(guó)協(xié)和醫(yī)科大學(xué);2009年

4 戚楠;TAM受體敲除小鼠發(fā)生自身免疫性肝炎[D];北京協(xié)和醫(yī)學(xué)院;2010年

5 趙文利;Th極化關(guān)鍵基因TBX21和TIM-1與甲/乙型肝炎及自身免疫性肝炎的遺傳關(guān)聯(lián)研究[D];第三軍醫(yī)大學(xué);2008年

6 艾國(guó);CD4~+CD25~+FOXP3~+Treg細(xì)胞及其功能性分子FGL2在自身免疫性肝炎中的作用和機(jī)制研究[D];華中科技大學(xué);2013年

7 浦仕彪;基于代謝組學(xué)的自身免疫性肝炎生物標(biāo)志物篩查及中醫(yī)藥干預(yù)研究[D];成都中醫(yī)藥大學(xué);2013年

相關(guān)碩士學(xué)位論文 前10條

1 劉燕燕;自身免疫性肝炎中醫(yī)證型與客觀指標(biāo)的相關(guān)性研究[D];廣州中醫(yī)藥大學(xué);2016年

2 黎勝;基于循證醫(yī)學(xué)中醫(yī)診治自身免疫性肝炎的臨床證據(jù)分析研究[D];廣州中醫(yī)藥大學(xué);2016年

3 鄒婷婷;里昂醫(yī)院與重慶醫(yī)科大學(xué)附屬兒童醫(yī)院兒童自身免疫性肝炎臨床分析[D];重慶醫(yī)科大學(xué);2016年

4 王巖;自身免疫性肝炎臨床特點(diǎn)分析[D];青島大學(xué);2009年

5 黃世江;自身免疫性肝炎24例臨床特點(diǎn)分析[D];廣西醫(yī)科大學(xué);2011年

6 李建鴻;自身免疫性肝炎研究進(jìn)展[D];成都中醫(yī)藥大學(xué);2004年

7 孫韜;盧秉久教授治療自身免疫性肝炎經(jīng)驗(yàn)[D];遼寧中醫(yī)藥大學(xué);2011年

8 曾雅軍;自身免疫性肝炎的中醫(yī)古籍文獻(xiàn)研究[D];廣州中醫(yī)藥大學(xué);2015年

9 王建榮;自身免疫性肝炎臨床特點(diǎn)及中醫(yī)藥治療療效回顧分析[D];北京中醫(yī)藥大學(xué);2014年

10 劉永方;藥物誘導(dǎo)自身免疫性肝炎的臨床與病理研究[D];吉林大學(xué);2015年

，

本文編號(hào)：1407810