本文選題：膽汁性肝硬化　切入點(diǎn)：原發(fā)性膽汁性膽管炎　出處：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的:通過(guò)本研究,明確PBC患者臨床特點(diǎn)、中醫(yī)證型分布情況、各中醫(yī)證型與Child-Pugh肝功能分級(jí)的關(guān)系,探討各個(gè)證型與多項(xiàng)理化指標(biāo)之間的相關(guān)性,對(duì)中醫(yī)規(guī)范化辨治本病及評(píng)估患者預(yù)后提供一定依據(jù)。研究方法:采用回顧性研究,即收集符合納入標(biāo)準(zhǔn)的患者的病歷資料,對(duì)患者的一般情況、癥狀、體征、理化檢測(cè)結(jié)果進(jìn)行分析總結(jié)。按照《中醫(yī)常見(jiàn)證診斷標(biāo)準(zhǔn)》[1-2]對(duì)納入研究的患者進(jìn)行中醫(yī)證型診斷,根據(jù)Child-Pugh標(biāo)準(zhǔn)對(duì)各患者進(jìn)行肝功能評(píng)分并分級(jí),應(yīng)用Logistic回歸法進(jìn)行所有研究對(duì)象的多項(xiàng)理化指標(biāo)與各中醫(yī)證型之間的相關(guān)性分析。研究結(jié)果:1.被納入研究的96例患者中,男性患者12例,女性患者84例,男女比例1:7,發(fā)病年齡最小20歲,最大76歲,平均發(fā)病年齡(56.87±13.57)歲;2.根據(jù)臨床表現(xiàn)出現(xiàn)頻率的高低排序,前6項(xiàng)依次為:神疲乏力(93.75%)、食少納差(87.5%)、脅脹(81.25%)、皮膚瘙癢(78.125%)、寐差(68.75%)、脅痛(59.375%);3.具體中醫(yī)證型及其分布情況為:肝郁脾虛證39例、肝腎陰虛證15例、肝郁血瘀證6例、肝膽濕熱證23例及脾腎陽(yáng)虛證13例;4.肝功能屬Child-Pugh A級(jí)患者共33例,屬Child-Pugh B級(jí)的患者共51例,Child-P ugh C級(jí)的患者共12例,肝郁脾虛證及肝腎陰虛證患者的Child-Pugh分級(jí)均為A級(jí)和B級(jí),肝膽濕熱證及脾腎陽(yáng)虛證的患者肝功能分級(jí)為B級(jí)和C級(jí),肝郁血瘀證患者的肝功能在三個(gè)級(jí)別均有分布;5.ALP、ALB與診斷肝腎陰虛證呈正相關(guān),GGT與診斷肝郁血瘀證呈正相關(guān),TBi L與診斷肝膽濕熱證呈正相關(guān),脾腎陽(yáng)虛證的相關(guān)預(yù)測(cè)因素有ALB、TBi L及脾面積大小。肝郁脾虛證的回歸結(jié)果顯示無(wú)任何一項(xiàng)協(xié)變量具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.PBC患者最常出見(jiàn)神疲乏力、食少納差、脅脹、皮膚瘙癢、寐差、脅痛及便溏的臨床表現(xiàn),就診患者的肝功能多數(shù)屬于Child-Pugh B級(jí);2.本病主要累及肝、脾、腎三臟,涉及中醫(yī)證型包括肝郁脾虛證、肝腎陰虛證、肝郁血瘀證、肝膽濕熱證及脾腎陽(yáng)虛證。肝郁脾虛證及肝腎陰虛證患者的預(yù)后好于證屬肝膽濕熱證和脾腎陽(yáng)虛證的患者;3.ALP與ALB值越高,被診斷肝腎陰虛證可能性越大;GGT數(shù)值越大,被診斷肝郁血瘀證可能性越大;TBi L的結(jié)果越高,證屬肝膽濕熱證的可能性越大;ALB值越小,TBi L與脾面積值越大,被診斷脾腎陽(yáng)虛證的可能性越大。
[Abstract]:Objective: to clarify the clinical characteristics of PBC patients, the distribution of TCM syndromes, the relationship between TCM syndromes and Child-Pugh liver function classification, and to explore the correlation between each syndrome type and several physical and chemical indexes.To provide some basis for the standardization of TCM differentiation and treatment of the disease and the evaluation of the prognosis of patients.Methods: retrospective study was used to collect the medical records of the patients who met the inclusion criteria, and to analyze and summarize the general situation, symptoms, signs and physical and chemical results of the patients.According to the diagnostic criteria of common syndromes of traditional Chinese medicine [1-2], the patients involved in the study were diagnosed with TCM syndrome types, and the patients were graded and graded according to the Child-Pugh criteria.Logistic regression method was used to analyze the correlation between the physical and chemical indexes of all the subjects and the types of TCM syndromes.The result of the study was: 1.Of the 96 patients included in the study, 12 were male and 84 were female. The ratio of male to female was 1: 7. The onset age was the youngest 20 years and the maximum 76 years. The average onset age was 56.87 鹵13.57 years.According to the order of frequency of clinical manifestation, the first six items were as follows: fatigue of mind was 93.75m, appetite was 87.5g, hypochondria was 81.25g, skin pruritus was 78.125am, insomnia was 68.75cm, hypochondriac pain was 59.375.The specific TCM syndromes and their distribution were as follows: 39 cases of liver stagnation and spleen deficiency, 15 cases of liver and kidney yin deficiency, 6 cases of liver stagnation and blood stasis, 23 cases of dampness and heat of liver and gallbladder and 13 cases of deficiency of spleen and kidney yang.There were 33 patients with Child-Pugh A and 51 patients with Child-Pugh B with Child-P ugh C. The Child-Pugh grades of liver stagnation and spleen deficiency and liver-kidney yin deficiency were grade A and B, respectively.The liver function of the patients with dampness and heat of liver and gallbladder and deficiency of spleen and kidney yang were classified as B grade and C grade.The distribution of liver function in the three grades of patients with liver stagnation and blood stasis syndrome. 5. There was a positive correlation between ALB and the diagnosis of liver and kidney yin deficiency syndrome. GGT was positively correlated with the diagnosis of liver stagnation and blood stasis syndrome and TBi L was positively correlated with the diagnosis of liver and gallbladder dampness and heat syndrome.The related predictors of spleen and kidney yang deficiency syndrome were ALBX TBi L and spleen area.The regression results of liver stagnation and spleen deficiency syndrome showed that there was no covariant.Conclusion 1. The most common clinical manifestations of patients with PBC are fatigue, lack of appetite, distension, itching, insomnia, hypochondriac pain and loose stools. Most of the patients' liver function belongs to Child-Pugh B grade 2.This disease mainly involving liver, spleen, kidney three viscera, involving TCM syndrome including liver stagnation and spleen deficiency syndrome, liver and kidney yin deficiency syndrome, liver stagnation blood stasis syndrome, liver and gallbladder dampness heat syndrome and spleen and kidney yang deficiency syndrome.The prognosis of the patients with liver stagnation and spleen deficiency and liver-kidney yin deficiency is better than that of the patients with liver and gallbladder dampness heat syndrome and spleen and kidney yang deficiency syndrome. 3. The higher the ALP and ALB values, the greater the possibility of diagnosis of liver and kidney yin deficiency syndrome.The greater the possibility of diagnosis of liver depression and blood stasis, the higher the result of TBi L, the greater the possibility of liver and gallbladder dampness and heat syndrome, the smaller the value of ALB and the greater the area of spleen, and the greater the possibility of being diagnosed as deficiency of spleen and kidney yang.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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