摘要
目的:旨在通过基于肝络病理论中药干预低γ-谷氨酰转肽酶(γ-GT)型婴儿胆汁淤积性肝病疗效对比,明确中药干预疗效特点,并筛选预后不良风险因素,为判断低γ-GT型婴儿胆汁淤积性肝病的中医治疗预后提供参考。方法:收集北京儿童医院中医科住院部以及门诊就诊低γ-GT型婴儿胆汁淤积性肝病患儿72例,根据中西医诊断标准,设定纳入及排除标准。根据治疗4周后疗效,将患儿分为治疗有效组和治疗不佳组。分别记录患儿人口生物学指标、血清学资料、中医证候等,收集资料后进行整理分析,并分别比较两组差异,从中、西医角度探讨低γ-GT型婴儿肝内胆汁淤积性肝病预后不佳的风险因素。结果:治疗不佳组患儿较治疗有效组治疗前TBil、DBil水平更高,差异有统计学意义(TBil:P=0.020,DBil:P=0.009);γ-GT水平较低(P=0.000),两组患儿的转氨酶、碱性磷酸酶等水平差异无统计学意义。治疗有效组中,以湿热滞络证为主,其次是肝络郁滞证;治疗不佳组中,肝络瘀阻证为主,经Fisher确切概率法,两组中医证候构成比差异有统计学意义(P=0.032)。中医各证型间治疗前TBil、DBil、ALT、Alb及TBA存在统计学差异,经进一步两两比较分析得出,湿热滞络证与肝络瘀阻证多个血清学指标均存在差异(TBil:P=0.002,DBil:P=0.002,ALT:P=0.021,Alb:P=0.011,ALP:P=0.037),湿热滞络证与肝络郁滞证的治疗前TBA存在差异(P=0.018)。利用单因素Logistic回归分析,发现治疗前TBil、DBil及γ-GT水平与婴儿胆汁淤积性肝病治疗效果相关。利用多因素Logistic回归分析,发现治疗前γ-GT水平为预后不佳危险因素(P=0.001)。根据ROC曲线分析,治疗前γ-GT水平可以较好的预测胆汁淤积性肝病患儿的预后(AUC=0.797),其最佳临界点为58 U/L。结论:应用肝络病理论可以改善部分低γ-GT型胆汁淤积患儿的症状,尤其当患儿辨证属湿热滞络证时,积极治疗可能预后较好�
Objective:The aim was to clarify the efficacy characteristics of herbal interventions and screen the risk factors for poor prognosis by observing the comparative efficacy of cholestatic liver disease in infants with lowγ-glutamyl transpeptidase(γ-GGT)and to provide a reference for judging the prognosis of Traditional Chinese Medicine(TCM)treatment for cholestatic liver disease in infants with low GGT.Methods:Seventy-two cases of children with low GGT infantile cholestatic liver disease were collected from the inpatient department of the Department of Traditional Chinese Medicine and outpatient clinics of Beijing Children′s Hospital.Inclusion and exclusion criteria were set according to the diagnostic criteria of Chinese and Western medicine.According to the efficacy after four weeks of treatment,the patients were divided into the effective treatment group and a poor treatment group.The demographic biological indicators,serological data,and TCM symptoms of the children were recorded separately,and the data were collected and analyzed,and the differences between the two groups were compared separately to investigate the risk factors for poor prognosis of intrahepatic cholestatic liver disease in infants with low GGT type from the perspective of Chinese and Western medicine.Results:1.Analysis of clinical characteristics of the two groups:1.1 Serological indexes:children in the poorly treated group had higher levels of TBil and DBil than those in the effectively treated group before treatment,with statistically significant differences(TBil:P=0.020,DBil:P=0.009);γ-GGT levels were lower(P=0.000),and the differences between the levels of transaminases and alkaline phosphatase in the two groups were not statistically.1.2 Characteristics of TCM evidence:in the effective treatment group,damp-heat obstructing vessel syndrome was predominant,followed by liver qi stagnation and blood stasis syndrome;in the poor treatment group,stagnation of liver collaterals syndrome was predominant,and by Fisher's exact probability meth
作者
张晓辉
何强
张艳菊
马津京
林筱萱
尤圣杰
ZHANG Xiao-hui;HE Qiang;ZHANG Yan-ju;YOU Sheng jie(Dongzhimen Hospital of Beijing University of Chinese Medicine(Beijing,100700),China;不详)
出处
《中西医结合肝病杂志》
CAS
2023年第7期582-587,共6页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
基金
首都卫生发展科研专项(No.2020-2-2092)。
