摘要
目的:分析无创诊断与代偿期乙型肝炎肝硬化患者中医证型的相关性。方法:回顾性分析2018年5月至2021年12月就诊于河南中医药大学第一附属医院的359例代偿期乙型肝炎肝硬化患者的临床资料,采集患者的中医证型、血常规、肝功能、Fibroscan肝脏硬度值(LSM)、肝胆脾胰彩超报告等,计算无创诊断模型中天门冬氨酸氨基转移酶(AST)和血小板比率指数(APRI)、肝纤维化4因子指数(FIB-4)、红细胞体积分布宽度(RDW)和血小板计数(PLT)比值(RPR)。无创诊断与分析中医证型的相关性,采用受试者工作特征曲线(ROC)评价无创模型对中医证型的诊断价值,De Long法对无创模型ROC曲线下面积准确性进行比较。结果:359例代偿期乙型肝炎肝硬化患者中医证型可分为肝郁脾虚证(n=189)、肝胆湿热证(n=75)、瘀血阻络证(n=70)、肝肾阴虚证(n=10)、脾肾阳虚证(n=15)6种证型。肝郁脾虚证、肝胆湿热证和瘀血阻络证患者除年龄外,在Alb、ALT、AST、PLT、门静脉内径和RDW差异有统计学意义(P<0.05)。4种无创诊断在肝郁脾虚证、肝胆湿热证和瘀血阻络证依次增高且差异有统计学意义(P<0.05)。ROC显示LSM评估肝郁脾虚证的诊断价值优于其他3种诊断方法,LSM值和APRI评估肝胆湿热证的诊断价值优于其他诊断方法,LSM值和RPR评估瘀血阻滞证的诊断价值优于其他诊断方法。结论:4种无创诊断与代偿期乙型肝炎肝硬化患者不同中医证型存在相关性,且在诊断不同中医证型时具有不同的诊断效能。
Objective:To analyze the correlation between non-invasive diagnosis and TCM syndrome types in patients with compensated hepatitis B cirrhosis.Methods:A retrospectively analyzed in The First Affiliated Hospital of Henan University of Chinese Medicine from May 2018 to December 2021.The related data including clinical data,TCM syndrome types,routine blood test results,liver function,LSM,and color Doppler ultrasound findings of the liver,gallbladder,spleen,and pancreas were collected.The non-invasive diagnosis including APRI,FIB-4,and RPR was calculated.Statistical methods were used to analyze the correlation between non-invasive diagnosis and TCM syndrome types.The receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic value of the non-invasive model for TCM syndrome types.De Long's method was used to compare the accuracy of the area under the ROC curve of the non-invasive model for TCM syndrome types.Results:The TCM syndrome types of 359 patients with compensated hepatitis B cirrhosis can be divided into six types,including,stagnation of liver Qi and spleen deficiency syndrome(n=189),liver-gallbladder damp-heat syndrome(n=75),blood stasis obstructing the collaterals syndrome(n=70),Liver and kidney yin deficiency syndrome(n=10),spleen and kidney yang deficiency syndrome(n=15);Except age,the ALB,ALT,AST,PLT,portal vein diameter and RDW between patients with tagnation of liver Qi and spleen deficiency syndrome,liver-gallbladder damp-heat syndrome and blood stasis obstructing the collaterals syndrome were statistically different(P<0.05).Four non-invasive diagnoses increased in sequence in tagnation of liver Qi spleen deficiency syndrome,liver-gallbladder damp-heat syndrome and blood stasis obstructing the collaterals syndrome,and the difference was statistically significant(P<0.05).The ROC curve analysis showed that LSM had better diagnostic value than the other methods in evaluating liver Qi and spleen deficiency syndrome,and LSM and APRI had better diagnostic value than the other method
作者
宋艺佳
刘素彤
张丽慧
赵文霞
刘鸣昊
SONG Yi-jia;LIU Su-tong;ZHANG Li-hui;LIU Ming-hao(The First Clinical Medical College,Henan University of Chinese Medicine,(Zhengzhou,450000),China;不详)
出处
《中西医结合肝病杂志》
CAS
2023年第11期981-985,共5页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
基金
国家自然科学基金项目(No.81904154)
河南省特色骨干学科中医学学科建设项目(No.STG-ZYX08-202167)。
关键词
代偿期乙型肝炎肝硬化
无创诊断
中医证型
compensated hepatitis B cirrhosis
noninvasive dignosis
TCM syndrome types
