基于中医瘀血理论分析乙型病毒性肝炎肝硬化与酒精性肝硬化患者证型差异及对预后的影响OA
Differences in Traditional Chinese Medicine Syndrome Patterns and Their Prognostic Impact in Hepatitis B Virus-Related Cirrhosis and Alcoholic Cirrhosis:An Analysis Based on the Theory of Blood Stasis
目的 基于中医瘀血理论探讨乙型病毒性肝炎肝硬化与酒精性肝硬化患者的中医证型分布差异及瘀血程度对预后的影响,为临床辨证施治提供依据.方法 回顾性分析 2023 年 1 月至 2024 年 9 月门诊就诊及住院治疗的 160例肝硬化患者的临床资料,根据病因分为乙肝肝硬化组(80 例)和酒精性肝硬化组(80 例).由 2 名副主任医师及以上资质的中医医师经统一培训后,采用双评估者盲法判定证型及瘀血程度(轻、中、重度),分歧时由第三方主任医师仲裁.比较两组患者证型分布及瘀血程度分级特征,分析不同瘀血程度患者的实验室指标及预后结局,采用多因素Logistic回归分别分析两组患者的预后影响因素.结果 乙肝肝硬化组中,气虚血瘀证占比最高(33.75%),其次为湿热瘀阻证(28.75%);酒精性肝硬化组中,痰浊瘀阻证占比最高(37.50%),其次为气虚血瘀证(25.00%).两组证型分布比较,差异无统计学意义(χ²=8.950,P=0.062);酒精性肝硬化组痰浊瘀阻证占比较高,差异有统计学意义(P＜0.05).乙肝肝硬化组轻度瘀血 28 例(35.00%)、中度瘀血 24 例(30.00%)、重度瘀血 28 例(35.00%);酒精性肝硬化组轻度瘀血 45 例(56.25%)、中度瘀血 24 例(30.00%)、重度瘀血 11 例(13.75%).两组瘀血程度分级分布差异有统计学意义(P=0.005),其中乙肝肝硬化组重度瘀血占比显著高于酒精性肝硬化组(P＜0.05).随着瘀血程度加重,患者PT及门静脉宽度逐渐升高,ALB水平逐渐降低,差异有统计学意义(P＜0.05);不同瘀血程度组间ALT、AST、TBIL、APTT水平比较,差异无统计学意义(P＞0.05).重度瘀血患者 12 个月生存率(46.15%)显著低于中度(72.92%)和轻度瘀血患者(90.41%),随访期间重度瘀血患者新发并发症发生率(84.62%)显著高于中度(54.17%)和轻度瘀血患者(33.88%),差异有统计学意义(P＜0.05);中度瘀血患者生存率显著低于轻度,并发症发生率显著高于轻度,差异有统计学意义(P＜0.05).在乙肝肝硬化组中,重度瘀血(OR=4.012,95%CI:1.752～9.188,P＜0.05)、Child-Pugh C级(OR=4.956,95%CI:1.985～12.376,P＜0.05)、合并基线并发症(OR=3.124,95%CI:1.354～7.206,P＜0.05)是影响患者预后的独立危险因素;ALB(OR=0.798,95%CI:0.687～0.927,P＜0.05)、规范使用抗病毒药物(OR=0.385,95%CI:0.172～0.862,P＜0.05)是保护因素.在酒精性肝硬化组中,重度瘀血(OR=3.845,95%CI:1.523～9.708,P＜0.05)、Child-Pugh C级(OR=5.123,95%CI:1.897～13.839,P＜0.05)、戒酒时长＜6个月(以＞12个月为参照,OR=3.215,95%CI:1.402～7.374,P＜0.05)是独立危险因素;ALB(OR=0.815,95%CI:0.698～0.951,P＜0.05)是保护因素.结论 乙肝肝硬化与酒精性肝硬化患者的中医证型分布无显著差异,瘀血程度分级与肝功能损伤及预后呈明显剂量-反应关系,临床应根据病因差异及瘀血程度制定个体化活血化瘀治疗方案.
Objective To investigate differences in traditional Chinese medicine(TCM)syndrome pattern distribution between patients with hepatitis B virus(HBV)-related cirrhosis and those with alcoholic cirrhosis,and to evaluate the impact of blood stasis severity on prognosis based on the TCM theory of blood stasis,thereby providing evidence for syndrome differentiation-based treatment in clinical practice.Methods Clinical data of 160 patients with cirrhosis who attended outpatient clinics or received inpatient treatment from January 2023 to September 2024 were retrospectively analyzed.According to etiology,patients were divided into an HBV-related cirrhosis group(n=80)and an alcoholic cirrhosis group(n=80).After standardized training,two TCM physicians with qualifications of associate chief physician or above independently determined the syndrome pattern and blood stasis severity(mild,moderate,or severe)using a dual-rater blinded approach;disagreements were adjudicated by a third-party chief physician.The distribution of syndrome patterns and the grading characteristics of blood stasis severity were compared between the two groups.Laboratory indices and prognostic outcomes were analyzed across different blood stasis severity levels.Multivariable logistic regression was performed separately in the two groups to identify prognostic factors.Results In the HBV-related cirrhosis group,the most prevalent pattern was Qi deficiency with blood stasis syndrome(33.75%),followed by damp-heat with stasis obstruction syndrome(28.75%).In the alcoholic cirrhosis group,phlegm-turbidity with stasis obstruction syndrome was most common(37.50%),followed by Qi deficiency with blood stasis syndrome(25.00%).There was no statistically significant difference in overall syndrome pattern distribution between groups(χ²=8.950,P=0.062);however,the proportion of phlegm-turbidity with stasis obstruction syndrome was higher in the alcoholic cirrhosis group,with a statistically significant difference(P＜0.05).In the HBV-related cirrhosis group,28 patients(35.00%)had mild blood stasis,24(30.00%)had moderate blood stasis,and 28(35.00%)had severe blood stasis;in the alcoholic cirrhosis group,45(56.25%),24(30.00%),and 11(13.75%)patients had mild,moderate,and severe blood stasis,respectively.The distribution of blood stasis severity differed significantly between groups(P=0.005),and the proportion of severe blood stasis was significantly higher in the HBV-related cirrhosis group than in the alcoholic cirrhosis group(P＜0.05).With increasing blood stasis severity,prothrombin time(PT)and portal vein width increased progressively,whereas albumin(ALB)decreased progressively(all P＜0.05).There were no significant differences in alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),or activated partial thromboplastin time(APTT)among blood stasis severity groups(all P＞0.05).The 12-month survival rate in patients with severe blood stasis(46.15%)was significantly lower than that in patients with moderate(72.92%)and mild blood stasis(90.41%).During follow-up,the incidence of newly developed complications in patients with severe blood stasis(84.62%)was significantly higher than that in patients with moderate(54.17%)and mild blood stasis(33.88%)(all P＜0.05).Survival was significantly lower and complication incidence was significantly higher in the moderate blood stasis group than in the mild blood stasis group(all P＜0.05).In the HBV-related cirrhosis group,severe blood stasis(OR=4.012,95%CI:1.752～9.188,P＜0.05),Child-Pugh class C(OR=4.956,95%CI:1.985～12.376,P＜0.05),and baseline complications(OR=3.124,95%CI:1.354～7.206,P＜0.05)were independent risk factors for poor prognosis,whereas ALB(OR=0.798,95%CI:0.687～0.927,P＜0.05)and standardized use of antiviral drugs(OR=0.385,95%CI:0.172～0.862,P＜0.05)were protective factors.In the alcoholic cirrhosis group,severe blood stasis(OR=3.845,95%CI:1.523～9.708,P＜0.05),Child-Pugh class C(OR=5.123,95%CI:1.897～13.839,P＜0.05),and duration of abstinence from alcohol＜6 months(reference:＞12 months;OR=3.215,95%CI:1.402～7.374,P＜0.05)were independent risk factors,whereas ALB(OR=0.815,95%CI:0.698～0.951,P＜0.05)was a protective factor.Conclusion No significant difference was observed in the distribution of TCM syndrome patterns between patients with HBV-related cirrhosis and those with alcoholic cirrhosis.Blood stasis severity grading shows an apparent dose-response relationship with liver function impairment and prognosis.Individualized blood-activating and stasis-resolving treatment strategies should be formulated based on etiology and blood stasis severity.
杨梅;李红德
安阳市第五人民医院 肝病科,河南 安阳 455000安阳市第五人民医院 肝病科,河南 安阳 455000
医药卫生
瘀血理论乙型病毒性肝炎肝硬化酒精性肝硬化中医证型瘀血分级预后
theory of blood stasishepatitis B virus-related cirrhosisalcoholic cirrhosistraditional Chinese medicine syndrome patternsblood stasis gradingprognosis
《临床研究》 2026 (1)
97-101,5
2025年安阳市科技计划项目(2025C01SF017).
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