乙型肝炎后肝硬化患者中医证候要素的生物化学特征

doi:10.3736/jcim20110405

Abstract

Objective: To investigate the characteristics of traditional Chinese medicine (TCM) syndromes and their elements in patients with posthepatitic cirrhosis by analyzing the relationships between signs and symptoms and biochemical parameters.
Methods: A total of 440 patients with hepatitis B cirrhosis treated in Shanghai Public Health Center and Shuguang Hospital, Longhua Hospital and Central Hospital of Putuo District Affiliated to Shanghai University of Traditional Chinese Medicine during January 2002 to January 2006 were enrolled in this study. Signs and symptoms and biochemical information of patients were collected by using a self-designed questionnaire regarding the four examinations of TCM. Signs and symptoms were firstly analyzed to find the frequency of occurrence. Then, the patients were divided into two groups according to non-existent or existent sign and symptom and the correlations between the signs and symptoms which occurred most frequently and their biochemical parameters were analyzed.
Results: Sixteen symptoms which occurred most frequently were fatigue, colored urine, liver palms, opaque complexion, string-like pulse, weakness at waist and knees, dry month and bitter taste in the mouth, profuse dreaminess and poor sleepiness, heaviness of limbs, abdominal distention, yellow eyes, fine pulse, impetuosity and susceptibility to rage, splenomegaly, poor appetite, and distension and fullness in the chest and hypochondrium. A previous study on syndrome differentiation of 900 patients with posthepatitic cirrhosis showed 4 syndrome patterns: internal accumulation of dampness-heat, liver-kidney yin deficiency, internal accumulation of blood stasis-heat, and liver depression and spleen deficiency. Further analysis showed that internal accumulation of dampness-heat syndrome was characterized by obvious hepatic inflammation, poor synthesis function and more asctites. Liver-kidney yin deficiency syndrome was characterized by low-level hepatic inflammation, poor synthesis function and more ascites. Internal accumulation of blood stasis-heat syndrome was characterized by low-level hepatic inflammation, poorer synthesis function, ascites and splenomegalia, and liver depression and spleen deficiency syndrome was characterized by slight hepatic inflammation, synthesis function injury, decreased internal portal vein diameter and less ascites.
Conclusion: Different syndrome patterns have different pathological features, showing the complexity and polymorphism of syndrome construction.

Key words: posthepatitis cirrhosis, syndrome, pathological conditions, signs and symptoms, biological parameters, clinical trial

Ji-li Yuan, Hua Zhang, Lei Wang, Yan Lin, Xin-cai Hu, Qin Zhang, Ping Liu. Biochemical characteristics of traditional Chinese medicine syndromes and their elements in patients with hepatitis B cirrhosis. Journal of Chinese Integrative Medicine, 2011, 9(4): 374-381.

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URL: http://www.jcimjournal.com/EN/10.3736/jcim20110405

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Figures/Tables 2

Table 2

Relationships between main signs and symptoms and experimental parameters of 440 patients with posthepatitic cirrhosis (x±s)"

Sign or symptom	Cr (μmol/L)	BUN (mmol/L)	TAG (mmol/L)	TC (mmol/L)	ALT (IU/L)	AST (IU/L)	GGT (IU/L)	ALP (IU/L)	ChE (kU/L)	TBil (μmol/L)	ALB (g/L)	G (g/L)	ApoA (g/L)	PT (s)	AFP (ng/mL)	Portal vein (mm)	Spleen (mm)	Ascites
Fatigue
No	72±15	4.7±1.6	1.4±0.6	4.3±1.5	72±74	71±55	88±72	172±116	5.6±3.0	43±67	35.1±7.9	34.2±6.1	0.98±0.38	16.2±3.1	37.4±88.6	13.2±1.8	48.7±11.1	0.85±0.90
Yes	79±27	5.1±3.2	1.3±0.7	4.0±1.3	77±72	89±76	82±75	187±130	5.2±3.3	55±58	34.4±8.0	35.9±7.4	0.89±0.36	17.1±4.0	56.6±93.2	12.6±1.8	48.7±13.3	0.93±1.07
Z	–1.875	–0.770	–2.094	–1.047	–1.539	–2.176	–0.926	–1.376	–1.246	–1.945	–0.894	–1.945	–2.019	–1.571	–3.295	–2.708	–0.147	–0.237
P	0.061	0.441	0.036	0.295	0.124	0.030	0.355	0.169	0.213	0.052	0.371	0.052	0.044	0.116	0.001	0.007	0.883	0.813
Yellow urine
No	76±27	5.2±2.0	1.5±0.7	4.5±1.5	73±113	66±68	71±65	149±80	5.6±2.8	30±58	38.3±7.4	34.1±7.1	1.03±0.35	14.9±2.3	32.0±53.6	12.9±1.7	45.7±12.1	0.57±0.82
Yes	78±24	5.0±3.2	1.3±0.7	3.9±1.3	97±121	109±133	93±100	203±171	5.1±3.4	66±76	33.3±7.7	36.1±7.2	0.86±0.36	17.5±4.0	60.0±101.5	12.7±1.9	49.7±13.0	1.03±1.07
Z	–1.020	–2.081	–3.505	–3.975	–3.410	–5.484	–2.281	–3.406	–1.948	–8.327	–6.208	–2.791	–4.111	–6.752	–2.816	–1.133	–2.691	–3.887
P	0.308	0.037	0.000	0.000	0.001	0.000	0.023	0.001	0.051	0.000	0.000	0.005	0.000	0.000	0.005	0.257	0.007	0.000
Liver palms
No	77±24	5.0±1.8	1.4±0.7	4.3±1.5	88±119	87±93	83±84	213±241	6.1±4.8	52±67	36.0±7.5	34.7±7.8	0.96±0.38	16.0±3.4	55.1±101.0	13.0±1.4	48.5±12.9	0.68±1.01
Yes	77±25	5.1±3.2	1.3±0.7	4.0±1.3	92±120	102±129	89±96	182±111	5.0±2.5	59±76	34.0±8.1	35.9±7.0	0.89±0.35	17.1±3.9	52.2±89.8	12.7±2.0	48.8±12.9	1.00±1.03
Z	–0.138	–1.053	–1.980	–2.121	–0.043	–1.359	–0.441	–0.542	–2.774	–2.087	–2.564	–1.879	–1.711	–2.771	–0.290	–1.839	–0.704	–3.151
P	0.891	0.292	0.048	0.034	0.966	0.174	0.659	0.588	0.006	0.037	0.010	0.060	0.087	0.006	0.772	0.066	0.481	0.002
Opaque complexion
No	77±22	5.1±4.1	1.5±1.0	4.2±1.4	144±164	146±184	112±117	237±172	5.8±3.2	67±83	35.1±7.7	36.1±7.5	0.90±0.33	17.6±4.5	67.1±113.0	12.7±2.0	46.4±12.9	0.73±1.09
Yes	78±26	5.0±2.1	1.3±0.5	4.0±1.3	70±89	79±78	78±80	171±144	5.1±3.3	53±69	35.3±8.1	35.4±7.1	0.91±0.38	16.6±3.5	47.4±82.8	12.7±1.8	49.7±12.8	0.99±1.00
Z	–0.224	–1.230	–2.424	–1.275	–6.172	–5.741	–3.804	–6.014	–2.252	–1.982	–1.219	–0.909	–0.602	–1.742	–1.928	–0.457	–2.336	–3.167
P	0.822	0.219	0.015	0.202	0.000	0.000	0.000	0.000	0.024	0.047	0.223	0.363	0.547	0.082	0.054	0.648	0.019	0.002
Stringlike pulse
No	78±29	5.1±2.1	1.3±0.7	3.9±1.1	80±118	87±98	78±78	179±117	5.0±2.7	50±66	35.0±8.1	36.1±8.2	0.93±0.38	16.4±3.2	35.7±72.0	12.7±1.8	49.0±12.0	1.07±0.99
Yes	77±23	5.0±3.3	1.4±0.7	4.1±1.4	96±120	103±131	92±99	195±169	5.4±3.5	60±76	34.3±7.9	35.4±6.8	0.89±0.35	17.1±4.1	61.0±99.7	12.8±1.9	48.7±13.3	0.84±1.05
Z	–0.242	–0.880	–2.743	–1.472	–2.098	–1.875	–2.123	–1.346	–1.302	–1.693	–1.064	–0.349	–0.721	–1.207	–2.799	–0.038	–0.360	–2.662
P	0.809	0.379	0.006	0.141	0.036	0.061	0.034	0.178	0.193	0.090	0.287	0.727	0.471	0.228	0.005	0.969	0.719	0.008
Weak at waist and knees
No	76±20	4.9±1.8	1.4±0.6	4.4±1.4	89±110	93±102	83±84	212±210	5.7±2.7	61±88	35.5±8.0	35.5±6.7	0.92±0.36	16.4±3.7	45.2±77.1	12.9±1.8	48.0±12.8	0.60±0.96
Yes	78±27	5.1±3.4	1.3±0.7	3.9±1.3	91±125	100±131	90±98	178±116	5.1±3.5	55±64	34.0±7.9	35.6±7.5	0.90±0.36	17.7±3.9	57.0±99.6	12.6±1.8	49.1±13.0	1.08±1.04
Z	–0.158	–0.381	–2.810	–2.976	–0.178	–1.077	–0.850	–2.424	–3.135	–0.280	–1.796	–0.208	–0.883	–1.872	–0.149	–1.105	–0.639	–5.147
P	0.875	0.703	0.005	0.003	0.859	0.281	0.395	0.015	0.002	0.780	0.072	0.835	0.377	0.061	0.882	0.269	0.523	0.000
Dry month and bitter taste in the mouth
No	78±26	5.2±4.1	1.3±0.6	4.2±1.5	110±149	127±172	98±105	230±214	5.3±2.7	64±79	33.9±8.4	36.4±7.9	0.85±0.37	17.3±4.1	63.5±109.0	12.8±1.8	49.1±13.8	0.76±1.05
Yes	77±24	4.9±2.0	1.3±0.7	4.0±1.3	80±98	82±76	82±86	167±104	5.2±3.8	53±70	34.9±7.7	35.1±6.8	0.94±0.35	16.6±3.6	47.0±81.8	12.7±1.7	48.5±12.3	1.00±1.02
Z	–0.329	–0.481	–0.394	–0.825	–2.115	–3.081	–1.514	–4.538	–0.997	–2.129	–1.554	–1.508	–2.536	–2.190	–2.003	–0.613	–1.176	–2.891
P	0.742	0.630	0.693	0.410	0.034	0.002	0.130	0.000	0.319	0.033	0.120	0.131	0.011	0.029	0.045	0.540	0.240	0.004
Profuse dreaminess and poor sleepiness
No	80±24	4.9±2.2	1.4±0.7	4.2±1.4	98±123	105±122	99±111	203±167	5.4±2.7	58±65	34.9±7.5	35.1±6.5	0.76±1.07	16.6±3.9	56.5±81.7	12.9±1.7	49.0±11.8	0.76±1.07
Yes	76±26	5.1±3.3	1.3±0.7	4.0±1.3	86±118	93±121	81±79	181±147	5.2±3.6	57±78	34.3±8.3	35.9±7.6	1.02±1.01	17.0±3.8	50.7±98.9	12.9±1.8	48.5±13.6	1.02±1.01
Z	–1.594	–0.162	–1.401	–1.213	–1.785	–0.473	–1.440	–2.726	–1.354	–0.500	–1.034	–0.984	–1.773	–1.159	–2.972	–0.007	–0.372	–3.259
P	0.111	0.871	0.161	0.225	0.074	0.636	0.150	0.006	0.176	0.617	0.301	0.325	0.076	0.246	0.003	0.994	0.710	0.001
Heaviness of limbs
No	73±19	5.0±1.8	1.3±0.6	4.3±1.3	77±92	82±85	83±85	171±153	5.4±3.9	45±64	36.1±7.5	34.6±6.5	0.99±0.35	15.7±3.0	40.5±76.1	12.8±1.9	47.5±12.7	0.89±0.94
Yes	81±29	5.1±3.6	1.3±0.7	3.9±1.3	103±139	112±145	92±100	206±156	5.2±2.6	68±79	33.1±8.1	36.4±7.7	0.83±0.36	17.8±4.2	63.9±104.0	12.7±1.8	49.8±13.0	0.94±1.12
Z	–3.330	–0.884	–0.793	–3.035	–3.370	–4.373	–1.989	–4.616	–0.400	–4.032	–4.362	–2.962	–4.934	–5.766	–3.909	–0.799	–2.086	–0.351
P	0.001	0.377	0.428	0.002	0.001	0.000	0.047	0.000	0.689	0.000	0.000	0.003	0.000	0.000	0.000	0.424	0.037	0.726
Abdominal distention
No	75±18	4.8±1.7	1.4±0.6	4.4±1.3	79±33	82±67	83±70	178±96	5.5±3.8	54±76	36.2±8.0	35.0±6.8	0.94±0.37	16.2±3.3	43.2±72.7	12.8±1.9	47.5±13.1	0.67±0.84
Yes	80±30	5.3±3.8	1.2±0.7	3.8±1.3	70±63	83±65	76±60	177±107	5.0±2.6	60±71	33.0±7.6	36.1±7.6	0.87±0.35	17.5±4.2	62.3±108.0	12.7±1.7	50.0±12.6	1.16±1.15
Z	–1.300	–0.651	–3.203	–5.101	–0.138	–1.432	–0.816	–0.723	–1.542	–1.400	–4.285	–1.611	–2.185	–3.435	–0.540	–0.658	–1.714	–4.336
P	0.194	0.515	0.001	0.000	0.890	0.152	0.414	0.470	0.123	0.161	0.000	0.107	0.029	0.001	0.589	0.511	0.087	0.000
Yellow eyes
No	73±20	4.9±1.7	1.4±0.6	4.4±1.3	76±102	72±82	76±67	170±157	5.9±3.8	29±42	38.1±7.6	34.7±7.2	1.02±0.36	15.0±2.3	34.1±62.8	12.8±1.6	46.4±11.0	0.65±0.86
Yes	81±28	5.2±3.8	1.3±0.8	3.7±1.3	106±134	124±147	99±112	209±151	4.7±2.4	85±87	30.9±6.5	36.5±7.1	0.79±0.33	18.7±4.2	71.9±112.0	12.7±2.0	51.1±14.2	1.19±1.12
Z	–3.009	–1.097	–3.074	–6.195	–4.105	–7.769	–2.018	–3.963	–4.818	–12.900	–9.828	–3.133	–6.760	–10.53	–4.274	–0.557	–4.477	–5.012
P	0.003	0.273	0.002	0.000	0.000	0.000	0.044	0.000	0.000	0.000	0.000	0.002	0.000	0.000	0.000	0.578	0.000	0.000
Thin pulse
No	78±23	5.0±3.4	1.4±0.8	4.1±1.4	109±134	113±144	98±101	217±178	5.5±3.9	69±83	34.0±8.0	35.5±6.9	0.86±0.36	17.3±4.2	64.5±100.0	12.7±2.0	48.8±13.7	0.86±1.08
Yes	76±27	5.1±2.2	1.2±0.5	4.1±1.3	68±95	78±80	74±81	155±112	5.0±2.3	42±56	35.2±7.9	35.6±7.6	0.96±0.36	16.2±3.2	38.4±79.8	12.7±1.7	48.6±11.8	0.99±0.97
Z	–0.925	–1.289	–1.813	–0.151	–4.965	–4.116	–4.067	–6.334	–0.541	–4.715	–1.748	–0.570	–2.882	–2.200	–4.973	–0.131	–0.332	–2.221
P	0.355	0.197	0.070	0.880	0.041	0.000	0.000	0.000	0.589	0.000	0.080	0.568	0.004	0.028	0.000	0.896	0.740	0.026
Impetuosity and susceptibility to rage
No	78±24	5.1±3.2	1.4±0.7	4.1±1.5	100±129	106±110	89±90	207±146	5.5±2.8	67±88	34.1±8.0	35.3±6.7	0.87±0.38	17.1±4.1	59.3±104.4	12.8±1.9	48.5±13.5	0.75±0.99
Yes	77±26	4.9±2.0	1.3±0.7	4.0±1.2	78±105	88±134	86±97	167±164	5.0±3.8	44±46	35.1±7.8	36.0±7.8	0.95±0.33	16.5±3.5	44.5±73.7	12.7±1.7	49.0±12.0	1.14±1.05
Z	–0.025	–0.291	–2.558	–0.659	–2.465	–2.406	–0.755	–4.925	–2.443	–3.565	–1.656	–0.579	–2.470	–1.406	–2.147	–0.333	0.000	–4.177
P	0.980	0.771	0.011	0.510	0.014	0.016	0.450	0.000	0.015	0.000	0.098	0.563	0.016	0.160	0.032	0.739	1.000	0.000
Splenomegaly
No	76±17	5.0±3.3	1.4±0.7	4.3±1.4	102±119	111±144	98±106	221±175	5.9±3.8	63±86	35.3±7.6	36.2±7.2	0.89±0.36	16.9±4.0	61.2±101.0	12.7±1.9	45.8±13.3	0.61±0.97
Yes	79±33	5.1±2.5	1.2±0.7	3.7±1.2	74±119	80±76	73±69	146±107	4.5±2.1	48±60	33.4±8.3	34.7±7.2	0.92±0.37	16.8±3.6	41.1±77.5	12.8±1.7	53.3±10.8	1.35±0.97
Z	–1.031	–0.238	–5.863	–4.588	–4.214	–2.614	–3.617	–8.052	–4.984	–0.644	–2.739	–2.189	–0.707	–0.255	–4.553	–1.774	–5.502	–8.363
P	0.302	0.812	0.000	0.000	0.000	0.009	0.000	0.000	0.000	0.520	0.006	0.029	0.480	0.799	0.000	0.076	0.000	0.000
Poor appetite
No	75±19	5.0±1.7	1.3±0.6	4.2±1.3	74±82	79±73	81±84	177±154	5.3±3.7	45±54	35.8±8.1	35.2±7.2	0.94±0.36	16.1±3.2	35.9±54.0	12.9±1.9	48.9±11.9	0.84±0.97
Yes	81±31	5.2±4.1	1.3±0.8	3.8±1.4	114±155	124±164	97±105	207±155	5.2±2.7	75±91	32.8±7.4	36.2±7.2	0.85±0.36	17.9±4.4	77.2±125.0	12.6±1.8	48.4±14.2	1.03±1.12
Z	–1.610	–1.798	–1.389	–3.866	–3.191	–4.767	–2.174	–2.944	–0.109	–4.013	–4.003	–2.003	–2.253	–4.240	–3.428	–2.008	–0.375	–1.478
P	0.107	0.072	0.165	0.000	0.001	0.000	0.030	0.003	0.913	0.000	0.000	0.045	0.024	0.000	0.001	0.045	0.708	0.139
Hypochondriac pain
No	78±27	5.0±2.1	1.3±0.6	4.1±1.4	81±105	92±117	87±95	185±166	5.0±3.3	57±77	34.7±8.1	35.2±7.1	0.94±0.35	16.7±3.8	52.4±96.4	12.9±1.8	48.5±13.4	1.01±1.04
Yes	76±18	5.1±5.0	1.5±1.0	4.0±1.3	124±159	121±134	91±86	205±107	6.2±3.0	58±99	33.7±7.5	36.9±7.4	0.78±0.37	17.4±4.0	54.7±77.0	12.2±1.9	49.5±10.9	0.58±0.95
Z	–0.032	–1.523	–1.995	–0.388	–2.691	–3.258	–1.717	–2.730	–3.652	–1.665	–1.115	–2.176	–4.076	–2.036	–1.521	–3.091	–0.577	–3.992
P	0.975	0.128	0.046	0.698	0.007	0.001	0.086	0.006	0.000	0.096	0.265	0.030	0.000	0.042	0.128	0.002	0.564	0.000

Table 2

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Biochemical characteristics of traditional Chinese medicine syndromes and their elements in patients with hepatitis B cirrhosis

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