肝硬化患者中医“证”的实质研究

目的：探讨肝硬化中医“证”的实质。方法：将８０例乙肝后肝硬化患者按辨证分为肝郁脾虚、气滞血瘀及热郁血瘀３型，分别检测血清透明质酸（ＨＡ）、腺苷脱氨酶（ＡＤＡ）、谷胱甘肽Ｓ转移酶（ＧＳＴ）、Ｎ乙酰 β Ｄ氨基葡萄糖苷酶（ＮＡＧ）、羟脯氨酸（ＨＹＰ）及５２例Ⅲ型前胶原（ＰＣⅢ）水平，并观察５２例辨证治疗后血清指标的变化。结果：ＨＡ、ＡＤＡ、ＧＳＴ及ＰＣⅢ水平较健康对照组显著升高（Ｐ＜００１），其水平与中医“证”密切相关，其规律为热郁血瘀型＞气滞血瘀型＞肝郁脾虚型＞健康对照组，证型之间有显著性差异（Ｐ＜００５，Ｐ＜００１）。经辨证治疗后，肝功能及上述血清学指标均显著好转及下降（Ｐ＜００５，Ｐ＜００１）。结论：肝硬化的中医“证”是有其内在实质内容的，血清ＨＡ、ＡＤＡ、ＧＳＴ及ＰＣⅢ可作为肝硬化辨证分型及指导治疗的客观指标，中医辨证治疗肝硬化具有良好的疗效及抗肝纤维化作用。

英文摘要:

Objective: To explore the essence of Syndrome of traditional Chinese medicine (TCM) in cirrhostic patients. Methods: Eighty patients of post hepatitis B cirrhosis were classified, according to Syndrome Differentiation of TCM, into three types: the Liver Qi Stagnancy and Spleen Deficiency type (A), the Qi Stagnancy and blood stasis type (B) and the Heat Stagnancy and blood stasis type (C), serum hyaluronic acid (HA), adenosine deaminase (ADA), glutathione s epoxide transferase (GST), N acetyl β D glucosaminidase (NAG), hydroxyproline (HYP) and procollagen type Ⅲ (PCⅢ) of 52 patients were determined before and after treatment based on Syndrome Differentiation. Results: Serum HA, ADA, GST and PCⅢ of patients were significantly higher than those of the healthy control (P<0 01), and the change of these parameters were closely associated with types of Syndrome, which were, in turn, C>B>A>control, the difference between groups was significant (P<0 05, P<0.01). After treatment, the liver function and above mentioned serologic parameters were significantly improved (P<0 05, P<0.01). Conclusions: Syndrome of cirrhosis patients has its inherent essential content. Serum HA, ADA, GST and PCⅢ could serve as objective indexes for establishing Syndrome Differentiation and guiding treatment. TCM treatment of cirrhosis based on Syndrome Differentiation has good effect with beneficial anti fibrotic action.

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