黄疸证型客观化研究

目的探讨黄疸湿、热病因的本质,寻找黄疸辨证的客观指标。方法95例成人黄疸性慢性乙型病毒性肝炎住院患者,其中61例不伴细菌或真菌感染,34例继发细菌或真菌感染,观察其血清生化指标、黄疸颜色、舌象、脉率。结果以直接胆红素升高为主者(DBIL/IBIL≥1),皮肤多呈暗黄色,舌质红或正常,苔白;肝硬化患者常因脾功能亢进,出现贫血,而使舌质变淡;合并感染的患者出现脉数、苔黄。以间接胆红素升高为主者(DBIL/IBIL<1),皮肤多呈鲜黄色,舌质红,苔黄。结论DBIL/IBIL能较为准确的反映患者的证型,DBIL/IBIL≥1者多湿重于热,DBIL/IBIL<1者多热重于湿;DBIL/IBIL≥1患者如出现脉数、苔黄提示湿郁化热。

英文摘要:

ObjectiveTo investigate the essence of dampness and heat, the two main etiological factors of jaundice, to seek the objectified indices for syndrome typing of jaundice. MethodsNinety-five adult in-patients with icteric viral hepatitis B were eligible, 61 of them were free from bacterial or fungal infection, while 34 with secondary bacterial or fungal infection. The serum biochemical indexes, and clinical features such as the color of jaundice, tongue picture and pulse frequency were observed. ResultsDark-yellow colored skin, red or normal tongue proper with white tongue fur appeared in most patients with dominant elevation of direct bilirubin, in whom the ratio of direct bilirubin to indirect bilirubin (DBIL/IBIL≥ 1). The color of tongue proper often turned pale in patients with cirrhosis due to the complicated anemia caused by hyperactivity of spleen, while the quick pulse and yellow tongue fur always presented in patients accompanied with infection. On the contrary, bright-yellow colored skin, red tongue with yellow fur appeared in patients with dominant elevation of indirect bilirubin, in whom DBIL/IBIL < 1. ConclusionDBIL/IBIL ratio can exactly reflect the syndrome types of jaundice, when it is equal to or above 1, the type is mostly of dampness dominant, whereas it is less than 1, heat dominant. If quick pulse and yellow tongue fur appeared in patients with DBIL/IBIL≥1, it indicates that the presence of heat conversion of the dampness stagnancy.

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