[1]丁涛?汪瀚.无创诊断对肝豆状核变性肝硬化评估及中医证型分析的作用[J].陕西中医药大学学报,2021,44(05):074-78.[doi:10.13424/j.cnki.jsctcm.2021.05.015]
　DING TaoWANG Han.Effects of Noninvasive Diagnosis on Evaluation of Hepatolenticular Degeneration and Cirrhosis and Analysis of TCM Syndrome Types[J].Journal of Shaanxi University of Traditional Chinese Medicine,2021,44(05):074-78.[doi:10.13424/j.cnki.jsctcm.2021.05.015]
点击复制

无创诊断对肝豆状核变性肝硬化评估及中医证型分析的作用
分享到：

《陕西中医药大学学报》[ISSN:2096-1340/CN:61-1501/R]

卷:
44
期数:
2021年05期
页码:
074-78
栏目:
出版日期:
2021-09-30

文章信息/Info

Title:
Effects of Noninvasive Diagnosis on Evaluation of Hepatolenticular Degeneration and Cirrhosis and Analysis of TCM Syndrome Types
文章编号:
2096-1340(2021)05-0074-05
作者:
?丁涛1?汪瀚2
1.安徽中医药大学，安徽 合肥 230031；
2.安徽中医药大学第一附属医院，安徽 合肥 230031
Author(s):
DING Tao1WANG Han2
1.Anhui University of Traditional Chinese Medicine,Hefei 230031,China;
2.The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei 230031,China
关键词:
肝豆状核变性; 瞬时弹性成像; 肝纤维4项; Child-Pugh; 中医证型
Keywords:
Hepatolenticular degeneration;  Transient elastography;  4 items hepatic fibers;  ChildPugh; TCM syndrome type
分类号:
R256.42
DOI:
10.13424/j.cnki.jsctcm.2021.05.015
文献标志码:
A
摘要:
目的 探讨肝脏瞬时弹性成像技术(FS)及血清肝纤维化指标①透明质酸（HA）、②层粘连蛋白(LN)、③Ⅲ型前胶原N端肽(PⅢNP)、④Ⅳ胶原(Ⅳ-C)在肝豆状核变性肝硬化程度评估及中医证型分析中作用。方法 研究对象为安徽省中医院2019年6月—2020年1月收治的首次治疗的肝豆状核变性肝硬化患者112例，在肝硬化程度评估中根据肝硬化ChildPugh分A、B、C三级，另选取对照组健康体检者30例，对各组研究对象进行肝脏瞬时弹性成像及血清肝纤维化4项指标检查，对各组指标与Child-Pugh分级评分进行相关性分析；在中医证型分析中，将WD患者按照中医证型分组，对各组指标进行差异性比较。结果 WD肝硬化Child-Pugh分级A、B、C级组患者LSM及血清HA、LN、PⅢNP、Ⅳ-C水平均显著高于对照组(P<0.05)，且血清肝纤维化4项指标中除PⅢNP外均随肝硬化ChildPugh分级评分的增加而明显升高，各组间差异比较显示均有统计学意义(P<0.05)，LSM、HA、LN、Ⅳ-C与Child-Pugh分级总分呈正相关(P<0.05)。证型分析中脾肾阳虚证患者在指标LSM、HA、LN、Ⅳ-C上高于湿热内蕴证及痰瘀互结证患者(P<0.05)。结论 肝豆状核变性肝硬化患者Child-Pugh分级越高，血清肝纤维化4项指标越高，LSM增加。不同证型患者各指标有一定差异，脾肾阳虚证患者明显高于其他证型。肝脏瞬时弹性成像技术及血清肝纤维化指标可作为肝硬化程度评估及中医证型分析的有效手段。
Abstract:
Objective To investigate the role of liver transient elastography (FS) and serum liver fibrosis indexes ①hyaluronic acid (HA),②laminin (LN),③type Ⅲ procollagen Nterminal peptide (PⅢNP) and ④collagen Ⅳ (Ⅳ- C) in the evaluation of liver cirrhosis and the analysis of TCM syndrome types.Methods The subjects were 112 patients with hepatolenticular cirrhosis treated for the first time in Anhui Hospital of traditional Chinese medicine from June 2019 to January 2020.In the evaluation of the degree of liver cirrhosis,the three levels A,B and C of liver cirrhosis according to cirrhosis Child Pugh.30 healthy subjects in the control group were selected.The subjects in each group were examined by transient elastic imaging of liver and 4 indexes of serum liver fibrosis.The correlation between the indexes of each group and Child Pugh score was analyzed; In the analysis of TCM syndrome types,WD patients were divided into groups according to TCM syndrome types,and the indexes of each group were compared.Results The levels of LSM and serum HA,LN,PⅢNP and Ⅳ-C in Child Pugh grade A,B and C groups of WD cirrhosis were significantly higher than those in the control group (P<0.05).Except PⅢNP,the four indexes of serum liver fibrosis increased significantly with the increase of Child Pugh grade of cirrhosis (P<0.05).Ⅳ-C was positively correlated with the total score of Child Pugh grade (P<0.05).In the analysis of syndrome types,the indexes LSM,HA,LN and Ⅳ-C of patients with spleen and kidney Yang deficiency syndrome were higher than those of patients with damp heat accumulation syndrome and phlegm and blood stasis syndrome (P<0.05).Conclusion The higher the child Pugh grade,the higher the four indexes of serum liver fibrosis and the increase of LSM in patients with hepatolenticular cirrhosis.The indexes of patients with different syndrome types are different,and the patients with spleen and kidney Yang deficiency syndrome are significantly higher than other syndrome types.Liver transient elastography and serum liver fibrosis index can be used as effective means to evaluate the degree of liver cirrhosis and analyze TCM syndrome types.

参考文献/References:

［1］王苏悦,蔡永亮.以精神障碍为首发症状的肝豆状核变性病人临床特点分析［J］.中西医结合心脑血管病杂志,2019,17(19):3052-3055.
［2］吴志英,王柠.中国肝豆状核变性诊治指南(修订版)［A］.中华医学会（Chinese Medical Association）、中华医学会神经病学分会（Chinese Society of Neurology）.中华医学会第十八次全国神经病学学术会议论文汇编（上）［C］.中华医学会（Chinese Medical Association）、中华医学会神经病学分会（Chinese Society of Neurology）:中华医学会,2015:1.
［3］Zhang Xinrong,Wong Grace LaiHung,Wong Vincent WaiSun.Application of transient elastography in nonalcoholic fatty liver disease.［J］.Clinical and molecular hepatology,2020,26(2):128-141.
［4］中华医学会肝病学分会,中华医学会感染病学分会,Association CM.慢性乙型肝炎防治指南（2010年版）［J］.中华肝脏病杂志,2011，19（3）:13-24.
［5］中华医学会神经病学分会帕金森病及运动障碍学组.肝豆状核变性的诊断与治疗指南［J］.中华神经科杂志,2008,41(8):566-569.
［6］中华医学会肝病学分会.肝硬化诊治指南［J］.临床肝胆病杂志,2019,35(11):2408-2425.
［7］Przybykowski A,Szeligowska J,Januszewicz M,et al.Evaluation of liver fibrosis in patients with Wilsons disease ［published online ahead of print,2020 May 15］.Eur J Gastroenterol Hepatol.2020;10.1097/MEG.00000000 00001754.doi:10.1097/MEG.0000000000001754.
［8］Iwabu J,Namikawa T,Tsuda S,et al.Successful Distal Gastrectomy for Gastric Cancer with ChildPugh Class B Alcoholic Liver Cirrhosis［J］.Anticancer Ｒes,2018,38(5):3085-3087.
［9］国家技术监督局.中医临床诊疗术语证候部分［M］.北京:中国标准出版社,1997:2.
［10］ Liu WY,Wang JH,Guo Y,et al.Transient elastography for assessment of fibrosis and steatosis of liver grafts from braindeath donors.［J］.Clinics and research in hepatology and gastroenterology,2020,44(2):155-161.
［11］Da Ben L,Surana Pallavi,Takyar Varun,et al.Vibrationcontrolled transient elastography for the detection of cirrhosis in chronic hepatitis D infection.［J］.Journal of viral hepatitis,2020,27(4):428-436.
［12］Rafael Paternostro,Jan Pfeiffenberger,Peter Ferenci,et al.Noninvasive diagnosis of cirrhosis and longterm disease monitoring by transient elastography in patients with Wilson disease［J］.Liver International,2020,40(4):894-904.
［13］李娟,沈有秀,杨永耿,等.肝脏瞬时弹性成像技术及血清肝纤维化指标在肝硬化中的评估作用［J］.肝脏,2019,11(24):1285-1287.
［14］吴一鸣,殷新光,章丽芳,等.弹性诊断仪(Fibroscan)与无创诊断模型在日本血吸虫肝病患者肝纤维化评估中的比较［J］.中华肝脏病杂志,2020,28(2):163-167.
［15］Tarun Joseph,Vishnu Reddy,P.V.Girish,et al.Transient Elastography(Fibroscan)Assessment in Patients with Hepatic and Neurological Wilsons Disease.2016,6:S93-S94.
［16］秦敏.术前瞬时弹性超声检查对肝内结石肝切除术安全性的影响［J］.肝脏,2019,8(24):936-938.
［17］张娟,王云宝,谢道俊,等.肝豆状核变性患者肝纤维化无创诊断模型与中医证型相关性研究［J］.时珍国医国药,2019,30(12):2927-2929.
［18］漆仲文.肝豆状核变性患者铜代谢障碍临床诊治思考［J］.陕西中医药大学学报,2016,39(6):22-24.
［19］程贤文,王振东,崔翔,等.中医证型与肝纤维化及细胞因子关系分析［J］.陕西中医药大学学报,2018,41(6):46-49.
［20］Baranova A,Lal P,Birerdinc A,et al.Noninvasive markers for hepatic fibrosis［J］.BMC Gastroenterol,2011,11:91.
［21］刘珺,管娟,周聪.3种抗精神病药物治疗精神分裂症对糖脂代谢、肝功能及心功能的影响［J］.川北医学院学报,2020,35(1):61-64,81.
［22］肝脏硬度评估小组.瞬时弹性成像技术诊断肝纤维化专家意见［J］.中华肝脏杂志,2013,21(6):420-424.

备注/Memo

备注/Memo:
基金项目：国家中医药管理局区域中医（专科）诊疗中心建设项目（20180712）
更新日期/Last Update: 2021-09-23