23例临床前代偿期肝硬化患者的Ishak组织学评分与其中医证候分布特点的相关性初步研究

目的：探讨23例经过肝脏大体形态学确诊的临床前代偿期肝硬化患者的Ishak组织学评分与其中医证候分布特点的相关性.方法：通过流行病学横断面调查的方法对23例研究对象的肝组织Ishak组织学评分及与其中医诊断资料的相关性进行分析.结果：①证候分布特点为：肝气郁结（60.87％）,湿热蕴结（21.74％）,水湿内阻（13.04％）,瘀血阻络（4.35％）.②从Ishak炎症坏死的评分值（反映炎症坏死的情况）看,分级A、分级B评分值在湿热蕴结证候中最高,在瘀血阻络、肝气郁结证、水湿内阻证候中逐渐略微减低;分级C评分值在湿热蕴结证候中最高,在水湿内阻、肝气郁结、瘀血阻络证候中逐渐略微减低;分级D评分值在湿热蕴结证候中最高,在瘀血阻络、肝气郁结、水温内阻证候中逐渐略微减低;分级总评分值在湿热蕴结证候中最高,在瘀血阻络、肝气郁结、水湿内阻证候中逐渐略微减低;③分期总评分值在瘀血阻络证候中最高,在水湿内阻、湿热蕴结、肝气郁结证候中逐渐略微减低,无脾肾阳虚、肝肾阴虚及无证可辨.结论：在该23例患者中,我们初步发现：①中医证候分布以肝气郁结、湿热蕴结为主,正虚尚不明显,相应的肝脏炎症程度评分较低,而湿热蕴结型的炎症程度评分相对偏高;②此组患者肝组织形态学活检诊断肝硬化存在一定的漏诊率.

Correlation between Ishak histological scoring and TCM syndrome distribution in 23 patients with pre-clinical compensatory liver cirrhosis

Objective： To explore the correlation between histological scoring and the characteristic of TCM syndromes dis- tribution in 23 patients with pre-clinical compensatory liver cirrhosis. Methods： We analyzed the correlation based on the cross section of epidemiology inverstigation. Results： The distribution of TCM syndromes in the group was ： ＂depression of liver-Qi （DOL-QI）＂ （60.87%）, ＂endoretention of damp heat （ERDH）＂ （21.74%）, ＂endoretention of damp heat （ERDH）＂ （13.04%） and ＂obstruction of collaterals by blood stasis （OCBS）＂ （4. 35% ）, ＂hepatic and renal Yin deficiency （HRYD）＂ （0%）, ＂asthenic splenonephre-Yang （ ASN-Yang）＂ （0%） and ＂no syndrome to differentiate （NSD）＂ （0%） . （2）With re- gard to the inflammatory and necrosis score value of Ishak scoring system, it got the highest value of grade A and B in the TCM syndroms of ERDH. While in the TCM syndroms of OCBS, DOL-Qi and SFD decreased gradually and slightly. It got the highest value of grade C in the TCM syndroms of ERDH. While in the TCM syndroms of SFD , DOL-Qi and OCBS decreased gradually and slightly. It got the highest value of grade D in the TCM syndroms of ERDH. While in the TCM syndroms of OCBS, DOL-Qi and SFD decreased gradually and slightly. The overall score value of liver inflammation and necrosis got the highest value in the TCM syndroms of ERDH. While in the TCM syndroms of OCBS, DOL-Qi and SFD decreased gradually and slightly. （3）With re- gard to the fibrosis score value of Ishak scoring system, it got the highest value in the TCM syndroms of OCBS. While in the TCM syndroms of ERDH, ERDH and DOL-Qi decreased gradually and slightly. Conclusion： In this research, （1）The main distribution of TCM syndromes in the group is DOL-Qi and ERDH. The deficiency syndrome is not obvious. Its inflammatory and necrosis score value is low. While it is relatively higher in the TCM syndromes of ERDH. （2）There is certain missed diagnosis rate in this group.