【摘要】 目的:探讨乙型肝炎肝硬化合并凝血功能紊乱的中医证候特点,为中医辨证论治肝硬化合并凝血功能紊乱提供临床依据。方法:按照乙肝肝硬化及凝血功能紊乱诊断标准收集乙肝肝硬化患者142例,观察患者临床中医证候转化规律、肝硬化各中医证候合并凝血功能紊乱的发生率、凝血指标、Child-pugh评分及并发症发生情况。结果:随着乙肝肝硬化病程的加快,遵循热伤营阴(舌红绛、脉细数)—热伤血络(皮肤瘀斑,淡紫色)—由营入血—血分证之血热阴伤(瘀斑颜色变深)—血热动血的发展规律逐渐出现合并凝血功能紊乱症状;现凝血功能紊乱的发病率为51.40%,在肝肾阴虚证型(74.19%)和瘀血阻络证型(65.63%)中的发病率最高;凝血功能指标PT、TT、APTT、FIB及Child-pugh评分依次为肝肾阴虚>瘀血阻络>湿热蕴结>脾肾阳虚>肝气郁结>水湿内阻,湿热蕴结、脾肾阳虚、肝气郁结证型与肝肾阴虚、瘀血阻络证型均具有明显差异(P<0.05);乙肝肝硬化合并凝血功能紊乱并发症的发生率为67.12%,明显高于未出现凝血功能紊乱患者的14.49%。结论:瘀血阻络证和肝肾阴虚证型乙肝肝硬化合并凝血功能紊乱的发病率较高,随着病程的增长,凝血功能紊乱程度加剧,且与"肝肾阴虚"、"瘀血阻络"关系密切,在临床治疗中应观察患者症状、体征、凝血指标及Child-pugh等因素,注意辨证施治,改善患者凝血功能。更多还原

【Abstract】 Objective: Characteristics of treating liver cirrhosis plus coagulation disorders in TCM were explored, to provide clinical evidence. Methods: 142 patients with liver cirrhosis and liver cirrhosis were collected according to the diagnostic criteria of liver cirrhosis plus coagulation disorders. Transformation of clinical syndromes, cirrhosis syndrome, the incidence of coagulopathy, coagulation, Childpugh scores and complications were observed. Results: The progression of liver cirrhosis would result in coagulation disorder symptoms; now the incidence of coagulation disorders was 51.40%, as the highest incidence; descending order of coagulation parameters PT, TT, APTT, FIB and Child-pugh score was from Ganshen Yinxu to Shuishi Neizu. Differences between Shire Yujie, Pishen Yangxu and Ganqi Yujie types and Ganshen Yinxu, Yuxue Zuluo types were significant(P<0.05). Complications of liver cirrhosis plus coagulation disorders was 67.12%, better than 14.49% in liver cirrhosis patients. Conclusion: Liver cirrhosis of the Yuxue Zuluo and Ganshen Yinxu types plus coagulation disorders shows highest incidence. The longer course, the heavier coagulation disorders, and related to Ganshen Yinxu, Yuxue Zuluo. Symptoms, signs, coagulation factors and Child-pugh scores were observed in clinic, with differentiation, to improve coagulation function.更多还原