临床研究2026，Vol.34Issue(1)：97-101,5.DOI:10.12385/j.issn.2096-1278(2026)01-0097-05
基于中医瘀血理论分析乙型病毒性肝炎肝硬化与酒精性肝硬化患者证型差异及对预后的影响
Differences in Traditional Chinese Medicine Syndrome Patterns and Their Prognostic Impact in Hepatitis B Virus-Related Cirrhosis and Alcoholic Cirrhosis:An Analysis Based on the Theory of Blood Stasis
摘要
Abstract
Objective To investigate differences in traditional Chinese medicine(TCM)syndrome pattern distribution between patients with hepatitis B virus(HBV)-related cirrhosis and those with alcoholic cirrhosis,and to evaluate the impact of blood stasis severity on prognosis based on the TCM theory of blood stasis,thereby providing evidence for syndrome differentiation-based treatment in clinical practice.Methods Clinical data of 160 patients with cirrhosis who attended outpatient clinics or received inpatient treatment from January 2023 to September 2024 were retrospectively analyzed.According to etiology,patients were divided into an HBV-related cirrhosis group(n=80)and an alcoholic cirrhosis group(n=80).After standardized training,two TCM physicians with qualifications of associate chief physician or above independently determined the syndrome pattern and blood stasis severity(mild,moderate,or severe)using a dual-rater blinded approach;disagreements were adjudicated by a third-party chief physician.The distribution of syndrome patterns and the grading characteristics of blood stasis severity were compared between the two groups.Laboratory indices and prognostic outcomes were analyzed across different blood stasis severity levels.Multivariable logistic regression was performed separately in the two groups to identify prognostic factors.Results In the HBV-related cirrhosis group,the most prevalent pattern was Qi deficiency with blood stasis syndrome(33.75%),followed by damp-heat with stasis obstruction syndrome(28.75%).In the alcoholic cirrhosis group,phlegm-turbidity with stasis obstruction syndrome was most common(37.50%),followed by Qi deficiency with blood stasis syndrome(25.00%).There was no statistically significant difference in overall syndrome pattern distribution between groups(χ²=8.950,P=0.062);however,the proportion of phlegm-turbidity with stasis obstruction syndrome was higher in the alcoholic cirrhosis group,with a statistically significant difference(P＜0.05).In the HBV-related cirrhosis group,28 patients(35.00%)had mild blood stasis,24(30.00%)had moderate blood stasis,and 28(35.00%)had severe blood stasis;in the alcoholic cirrhosis group,45(56.25%),24(30.00%),and 11(13.75%)patients had mild,moderate,and severe blood stasis,respectively.The distribution of blood stasis severity differed significantly between groups(P=0.005),and the proportion of severe blood stasis was significantly higher in the HBV-related cirrhosis group than in the alcoholic cirrhosis group(P＜0.05).With increasing blood stasis severity,prothrombin time(PT)and portal vein width increased progressively,whereas albumin(ALB)decreased progressively(all P＜0.05).There were no significant differences in alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),or activated partial thromboplastin time(APTT)among blood stasis severity groups(all P＞0.05).The 12-month survival rate in patients with severe blood stasis(46.15%)was significantly lower than that in patients with moderate(72.92%)and mild blood stasis(90.41%).During follow-up,the incidence of newly developed complications in patients with severe blood stasis(84.62%)was significantly higher than that in patients with moderate(54.17%)and mild blood stasis(33.88%)(all P＜0.05).Survival was significantly lower and complication incidence was significantly higher in the moderate blood stasis group than in the mild blood stasis group(all P＜0.05).In the HBV-related cirrhosis group,severe blood stasis(OR=4.012,95%CI:1.752～9.188,P＜0.05),Child-Pugh class C(OR=4.956,95%CI:1.985～12.376,P＜0.05),and baseline complications(OR=3.124,95%CI:1.354～7.206,P＜0.05)were independent risk factors for poor prognosis,whereas ALB(OR=0.798,95%CI:0.687～0.927,P＜0.05)and standardized use of antiviral drugs(OR=0.385,95%CI:0.172～0.862,P＜0.05)were protective factors.In the alcoholic cirrhosis group,severe blood stasis(OR=3.845,95%CI:1.523～9.708,P＜0.05),Child-Pugh class C(OR=5.123,95%CI:1.897～13.839,P＜0.05),and duration of abstinence from alcohol＜6 months(reference:＞12 months;OR=3.215,95%CI:1.402～7.374,P＜0.05)were independent risk factors,whereas ALB(OR=0.815,95%CI:0.698～0.951,P＜0.05)was a protective factor.Conclusion No significant difference was observed in the distribution of TCM syndrome patterns between patients with HBV-related cirrhosis and those with alcoholic cirrhosis.Blood stasis severity grading shows an apparent dose-response relationship with liver function impairment and prognosis.Individualized blood-activating and stasis-resolving treatment strategies should be formulated based on etiology and blood stasis severity.关键词
瘀血理论/乙型病毒性肝炎肝硬化/酒精性肝硬化/中医证型/瘀血分级/预后Key words
theory of blood stasis/hepatitis B virus-related cirrhosis/alcoholic cirrhosis/traditional Chinese medicine syndrome patterns/blood stasis grading/prognosis分类
医药卫生引用本文复制引用
杨梅,李红德..基于中医瘀血理论分析乙型病毒性肝炎肝硬化与酒精性肝硬化患者证型差异及对预后的影响[J].临床研究,2026,34(1):97-101,5.基金项目
2025年安阳市科技计划项目(2025C01SF017). （2025C01SF017）
