1. 首都医科大学附属北京佑安医院中西医结合中心
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杨洋, 李秀惠. HBV相关慢加急性肝衰竭患者生化指标与中医虚实属性的相关性分析[J]. 北京中医药, 2019,38(3):207-211.
YANG Yang, LI Xiu-hui. Correlation analysis between biochemical indicators and TCM attributes in HBV-related acute-on-chronic liver failure[J]. Beijing Journal of Traditional Chinese Medicine, 2019,38(3):207-211.
杨洋, 李秀惠. HBV相关慢加急性肝衰竭患者生化指标与中医虚实属性的相关性分析[J]. 北京中医药, 2019,38(3):207-211. DOI: 10.16025/j.1674-1307.2019.03.003.
YANG Yang, LI Xiu-hui. Correlation analysis between biochemical indicators and TCM attributes in HBV-related acute-on-chronic liver failure[J]. Beijing Journal of Traditional Chinese Medicine, 2019,38(3):207-211. DOI: 10.16025/j.1674-1307.2019.03.003.
目的探究并筛选出HBV相关慢加急性肝衰竭(HBV-ACLF)患者生化指标中与中医虚实属性相关的指标,评估其预测中医虚实属性趋势的价值,为对HBV-ACLF患者进行中医虚实辨证提供帮助。方法纳入符合条件的HBV-ACLF患者130例,根据中医辨证分型标准分为:瘀热发黄证、湿热发黄证、气虚瘀黄证、阴虚瘀黄证、阳虚瘀黄证5个证型,将湿热发黄证和瘀热发黄证归纳为实证组共90例,气虚瘀黄证、阳虚瘀黄证和阴虚瘀黄证归纳为虚证组共40例。从ALT、AST、TBiL、ALB、γ-GT、ALP、PA、CREA、PTA、INR、TC、TG、HDL-C、LDL-C、AFP、AFU、WBC、Hb及PLT等指标中筛选出中医虚实属性相关性指标,以实证为阳性趋势预测,将统计学差异P<0.1的生化指标纳入二项Logistic回归模型进行相关性分析,并以受试者工作曲线下面积(AUROC)确定相关性指标临界值、敏感度及特异性。结果 AFU、PA、HDL-C、LDL-C等指标实证组高于虚证组,差异有统计学意义(P<0.05),余各项指标差异无统计学意义(P>0.05)。实证组与虚证组比较,统计学差异P<0.1的生化指标包括AFU、γ-GT、INR、PA、TC、TG、HDL-C、LDL-C、Hb等,将以上指标纳入二项Logistic回归模型,以实证为阳性趋势预测,其中AFU、PA及HDL-C为实证的独立预测因子。AFU水平预测实证趋势的AUROC值为0.706(95%CI 0.583~0.829),临界值为39.20(U/L),高于临界值提示很有可能为实证,敏感性为78.20%,特异性为47.60%;PA水平预测实证趋势的AUROC值为0.706(95%CI 0.587~0.826),临界值为37.60(mg/L),高于临界值提示很有可能为实证,敏感性为74.50%,特异性为42.90%;HDL-C水平预测实证的AUROC值为0.711(95%CI 0.597~0.826),临界值为0.36(mmol/L),高于临界值提示很有可能为实证,敏感性为65.50%,特异性为38.10%。结论 AFU、PA及HDL-C 3个指标对于预测中医虚实属性趋势有较好的敏感性,然而特异性较低,有一定假阳性,尚需扩大样本,多中心共同研究,进一步筛选出预测中医虚实属性趋势更灵敏的客观指标。
Objective To explore and screen out the biochemical indicators in relationship with the indexes of TCM deficiency and excess attributes in patients with acute-on-chronic acute-on-chronic liver failure(HBV-ACLF),and evaluate their diagnostic value for predicting development of TCM deficiency and excess in order to provide assistance in making syndrome differentiation of TCM.Methods 130 patients with HBV-ACLF were included,and according to TCM syndrome differentiation criteria,they were divided into:blood stasis-heat jaundice,damp-heat jaundice,Qi-deficiency stasis jaundice,Yin-deficiency stasis jaundice and Yang-deficiency stasis jaundice.Blood stasis-heat jaundice and damp-heat jaundice were classified into excessive syndrome group with 90 cases.Qi-deficiency stasis jaundice,Yin-deficiency stasis jaundice and Yang-deficiency stasis jaundice were classified into deficiency syndrome group of 40 cases.Those index,including ALT,AST,TBiL,ALB,γ-GT,ALP,PA,CREA,PTA,INR,TC,TG,HDL-C,LDL-C,AFP,AFU,WBC,Hb and PLT Etc were screened out.The excess syndrome were taken as the positive trend prediction,the biochemical indicators of P<0.100 were included in the binomial logistic regression model for independent prediction analysis,and the threshold value,sensitivity and specificity of the prediction index were determined by the area under the receiver’s working curve(AUROC).Results The indicators,such as AFU,PA,HDL-C and LDL-C excessive syndrome groups were higher than those of deficiency syndrome groups and the differences were statistically significant(P<0.05).The rest indicators were not statistically significant(P>0.05).To compare the excessive syndrome groups with the deficiency syndrome groups,the excessive syndrome trend prediction was used to compare the biochemical indicators including AFU,γ-GT,INR,PA,TC,TG,HDL-C,LDL-C and Hb of P<0.100 in Chinese medicine to the binomial logistic regression model.Indicators such as AFU,PA,and HDL-C were the excessive syndrome independent predictors.The empirical AUROC value of AFU level prediction was 0.706(95%CI 0.583~0.829),and the threshold value was 39.20(U/L).Above the threshold value,it was likely to be the excessive syndrome,with sensitivity of 78.20% and specificity of 47.60 %;PA level prediction the excessive syndrome AUROC value was 0.706(95%CI 0.587~0.826),the threshold value was 37.60(mg/L),above the threshold value was likely to be the excessive syndrome,the predicted trend sensitivity was 74.50%,and specificity 42.90%;the excessive syndrome AUROC value of HDL-C level was 0.711(95%CI 0.597~0.826),and the threshold value was 0.36(mmol/L).The fact that was above the threshold value suggest possibility of excessive syndrome,and the predicted trend sensitivity was 65.50 %,specificity was 38.10%.Conclusion AFU,PA and HDL-C can predict deficiency and excess syndromes in TCM with better sensitivity but less specificity,there is also a certain false positive,and the sample needs to be expanded.Multi-centered joint research can further screen out objective indicators that are more sensitive to predict TCM deficiency and excess attributes.
慢加急性肝衰竭乙型肝炎中医辨证生化指标相关性分析
Acute-on-chronic liver failurehepatitis Bdifferentiation of syndromes in TCMbiochemical indicatorcorrelation analysis
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