何凯茵，肖光明，陈志敏，林路平，范慧敏，谭行华

慢性乙型肝炎患者舌脉象参数特征分析*

何凯茵，肖光明，陈志敏，林路平，范慧敏，谭行华

目的分析慢性乙型肝炎（CHB）患者舌脉象参数变化特征，为CHB患者中医临床辨证提供量化的客观依据。方法应用DS01-A型舌脉象数字分析仪检测120例CHB患者舌脉象参数，分析其舌脉象参数特征。结果与45例健康对照组比，CHB患者脉象参数h3/h1、h4/h1、W/t升高，h5/h1下降，差异有统计学意义（P<0.05）；湿热中阻组患者h3/h1和h4/h1高于肝肾阴虚组患者（P<0.05），肝郁脾虚组h3/h1高于肝肾阴虚组（P<0.05）；与健康对照组比较，CHB患者舌象参数R、G、B、V值下降，S值升高，差异有统计学意义（P<0.05）；湿热中阻、肝郁脾虚和肝肾阴虚组R值均高于瘀血阻络组（P<0.05），B值均低于瘀血阻络组（P<0.05）；湿热中阻和肝郁脾虚组S值低于瘀血阻络组（P<0.05）；肝肾阴虚组B值高于湿热中阻组（P<0.05）。结论检测舌脉象参数变化可以反映CHB患者舌脉象变化规律，为CHB患者中医临床辨证提供量化的客观依据。

慢性乙型肝炎；舌象；脉象；舌脉象数字分析仪

【Abstract】ObjectiveTo analyze the characteristics of tongue and pulse parameters in patients with chronic hepatitis B（CHB），and to provide evidence for the clinical syndrome differentiation of Traditional Chinese Medicine（TCM）in patients with CHB.MethodTongue and pulse parameters of 120 patients with CHB and 45 health persons were detected and analyzed by DS01-A type digital tongue and pulse presentation analyzer. ResultsCompared with those in the healthy controls，the pulse parameters of h3/h1，h4/h1，W/t in patients with CHB increased，while h5/h1 decreased，and the difference was statistically significant（P<0.05）；the h3/h1 and h4/ h1 of patients in damp heat group were higher than those of patients with yin deficiency of liver and kidney group（P<0.05），but h3/h1 in patients of liver stagnation and spleen deficiency group was higher than that of patients with yin deficiency of liver and kidney（P<0.05）；Compared with the healthy control group，tongue parameters including R，G，B，V values in patients with CHB decreased and S value increased，and the difference was statistically significant（P<0.05）；Compared with the blood stasis group，the R values of patients with damp heat with liver stagnation and spleen deficiency or yin deficiency of liver and kidney increased（P<0.05），but B values decreased（P<0.05）；The S values of patients with damp heat with liver stagnation and spleen deficiency were lower than that of patients with blood stasis（P<0.05）；The B value of patients with yin deficiency of liver and kidney was higher than that of patients with damp heat（P<0.05）.ConclusionDetection of the tongue and pulse parameters can reflect the change of liver functions in patients with CHB，and provide evidence for the clinical syndrome differentiation of TCM.

【Key words】Chronic hepatitis B；Tongue and pulse parameters；Digital tongue and pulse presentation analyzer

辨证论治是中医最具特色的诊断和治疗方法，在临床上具有重要的指导意义。现代医学认为，规范的抗病毒治疗是治疗慢性乙型肝炎的关键。目前，聚乙二醇α干扰素是抗病毒治疗CHB患者优先选择的药物之一[1，2]。有研究显示，CHB患者进行中医辨证分型可以预测干扰素治疗的疗效，不同中医证型的患者对干扰素治疗疗效可能不同，肝郁脾虚型和肝胆湿热型患者对干扰素的生化学和病毒学应答率显著高于脾肾阳虚型和瘀血阻络型[3～5]。但是，对CHB患者进行中医辨证分型仍处于传统经验医学阶段，证型诊断标准中主观性指标较多，缺乏客观性量化指标。近年来，随着循证医学的发展，中医辨证诊断指标的客观化、标准化已经成为中医现代化研究的重要部分。舌脉象变化是辩证论治的重要指标。舌脉象数字分析仪的研制成功为舌脉象指标的量化奠定了基础。本研究应用DS01-A型舌脉象数字分析仪分析了CHB患者舌脉象参数特征，为CHB患者的中医临床辨证提供了量化的客观依据。……