世界中医药

目的：观察广州市慢性乙型肝炎各常见证型与大便异常症状发生的相关性。方法：采集广州市2所医院612例慢性乙型肝炎患者的一般资料、病情程度指标、大便异常情况、症状体征、中医辨证分型等一手资料，统计分析揭示大便情况（a.泄泻或大便稀溏，b.大便黏滞不爽，c.大便时干时溏，d.大便正常，e.便结或便秘）与慢性乙型肝炎、各证型、年龄性别、病情程度的关系。结果：612例慢乙肝病例中，大便异常发生率为70.91%。其中，男女大便异常发生率分别为72.28%和69.12%，差异无统计学意义（P>0.05）；不同年龄组大便异常发生率之间差异有统计学意义（P<0.05），41～50岁年龄组大便异常发生率为75.52%，51～65岁为88.27%，明显高于31～40岁和18～30岁年龄组。大便异常发生率顺位为b、a、e、c。612例慢乙肝病例辨证分型顺位为肝胆湿热证、肝郁脾虚证、湿困脾胃证、肝肾阴虚证、肝血瘀阻证5型，各证型大便异常发生率顺位为肝胆湿热证、湿困脾胃证、肝郁脾虚证、肝血瘀阻证、肝肾阴虚证。肝胆湿热证患者中，94.61%的患者大便异常，其中b型异常发生率最高，为86.53%；湿困脾胃证患者中，85.57%的患者大便异常，其中也是b型异常发生率最高，为54.64%；肝郁脾虚证患者中，51.75%的患者大便异常，其中a型异常发生率最高，为40.35%。612例慢乙肝患者中，重度患者38例，92.10%的患者大便异常，其中a型异常发生率最高，为47.37%；中度患者303例，98.02%的患者大便异常，其中b型异常发生率最高，为80.86%；轻度患者271例，仅37.64%的患者大便异常，其中b型异常发生率最高，为25.09%。中重度患者大便异常发生率均极高，轻度患者则较低，差异有统计学意义（P<0.05），此也可能与慢乙肝病情发展及用药影响胃肠道功能有关。结论：大便异常实为慢乙肝患者极常见的一种症状，尤其是中老年患者；大便黏滞不爽、泄泻或稀溏是其中最常见的大便异常，值得临床医者关注。肝胆湿热证是广州慢性乙型肝炎患者最常见证型，且同时也是大便异常发生率最高者，其中又以大便黏滞不爽最为高发，可以部分印证便溏不爽为岭南慢乙肝湿热证临床的极为常见症状、应纳入肝胆湿热证证型辨证的主症之假说。

English Summary:

To observe the relation between main syndromes of chronic hepatitis B and the occurrence of stool abnormality. Methods: General information of 612 chronic hepatitis B patients from two hospitals in Guangzhou, including the index of the severity of patients, their stool abnormality, symptoms and signs, syndrome differentiation of TCM and other first-hand accounts were collected. Then these were used to statistically analyze the relation between stool (a. diarrhea or thin sloppy stool, b. stool viscosity and stoppage, c. sometimes dry, while sometimes viscous stool, d. normal stool, e. constipation) and chronic hepatitis B, different syndrome types, age, gender and severity of patient’s condition. Results: Among the 612 chronic hepatitis B patients, the incidence of abnormal stools was 70.91%, with the incidence of male abnormal stools being 72.28% and female being 69.12%, there being no statistical significance(P>0.05). There was statistical significance among different age groups(P<0.05). The incidence of abnormal stools of the 41 to 50 and 51 to 65 age groups were 75.52% and 88.27% respectively, which was much higher than that of the 31 to 40 and 18 to 30 age groups. The priority of the incidence of abnormal stools was b, a, e, c. The priority of the five types of syndrome differentiation among the 612 chronic hepatitis B patients was dampness-heat of liver and gallbladder syndrome, liver depression and spleen deficiency syndrome, dampness obstructing spleen-stomach syndrome, yin deficiency of liver and kidney syndrome and hepatic blood stagnation syndrome. Among patients with dampness-heat of liver and gallbladder syndrome, 94.61% of them suffered from stool abnormality and the abnormal rate of type b was the highest, accounting for 54.64%. Among patients with liver depression and spleen deficiency syndrome, 51.75% of them suffered from stool abnormity and the abnormal rate of type a was the highest, amounting to 40.35%. Among the 612 chronic hepatitis B patients, 38 were severe cases, of whom 92.10% suffered from stool abnormality, also the abnormal rate of type a was the highest, accounting for 47.37%; 303 were moderate cases, of whom 98.02% suffered from stool abnormality and the abnormal rate of type b was the highest, accounting for 80.86%; 271 were mild cases, of whom only 37.64% suffered from stool abnormality and the abnormal rate of type b was the highest, amounting to 25.09%. The abnormal rate of severe and moderate patients who suffered from stool abnormality was high, while that of mild patients was relatively low(P<0.05). This may relate to the development of chronic hepatitis B and the drugs influence on gastrointestinal function. Conclusion: Stool abnormality was a common syndrome among chronic hepatitis B patients, especially among middle-old aged patients; stool viscosity and stoppage, diarrhea or thin sloppy stool were the most common abnormal stool, which deserved special concern by clinicians. The dampness-heat of liver and gallbladder syndrome was the most common type among chronic hepatitis B patients in Guangzhou Province with the highest occurrence of stool abnormality. Stool viscosity and stoppage being the most common syndrome. This paper can partially prove that stool viscosity and stoppage is the most common syndrome of damp-heat syndrome for chronic hepatitis B patients in the south of the Five Ridges, which should be the primary symptom of dampness-heat of liver and gallbladder syndrome.

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