慢性乙型肝炎患者中医证型与肝脏病理改变及血清转化生长因子β_1相关性研究

A correlation study on TCM′s syndrome differentiati on typing with hepatopathological changes and serum transforming growth factor- β_1 in chronic hepatitis-B cases

目的 探讨慢性乙型肝炎患者中医辨证分型与肝脏病理改变及血清转化生长因子(TGF) β1含量的关系。方法 对92例慢性乙型肝炎患者进行肝组织病理诊断和中医分型。采用酶联免疫吸附试验(ELISA)测定92例患者血清TGF β1。结果 ①92例患者病理分型,轻度6 5例,中度19例,重度8例;②92例患者中医分型为肝郁脾虚型4 9例,湿热中阻型3例,肝肾阴虚型11例,脾肾阳虚型6例,瘀血阻络型2 3例;③病理分型轻度者以肝郁脾虚型为主(72 % ) ,中度者瘀血阻络型占6 3% ,重度者8例均为瘀血阻络型;④肝郁脾虚型者血清TGF β1含量最低,肝内纤维化程度轻;瘀血阻络型患者血清TGF β1含量最多,肝内纤维化程度最重(P <0 .0 1) ,其余3型介于两者之间,血清TGF β1含量差异无统计学意义(P >0 . 0 5 )。结论 慢性乙型肝炎以肝郁脾虚型为主,随着肝损害加重,瘀血阻络型逐渐增加。因此,对慢性乙型肝炎轻度者要注重疏肝健脾,对中。

Objective To study the relationship between TCM ′ s syndrome differentiation typing and serum levels of transforming growth factor -β 1 (TGF-β 1) as well as hepatopathological changes.Methods Ninety-two cases were all in patients,verified by hepatopathology and TCM′ s syndrome differentiation,serum TGF-β 1 was detected by ELISA.Result s ①According to pathological typing,65 cases belonged to mild grade, 19 belonged to moderate grade,and 8 severe grade.②According to the TCM′s typin g,of the 92 cases 49 were of the liver-qi stagnation & spleen deficiency type,3 of the damp-heat obstructing the middle-energizer type,11 of the liver-kidne y yin deficiency type, 6 of the spleen-kidney yang deficiency type,and 23 of th e static blood obstructing network type.③Pathological typing showed that mild t ype mainly consisted of those of liver-qi stagnation & spleen deficiency (72%), moderate type consisted of those of static blood obstructing network (63%),and s evere type (8 cases) consisted also of those of static blood obstructing network .④The type of liver-qi stagnation & spleen deficiency had the lowest serum TGF -β 1 and the lightest degree of liver fibrosis;the type of static blood obstr ucting network had the highest serum TGF-β 1 and the heaviest degree of liver fibrosis (P<0.01);the another three types showed no statistica l difference in serum TGF-β 1 (P>0.05).Conclusion Ini tially with liver-qi stagnation & spleen deficiency as its main type,chronic he patitis B (CHB),along with the aggravated liver injury,gradually turned into the type of static blood obstructing network;so attention must be paid to soothing the liver & invigorating the spleen for the mild CHB,and to quickening the blood & transforming stasis,as well as anti-hepatic fibrosis for severe CHB.