慢性乙型肝炎患者外周血单个核细胞内HBV-DNA与中医证型关系的研究

Relationship between HBV-DNA in Peripheral Blood Mononuclear Cells and Syndrome Types of TCM in Chronic Hepatitis B Patients

目的探讨慢性乙型肝炎患者血清乙肝病毒脱氧核糖核酸(HBV-DNA)及外周血单个核细胞(PBMCs)中HBV-DNA感染与中医证型的关系。方法220例慢性乙型肝炎患者进行乙肝标志物检查、血清HBV-DNA(定量)及PBMCs中HBV-DNA检测(PCR方法),经中医辨证确定205例患者的中医证型。结果研究发现各中医证型血清HBV-DNA(定量)≥1.0×105拷贝/mL(高病毒载量)患者比例由小到大排列依次为:湿热中阻证<瘀血阻络证<肝肾阴虚证<脾肾阳虚证<肝郁脾虚证。肝郁脾虚证组血清HBV-DNA(定量)≥1.0×105拷贝/mL患者比例最高(占82.5%),与湿热中阻证组(占55.2%)差异有显著性(P<0.01)。各中医证型PBMCs中HBV-DNA感染患者比例由小到大排列依次为:肝肾阴虚证<湿热中阻证<脾肾阳虚证<瘀血阻络证<肝郁脾虚证。肝郁脾虚证组PBMCs中HBV-DNA感染患者比例最高(占77.2%),与肝肾阴虚证(占27.3%)、湿热中阻证(占34.3%)、瘀血阻络证(占53.1%)比较,差异均有显著性(P<0.01)。结论血清HBV-DNA(定量)及PBMCs中HBV-DNA感染与中医证型之间有一定关系,肝郁脾虚证组血清HBV-DNA(定量)≥1.0×105拷贝/mL患者比例及PBMCs中HBV-DNA感染患者比例最高,治疗应注重扶正祛邪。

Objective To study the relationship between TCM syndrome type and HBV-DNA in serum and peripheral blood mononuclear cells （PBMCs） in chronic hepatitis B （CHB） patients. Methods The serum HBV markers,HBV-DNA levels in serum and PBMCs, were quantitatively detected in 220 CHB patients by PCR method,and TCM syndrome type of 205 patients were differentiated. Results Arranged from low to high, the percentages of CHB patients with the serum HBV-DNA ≥1.0 × 10^5copy/mL （high viral loading） in the five syndrome types were as follows： damp-heat retention in middle-jiao syndrome （DHRS, 55.2% ）, blood stasis blocking collateral syndrome （BSBC）, Gan-Shen yin deficiency syndrome （GSYS）, Pi-Shen yang deficiency syndrome （PSDS） and Gan stagnation with Pi deficiency syndrome （GSPS, 82.5 % ）, the difference was significant between DHRS and GSPS; those with HBV-DNA in PBMCs infection were： GSYS （27.3 % ）, DHRS （34.3 % ）, BSBC （53.1% ） and GSPS （77.2 % ）. The percentage in GSPS was the highest, which was significantly different to that in other syndromes. Conclusion Amount of serum HBV-DNA and PBMCs HBV-DNA infection has certain correlation with the TCM syndrome type of CHB. The highest percentage of patients with HBV-DNA≥1. 0 × 10^5copy/mL and PBMCs HBV-DNA infection presented in CHB patients of GSPS type. We should pay more attention to strengthen genuine qi to eliminate pathogenic factors in treatment of CHB.