血清Ⅳ型胶原测定对慢性肝病中医证型的诊断作用及临床意义

Relationship Between Serum Ⅳ-Collagen and TCM Syndrome Types in Chronic Hepatitis and Cirrhosis

采用放射免疫法测定160例慢性肝病患者血清肝纤维化标志物Ⅳ型胶原（Ⅳ-C），以探讨在血清中Ⅳ-C的质量浓度ρⅣ-C与中医证型的关系及临床意义。结果显示，各中医证型组的ρⅣ-C均较对照组明显升高，其升高程度依次为肝郁脾虚＜瘀血阻络＜肝肾阴虚＜湿热中阻＜脾肾阳虚。统计分析表明，湿热中阻和脾肾阳虚组ρⅣ-C的升高与肝郁脾虚组比较存在显著性差异（P＜0．01）。提示：（1）测定ρⅣ-C对慢性肝病中医分型有一定指导意义；（2）肝纤维化在肝郁脾虚阶段已启动，但相对静止；（3）湿热中阻和脾肾阳虚是肝纤维化的活跃期，后者的病情尤其严重。

Serum Ⅳ-collagen(Ⅳ-C) content was the criteria for the diagnosis of chronic hepatitis andcirrhosis(CHC).To explore the relationship between Ⅳ-C and TCM syndrome types,the content ofⅣ-C in 160 cases of CHC was determined by radioimmunoassay,and 35 cases of internal diseases(excluding CHC and desmis) served as control.CHC was differentiated as liver-Qi-stagnation and spleendeficiency syndrome,blood-stasis blocking collateral syndrome, liver-Yin and kidney-Yin deficiencysyndrome, dampness-heat stagnation syndrome, and spleen-Yang and kidney-Yang deficiency syndrome.The results showed that Ⅳ-C content in CHC Patients with different TCM syndromes was obviously higherthan that in the control group and Ⅳ-C content in the above five syndromes was in an increasing sequence. The differences of Ⅳ-C content between the groups of dampness-heat syndrome syndrome andspleen-Yang and kidney-Yang deficiency syndrome and the group of liver-Qi-stagnation and spleen-deficiency syndrome were significant(P< 0.01 ). It is indicated that determination of Ⅳ-C content exertsa certain degree of significance for the TCM syndrome differentiation of CHC; cirrhotic change begins inthe stage of liver-Qi-stagnation and spleen-deficiency but is relatively static; cases with dampness-heatstagnation syndrome and spleen-Yang and kidney-Yang deficiency syndrome are in the active stage of cirthosis and the pathologic changes in the latter are more severe.