慢性乙型肝炎病毒基因分型与中医辨证规律初探

Relationship between HBV genotypes and TCM differentiating syndromes of chronic hepatitis B

目的研究慢性HBV基因型与慢性乙型肝炎(chronic hepatitis B,CHB)中医辨证的相关性。方法在中医辨证基础上,测定300例CHB患者的外周血HBV基因型。结果①HBV基因型分布特点:B型和C型占大多数,分别为48例(16.0%)和233例(77.7%)。②中医证型分布特点:肝郁脾虚型和瘀血阻络型比例较大,分别为149例(49.7%)和110例(36.7%),HBV基因型在各中医证型间的分布差异无统计学意义。③瘀血阻络型患者中21.8%(24/110)诊断为重度,高于肝郁脾虚型的12.1%(18/149)。结论中国人感染HBV,基因C型明显高于其他型;瘀血阻络型肝损害较重;HBV基因型与中医证型无明显相关性,临床治疗CHB应以辨证论治为主,不必拘泥于基因分型。

objective To investigate the correlation between HBV genotypes and traditional Chinese medicine （TCM） differen- tiating syndromes of chronic hepatitis B （CHB）. Method Based on TCM syndrome differentiation, HBV genotypes were deter- mined in the peripheral blood of 300 CHB patients. Results HBV genotype B and C were predominant in the 300 CHB patients, in 48 （16.0%） and 233 （77.7%）, respectively. With respect to TCM differentiating syndromes, stagnation of liver-Qi with deficiency of the spleen and obstruction of collaterals by blood stasis were prevalent, in 149 patients （49.7%） and 110 patients （36.7%）, respec- tively. No significant differences were found in the distribution of HBV genotypes between TCM differentiating syndromes. Severe degree of CHB was found in 21.8% of the patients with obstruction of collaterals by blood stasis, higher than that of the patients with stagnation of liver-Qi with deficiency of the spleen （12.1%）. Conclusions HBV genotype C is more prevalent than the other geno- types in Chinese patients with HBV infection. The liver injury in obstruction of collaterals by blood stasis is worse than that in the other syndromes. There is no obvious relationship between HBV genotypes and TCM differentiating syndromes of CHB. The treatment for CHB should depend on TCM differentiating syndromes, with no need to stick to HBV genotypes.