慢性乙型肝炎患者中医证型与肝脏病理改变肝内Ⅳ型胶原定量分析研究

Study on Relationship among Pathologic Diagnosis and Quantitative Analysis of Collagen Type Ⅳ in the Liver and TCM Type of Syndromes in 104 Patients with Chronic Hepatitis B

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、肝内Ⅳ型胶原含量的关系。方法:对104例患者进行肝组织病理诊断,并行肝内Ⅳ型胶原免疫组化检测及病理图像定量分析和中医分型。结果:①104例患者病理诊断分型,轻度74例,中度21例,重度9例;②104例患者中医分型为肝郁脾虚型56例,肝胆湿热型3例,肝肾阴虚型14例,脾肾阳虚型5例,瘀血阻络型26例;③病理分型轻度者以肝郁脾虚型为主(71.62％),中度者中瘀血阻络型占66.67％,重度者9例均为瘀血阻络型;④肝郁脾虚型患者肝内Ⅳ型胶原含量最低,肝内纤维化程度轻;瘀血阻络型患者肝内Ⅳ型胶原含量最多,肝内纤维化程度最重(P<0.01),其余3型介于两者之间,肝内Ⅳ型胶原含量无显著性差异(P>0.05)。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、重度者要注意活血化瘀。

Aim: To study the relationship between pathologic diagnosis and quantity of collagen type Ⅳ in the liver tissue and traditional Chinese medicine (TCM) type of syndromes. Methods: 104 cases were all in-patients, verified by the liver pathology and diagnosed in according to the pathology quantitative analysis of collagen type Ⅳimmunohis-tochemistry in the liver and TCM differentiation of syndromes.①There were the low-grade 74. moderate 21 and the severe 9 patients. ②TCM differentiation of symptoms and signs: Stagnation of the liver Qi and deficiency of the spleen was 56, damp-heat of liver and gall 3,deficiency of liver-yin and kidney-yin 14,insufficiency of both the spleen and the kidney 5, blood stasis vessel obstruction syndrome 26 patients. ③Among low-grade chronic hepatitis B stagnation of the liver-Qi and deficiency of the spleen was 71. 62% . among moderate chronic hepatitis B blood stasis vessel obstruction syndrome was 66.67%,the patients were all blood stasis vessel obstruction syndromes among severe grade chromic hepatitis B. ④The collagen type Ⅳof stagnation of the liver-Qi and deficiency of the spleen was the lowest in the liver tissue and was the smallest degree of liver fibrosis. While blood stasis vessel obstruction syndrome was maximum collagen type Ⅳ and was the severest degree of liver fibrosis in the liver tissue. P<0. 01. The collagen type IIIVV of other 3 types of TCM syndrome were moderate ,P>0. 05. Conclusion:①In chronic hepatitis B of low-grade was characterized by the stagnation of the liver-Qi and deficiency of the spleen: ②As the exacerbation of hepatic lesion, blood stasis vessel obstruction syndrome became main syndrome: 33333It was advocated to the treatment, low-grade chronic hepatitis B stage should pay more attention to smoothing the liver and invigorating the spleen, moderate and severe stage should pay more attention to promoting blood circulation to remover blood stasis and anti-hepatic fibrosis.