慢性乙型肝炎中医证型与纤维化指标及肝脏病理的相关性研究

The Research on the Relevance of TCM Dialectical Chronic Hepatitis B and Liver Fibrosis and Pathology

目的:探讨慢性乙型肝炎中医证型的相关因素。方法:检侧符合诊断标准的381例慢性乙型肝炎患者透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)、层粘连蛋白(LN)、肿瘤坏死因子-α(TNF-α)、转化生长因子β1(TGF-β1)等指标的水平及208例患者肝组织病理,观察上述指标与中医证型的关系。结果:瘀血阻络组HA、PCⅢ、LN、Ⅳ-C、TGF-β1高于其它各型(P<0.01);肝郁脾虚型HA、PCⅢ、LN、Ⅳ-C、TGF-β1、TNF-α高于正常水平(P<0.01或P<0.05),明显低于其他各型(P<0.01);湿热中阻、瘀血阻络组TNFα、TGF-β1高于肝肾阴虚、脾肾阳虚组(P<0.01),而湿热中阻组TNF-α高于瘀血阻络组(P<0.01);肝郁脾虚、湿热中阻型S1～S2级G1～G2期较多,肝肾阴虚型和脾肾阳虚型S3级G2～G3期较多,瘀血阻络型以S3～S4级G3～G4期为主。结论:慢性乙肝的肝组织病理改变、HA、PCⅢ、LN、Ⅳ-C、TGF-β1、TNF-α等指标的异常变化与中医证型之间存在一定相关性。

Objective：The aim of this study is to investigate the factors related to TCM dialectical of chronic hepatitis B（CHB）.Methods：381 cases of CHB patients were tested blood parameter including hyaluronic acid（HA）,Ⅲ procollagen type（PC Ⅲ）,Ⅳ collagen（Ⅳ-C）,laminin（LN）,tumor necrosis Factor-α（TNF-α）and transforming growth factor β1（TGF-β1）.208cases of patients were liver biopsy.We observed the relationship of the above-mentioned targets with TCM diactical.Results：Comparision among the different syndrome types revealed that in static blood obstructing the Channels and collaterals patients,HA,PC Ⅲ,Ⅳ-C,LN and TNF-α were significantly higher than the other type（P0.01）.In Liver depression and spleen deficiency patients,HA,PC Ⅲ,LN,Ⅳ-C,TGF-β1 and TNF-α higher than normal levels（P0.01or P0.05）Spleen-kidney yang deficiency patients all that blood parameter were obviously lower than other TCM dialectical type.However in damp-heat obstracting the center and tatic blood obstructing the Channels and collaterals patients,TNF-α,TGF-β1 were higher than that of kidney-yin deficiency and liver and spleen Yang Deficiency patients.（P0.01）In damp-heat obstracting the center patients TNFα was higher than that in static blood obstructing the Channels and collaterals patients.（P0.01）In liver depression and spleen deficiency,damp-heat obstracting the center patients liver pathologcal change were class S1~S2 and G1~G2 period.most liver-kidney-yin deficiency type and spleen and kidney-yang deficiency patients belong to class S3 and G2~G3 period.Static blood obstructing the Channels and collaterals patients liver pathologcal change were class S3~S4 and G3~G4 period.Conclusion：It is related that CHB patients liver pathology change,HA,PCⅢ,LN,Ⅳ-C,TGF-β1,TNF-α and TCM dialectical type.