辨病与辨证相结合治疗慢性乙型肝炎的组织学基础

The histological base of treating chronic hepatitis B on disease differentiation combining with syndrome differentiation

目的:探讨慢性乙型肝炎(CHB)患者中医证型与肝组织学改变的关系,揭示中医"证"的本质,指导临床抗病毒治疗。方法:对705例经肝穿活检证实的CHB患者进行中医辨证分型,探讨中医证型与肝脏组织学改变的相关性。结果:①中医辨证分型:属肝胆湿热型245例(34.8%),肝郁脾虚型206例(29.2%),瘀血阻络型184例(26.1%),肝肾阴虚型43例(6.1%),脾肾阳虚型27例(3.8%)。②肝脏炎症程度分级:肝郁脾虚型主要为G1(33%)、G2(57.8%);肝胆湿热型主要为G2(49.8%)、G3(36.3%);瘀血阻络型主要为G3(48.4%)、G4(40.7%);肝肾阴虚型主要为G3(48.8%);脾肾阳虚型主要为G1(37%)、G2(40.8%)。③肝脏纤维化分期:肝郁脾虚型、肝胆湿热型、脾肾阳虚型主要为S1(81.0%、56.7%、40.8%);肝肾阴虚型主要为S3(32.5%);瘀血阻络型主要为S3(51.6%)、S4(23.4%)。结论:①CHB肝脏组织学改变与中医证型有显著相关性。肝郁脾虚型及肝胆湿热型患者肝组织学改变较轻,随着病情进展,肝脏损害逐渐加重,最终多表现为瘀血阻络型和肝肾阴虚型。②肝肾阴虚型及瘀血阻络型患者肝组织学改变显著,在辨证论治的同时应给予抗乙肝病毒治疗。

Objective：To study the correlation between syndrome types of traditional Chinese medicine（TCM） and liver histological changes in patients with chronic hepatitis B（CHB） in order to reveal the essence of Zheng of TCM and guide clinical antiviral therapy.Methods： A total of 705 patients with CHB proven by liver biopsy,syndrome types of them were Zheng differentiation-classified.The relationship between them was analyzed.Results：①TCM differentiation of symptoms and signs：damp-heat of liver and gall type（typeⅠ） was 245,stagnation of the liver Qi and deficiency of the spleen type（type Ⅱ） 206,blood stasis vessel obstruction type（type Ⅲ） 184,deficiency of liver-Yin and kidney-Yin type（type Ⅳ） 43,insufficiency of both spleen-Yang and kidney-Yang type（typeⅤ） 27 patients.②The grade of liver inflammation was mainly G1 and G2 in patients of type Ⅱand Ⅴ;G2 and G3 in patients of type Ⅰ;G3 in patients of type Ⅳ;while G3 and G4 in patients of type Ⅲ.③The liver fibrosis stage in patients of type Ⅰand Ⅱ and Ⅴ was mainly S1,S2-S4 was mainly in patients of type Ⅳ,while it was mainly S3 and S4 in type Ⅲ.Conclusion：①The TCM syndrome type is closely associated with liver histological changes.The liver histological changes of of typeⅠand Ⅱwere less than other groups.As the disease progression,the liver damage was growing worse,and at last type Ⅲ and Ⅴ became main sydromes.②The liver histological changes of typeⅢ andⅤwere significant.We should have treatment based on sydrome differentiation and antiviral therapy at the same time.