江苏启东地区4618例乙型肝炎病毒感染者证候调查

Investigation on traditional Chinese medicine syndrome distribution of 4 618 hepatitis B virus infection subjects in Qidong of Jiangsu Province,China

目的:探索江苏启东社区居民乙型肝炎病毒感染者中医证候的分布情况。方法:采用横断面调查,2007年5月至2011年5月对江苏启东的当地社区居民进行乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)筛查,建立HBsAg阳性的乙型肝炎病毒感染者队列及HBsAg阴性的对照队列,结合B超、血液检查等进行诊断,将调查对象分为非乙肝病毒感染、乙型肝炎病毒携带、慢性乙型肝炎、肝炎后肝硬化和肝癌5组。利用制定好的中医证候调查问卷,对调查对象进行基本证候和复合证候的判定。结果:共调查5908例对象,其中HbsAg阳性对象4618例,HbsAg阴性对象1147例,143例未检测血液指标的对象被排除。调查发现,乙型肝炎病毒感染者与非乙型肝炎病毒感染者在证候分布特点上有明显差异:乙型病毒性肝炎相关性肝病患者证候主要以气虚、气滞、血瘀、湿热为主,涉及脏腑主要为肝脾。乙型肝炎病毒携带者、慢性乙型病毒性肝炎患者、肝硬化患者证候分布类似,且证候严重程度逐渐增加,兼夹证候逐渐增多。肝癌患者与乙型肝炎病毒携带者、慢性乙型肝炎患者、肝硬化患者证候分布情况略有差异,主要以血瘀证、实热证为主。结论:江苏启东地区乙型肝炎病毒相关性肝病患者证候分布具有一定规律性。其主要病机在于气结血瘀,又有正气不足的因素参与,尤其以脾虚为多见,形成虚实夹杂之证。

OBJECTIVE： To study the traditional Chinese medicine （TCM） syndrome distribution in patients with hepatitis B virus （HBV） infection in Qidong region of Jiangsu Province, China. METHODS： A cross-sectional survey was performed. Subjects from Qidong of Jiangsu Province of China were screened among the locally enrolled residents by detecting hepatitis B surface antigen （HBsAg） from May 2007 to May 2011 and were assigned to HBsAg-negative cohort or HBsAg-positive cohort. Then, the subjects were diagnosed according to alanine aminotransferase, alpha-fetoprotein and B ultrasound. The syndrome of the subjects was determined using a TCM questionnaire consisting of signs and symptoms. RESULTS： A total of 5 908 subjects were enrolled in this survey, among whom, 4 718 were diagnosed with HbsAg infection （positive result of HbsAg detection） and 1 147 were negative. 143 subjects were excluded for not receiving the blood examination. The final diagnoses of the subjects were non-HBV infection （n： 1 128）, HBV carrier （n =4 019）, chronic hepatitis B （n ：225）, posthepatitic cirrhosis （n = 263） or liver cancer （n =111）. The TCM syndrome differentiation results showed that there were differences in syndrome distribution between HBV-infected and non-HBV-infected patients. The main syndromes of the HBV-infected patients were qi deficiency, qi stagnation, blood stasis and dampness heat, related to the Zang of liver and spleen. The distribution principles of TCM syndrome among patients of HBV carrier, chronic hepatitis B and cirrhosis were similar. Moreover, with the progression of the patients＇ condition, the scores of syndromes increased, and the number of accompanying syndromes increased as well. The main syndromes of patients with liver cancer were blood stasis and excess heat, which was slightly different from that of the other HBV- infected patients. CONCLUSION： The TCM syndrome distribution in patients of HBV infection in Qidong region of Jiangsu Province shows regularity. The disorder is mainly due to qi stagnation and blood stasis and is also related to deficiency of healthy qi, especially deficiency of spleen qi.