不同中医证型慢性乙型肝炎轻度患者肝组织病理研究

Study of liver histopathology in different Chinese medicine syndrome patients with chronic hepatitis B

目的:研究不同中医证型的慢性乙型肝炎(CHB)轻度患者肝组织病理特点,并探讨其临床意义。方法:将310例CHB轻度患者进行中医辨证分型,采用Menshini法1秒钟经皮肝穿取肝组织进行炎症和纤维化程度判断,并与车祸死亡正常人作对照,同时荧光定量PCR法检测患者血清HBV DNA水平。结果:①肝组织炎症≥G2、肝纤维化≥S2等级的患者年龄明显高于肝组织炎症<G2、肝纤维化<S2等级的年龄;②各中医证型患者肝组织炎症级别≥G2的比率明显高于正常组,但证型间比较差异均无显著性意义;③各中医证型患者肝组织纤维化程度≥S2的比率明显高于正常组,但证型间比较仅肝肾阴虚和脾肾阳虚两型明显高于肝郁脾虚和湿热中阻型;④各中医证型间HBV DNA水平比较,肝肾阴虚和脾肾阳虚两证型明显低于肝郁脾虚型,其他证型之间差异无显著性意义。结论:CHB轻度患者至少有1/3的患者需要抗病毒治疗,而且年龄越大越有必要;在控制肝脏炎症方面,辨证治疗应多加倡导,在抗纤维化治疗方面应重视补肾法研究。

Objective： To study pathological features of chronic hepatitis B patients with mild disease and different tradi- tional chinese medicine （TCM） syndrome types, and to explore its clinical significance. Methods： The TCM syndrome types of three hundred and ten chronic hepatitis B patients with mild disease were identified syndrome differentiation. A second percutane- ous transhepatic hepatic tissue inflammation and fibrosis degree was judged by Menshini method, and compared with the car acci- dent death of normal people, at the same time fluorescent quantitative PCR method was used to detect the level of serum HBV DNA in patients with CHB. Results： ①Patient age of inflammation ≥ G2 and fibrosis ≥ S2 was significantly higher than that of inflammation 〈 G2 and fibrosis 〈 S2 grade ; ②The ratio of liver tissue inflammation level ≥ G2 in patients with different TCM syndrome types were significantly higher than normal group, but among different syndrome types were not statistical significance; ③The ratio of liver tissue fibrosis degree ≥S2 in patients with different TCM syndrome types were significantly higher than nor- mal group, the syndrome type of Yin deficiency of liver and kidney, and the spleen kidney Yang deficiency type was significantly higher than that of liver stagnation and spleen deficiency and damp heat resistance type; ④Comparison of HBV DNA levels be- tween the TCM syndrome type, liver and kidney Yin deficiency, and Yang deficiency of spleen and kidney type were significantly lower than that of liver stagnation and spleen deficiency type, difference between other syndrome type was not statistical signifi- cance. Conclusion： Mild chronic hepatitis B patients of at least 1/3 need antiviral therapy, and the older the more necessary. In the control of inflammation of the liver, syndrome differentiation and treatment should be initiated, in anti fibrosis treatment should pay attention to the study of tonifying kidney.