慢性乙型肝炎中医辨证分型与联苯双酯降酶效应的关系

Relationship between Different TCM Types of Syndrome in Patients with Chronic Hepatitis B and Reaction of Biphenyldicarboxylate Lowering Transaminase

探讨慢性乙型肝炎中医辨证分型与联笨双醋降酶效应的关系。方法:选择慢乙肝患者256例,按湿热中阻、肝郁脾虚、肝肾阴虚、瘀血阻络、脾肾阳虚等不同中医证型,分别观察联苯双酯治疗后血清转氨酶的降低效应及联苯双酯减量过程中或停药后ALT的反跳效应。结果:联苯双酯对不同中医证型的ALT均有明显的降低作用,相互比较无显著性差异(P>0.05),对AST、GGT的效应欠佳。联苯双酯减量过程中或停药后,湿热中阻、肝郁脾虚、瘀血阻络、脾肾阳虚4型ALT反跳率均较高,相互间无显著性差异(P>0.05);而肝肾阴虚型ALT反跳率最低,与其他各型比较有非常显著性差异(P<0.01)。结论:联苯双酯对不同中医证型的ALT均有明显的降低作用,联苯双酯减量过程中或停药后,湿热中阻、肝郁脾虚、瘀血阻络、脾肾阳虚4型ALT反跳率均较高,肝肾阴虚型ALT反跳率最低。临床上不宜将联苯双酯的降酶作用作为慢乙肝的常规治疗措施,可根据不同中医证型停用联苯双酯后ALT反跳率的高低,有针对性的选择使用。

To study the relationship between different TCM type of syndrome in patients with chronic hepatitis B and the reaction of the Biphenyldicarboxylate lowering the level of transaminase. Methods: 256 patients with chronic hepatitis B were selected and divided into different TCM type of syndrome-damp-heat hindering in the middle-jiao,stagnation of the liver-Qi and insufficiency of the spleen, deficiency of liver -Yin and kidney-Yin,blood stasis hindering in the channels,deficiency of spleen-Yang and kidney-Yang. In the above different TCM types of syndrome,the reaction of Biphenyldicarboxylate lowering the level of transaminase and the rebound rate of ALT due to the Biphenyldicarboxylate being reduced or stopped to use were respectively observed. Results: The Biphenyldicarboxylate could obviously lower the level of ALT in different TCM types of syndrome and had no marked difference contrasted with each other (P>0. 05). But, the reaction lowering the level of AST and GGT were not so satisfied. After this drug being reduced or stopped to use, these TCM types of syndrome-the damp-heat hindering in the middle-jiao, stagnation of the liver-Qi and insufficiency of the spleen, blood stasis hindering in the channels and deficiency of spleen-Yang and kidney-Yang, all had a higher rebound rate of ALT and had no marked difference contrasted with each other (P> 0. 05). However, the syndrome of deficiency of liver-Yin and kidney-Yin had a lower rebound rate of ALT and had a marked difference contrasted with the other TCM types of syndrome (P<0. 01). Conclusion; The Biphenyldicarboxylate can obviously lower the level of ALT in different TCM type of syndrome. After the Biphenyldicarboxylate having been reduced or stopped to use, these TCM types of syndrome-the damp-heat hindering in the middle-jiao, stagnation of the liver-Qi and insufficiency of the spleen, blood stasis hindering in the channels and deficiency of spleen -Yang and kidney-Yang, all had a higher rebound rate of ALT, but the syndrome of deficiency of liver-Yin and kidney-Yin had a lower rebound rate of ALT. Therefore, the function lowering the level of transaminase of Biphenyldicarboxylate can not be used as the common treatment in patients with chronic hepatitis B, which should be selectively used according to the rebound rate of ALT in different TCM type of syndrome after the Biphenyldicarboxylate having been reduced or stopped to use.