慢性乙型肝炎患者肝组织HBcAg表达模式与中医证型的关系

Correlation analysis on expression patterns of HBcAg in hepatocytes and TCM syndrome in chronic hepatitis B patients

目的:观察慢性乙型肝炎(CHB)患者肝组织乙型肝炎核心抗原(HBcAg)表达模式与中医证型及肝组织炎症、纤维化等指标的关系并进一步探讨相应的机制。方法:选择CHB患者556例,均进行中医辨证分型及肝组织活检,测定肝组织HBcAg表达模式、炎症、纤维化程度及ALT、AST、HBV DNA水平。结果:(1)556例患者按中医辨证标准分为6组:瘀血阻络证44例、肝肾阴虚证42例、肝郁气滞证48例、肝郁脾虚证282例、湿热蕴结证140例、脾肾阳虚证0例;按HBcAg表达模式分HBcAg阴性组42例、胞浆型HBcAg组186例、胞浆优势型HBcAg组290例、浆核各半型HBcAg组38例。(2)经Spearman秩相关分析,肝组织HBcAg表达模式与肝组织炎症活动度、纤维化程度均呈负相关;经Fisher确切概率检验,肝组织HBcAg表达模式与中医证型分布具有相关性。结论:肝组织HBcAg表达模式与中医证型、肝组织炎症、纤维化程度均有相关性;HBcAg阴性组、胞浆型HBcAg组及肝郁脾虚证、湿热蕴结证多处于慢性乙型肝炎活动期,正气未伤,免疫功能较强,为抗病毒治疗的较佳时机。

Objective:To observe the relationship among expression patterns of HBcAg in liver tissue of chronic hepatitis B patients with TCM syndrome,liver inflammation,fibrosis and so on to investigate the mechanism.Methods:A total of 556 cases of patients with chronic hepatitis B were chosen and classified into specific TCM syndrome according to guidelines for traditional Chinese medical diagnosis of chronic hepatitis B,liver biopsy were conducted as well,then determined expression patterns of HBcAg and inflammation,fibrosis in liver tissue.Meanwhile,serum alanine transaminase(ALT),serum aspartate aminotransferase(AST),serum HBV DNA were measured.Results:(1)556 patients were classified into syndrome of static blood blocking collaterals (44),syndrome of yin deficiency of liver and kidney (42),syndrome of liver depression and qi stagnation (48),syndrome of stagnation of liver qi and spleen deficiency (282),syndrome of accumulation and binding of damp-heat (140) and syndrome of yang deficiency of spleen and kidney (0)based on TCM Syndrome Differentiation Standard.556 patients were classified into HBcAg-negative group (42),cHBcAg group (186),cdHBcAg group (290)and mHBcAg group (38).(2)Spearman rank correlation analysis showed the degree of liver inflammation and fibrosis were negatively correlated with the expression pattern of HBcAg.The expression patterns of HBcAg in liver tissue was correlated with the distribution of TCM Syndromes according to Fisher definite probability methods.Conclusion:The expression pattern of HBcAg in liver tissue was correlated with TCM syndrome,liver inflammation and fibrosis degree.HBcAg-negative group,cHBcAg group,syndrome of stagnation of liver qi and spleen deficiency group and syndrome of accumulation and binding of damp-heat group were in Chronic hepatitis B active stage with higher vital qi and active immune function,which may be the good timing of antiviral treatment.