92例ALT持续正常的慢性乙型肝炎患者肝组织病理及HBV-DNA水平与中医证型相关性分析

The Correlation Analysis of Liver Tissue Pathologies and HBV-DNA Levels with TCM Syndrome for 92 Cases of Chronic Hepatitis B Patients with Persistent Normal ALT Level

目的探讨乙型肝炎病毒(HBV)HBe Ag阳性和HBe Ag阴性2种病原学状态下ALT持续正常的慢性乙型肝炎患者肝组织病理特点、HBV-DNA水平及中医证型的分布规律,观察分析其相互间的联系,为中医辨证治疗提供客观基础支持。方法筛选2012年4月—2014年6月在我科就诊的34例HBe Ag阳性和58例HBe Ag阴性ALT持续正常的慢性乙型肝炎患者,比较HBe Ag阳性和HBe Ag阴性的慢性乙型肝炎患者肝组织病理特点、不同血清HBV-DNA水平及中医证型的分布特点。结果 HBe Ag阳性平均年龄小于HBe Ag阴性平均年龄,HBe Ag阴性组HBV-DNA水平明显低于阳性组,92例患者中医证型以肝郁脾虚证、湿热中阻证为主,分别占45.7%、33.7%,炎症活动度以G2为主,肝郁脾虚证占33.7%、湿热中阻证占30.4%,纤维化分级以S2为主,肝郁脾虚证占37.0%、湿热中阻证27.2%;瘀血阻络证患者的肝组织炎症程度和纤维化程度较其余证型严重。湿热中阻证的HBV-DNA水平较其余证型高。结论中医证型与其肝组织病理及HBV-DNA间具有一定的相关性。

Objective To discuss the liver tissue pathology characteristics,HBV DNA levels and TCM syndrome distribution of chronic hepatitis B patients with persistent normal ALT level under the etiologies of Hepatitis b virus（HBV）HBe Ag positive and HBe Ag negative. Observe and analyze the connection with each other in support of traditional Chinese medicine dialectical treatment.Methods Screening 34 cases of HBe Ag positive and 58 cases of HBe Ag negative chronic hepatitis B patients with persistent normal ALT level who were hospitalized in our hospital from April 2012 to June 2014, and compared their liver tissue pathology characteristics,HBV DNA levels and TCM syndrome distribution. Results The average age of HBe Ag positive patients was less while the HBV DNA levels was higher than HBe Ag negative patients＇. Among 92 cases of chronic hepatitis B patients,the principal TCM syndrome were the syndrome of liver-depression and spleen-deficiency and the syndrome of humid heat to hinder type,accounted for45.7% and 33.7%,respectively;the primary inflammatory activity was G2,and the syndrome of liver-depression and spleen-deficiency and the syndrome of humid heat to hinder type accounted for 33.7% and 30.4%,respectively;the main fibrosis grading was S2,and the syndrome of liver-depression and spleen-deficiency and the syndrome of humid heat to hinder type accounted for37.0% and 27.2%,respectively;the degrees of liver inflammation and fibrosis for the patients of blood stasis syndrome were serious than any other syndromes. The HBV DNA level of humid heat to hinder type syndrome was higher than the others. Conclusion The liver tissue pathologies and HBV-DNA levels of chronic hepatitis B patients have certain correlation with TCM syndrome.