慢性乙型肝炎患者不同中医体质与肝组织病理表达的相关性研究

Correlation between TCM constitution and hepatic histopathology of patients with chronic hepatitis B

目的探讨慢性乙型肝炎患者不同中医体质与肝组织病理的相关性,依据分型指导治疗。方法选取2012年10月-2013年10月医院肝病中心收治的慢性乙型肝炎患者140例,判断中医体质类型,依据肝组织炎症及纤维化程度进行分组,比较各组间体质类型分布的差异,探讨其相关性,采用SPSS13.0对数据进行统计分析。结果慢性乙型肝炎纤维化主要分布在S1-S2期,炎症主要分布在G1-G3期;平和质及气虚质炎症分级主要是G1-G2,阴虚质及湿热质主要是G2-G3;平和质、气虚质、湿热质纤维化分期主要是S1-S2,阴虚质主要是S3-S4,瘀血质主要是G3-G4,纤维化分期主要是S3-S4。结论气虚质患者多处于疾病后期,肝脏开始出现纤维化,免疫状态低下;湿热质处于疾病交争状态,病毒大量复制,肝脏处于炎症中期,机体免疫状态亢进;从平和质、气虚质、湿热质、阴虚质,瘀血质,肝组织损害有逐渐加重趋势,阴虚质及瘀血质最有可能出现肝硬化,慢性乙型肝炎平和质、气虚质、湿热质、阴虚质、瘀血质的中医体质类型与肝组织病理学改变具有一定的相关性。

OBJECTIVE To explore the correlation between the TCM constitution of the patients with chronic hepatitis B and the hepatic histopathology so as to provide guidance for the treatment based on the typing. METHODS A total of 140 patients with chronic hepatitis B who were treated in the liver diseases center from Oct 2012 to Oct 2013 were enrolled in the study, the types of the TCM constitution were judged, the enrolled patients were grouped based on the liver inflammation and the degree of fibrosis. The distribution of the TCM constitution types was observed and compared among the groups, the correlation was explored, and the statistical analysis of data was performed with the use of SPSS13.0 software. RESULTS The chronic hepatitis B fibrosis mainly distributed in the S1-S2, the inflammation in the G1-G2 phase. The gentleness and Qi deficiency inflammations were mainly in G1-G2,the yin deficiency and heat medium inflammations in G2-G3. The gentleness, Qi deficiency, damp interstitial fibrosis was mainly in S1-S2, the yin deficiency in S3-S4, the blood stasis in G3-G4, the fibrosis in S3-S4. CONCLUSION The Qi deficiency patients are in advanced stages of diseases, the liver fibrosis begins to occur, and the immune status is low. The damp and heat constitution is in belligerency state, with the viral replication mas- sive, the liver inflammation in the mild stage, the immune status hyperactive. By judging from the increasing se- verity of the gentleness, Qi deficiency, heat and damp, yin deficiency, blood stasis, and liver damage, the yin de- ficiency and blood stasis are most likely to develop cirrhosis. The change of hepatic histopathology shows certain correlation with the types of TCM constitutions of the patients with chronic hepatitis B such as gentleness, Qi deficiency, damp and heat, yin deficiency, and blood stasis.