不同免疫状态慢性乙型肝炎患者中医体质类型分布

Distribution of Chinese Medicine Constitution Types in Patients with Chronic Hepatitis B in Different Immune States

目的探讨慢性乙型肝炎患者不同免疫状态、丙氨酸氨基转移酶(ALT)水平、乙肝病毒的脱氧核糖核酸(HBV DNA)载量、乙型肝炎e抗原(HBe Ag)状态下中医体质类型的分布特点。方法将129例慢性乙型肝炎患者根据免疫状态分为免疫耐受期55例、免疫清除期53例、低水平复制期21例,运用问卷调查方法对患者进行中医体质类型判定,同时记录患者相关实验室指标,统计并比较不同免疫状态、ALT水平、HBV DNA载量、HBe Ag状态下中医体质类型分布情况。结果 129例患者各体质类型共出现401次,其中免疫耐受组体质频次141、免疫清除期组194、低水平复制期组66。全部患者体质类型出现频数百分比由高到低依次为气虚质(18.7%)、阳虚质(15.2%)、湿热质(12.5%)、痰湿质(12.2%)、平和质(11.5%)、阴虚质(10.2%)、气郁质(8.7%)、血瘀质(7.7%)、特禀质(3.2%)。不同免疫状态组间比较9种体质类型分布差异具有统计学意义,其中平和质在免疫耐受期分布最多(21.3%),气虚质在免疫清除期(22.2%)和低水平复制期(21.2%)分布最多(P<0.05)。不同ALT水平患者中医体质分布比较差异具有统计学意义(P<0.05)。不同HBV DNA载量以及HBe Ag状态之间中医体质类型分布比较差异无统计学意义(P>0.05)。结论慢性乙型肝炎患者的免疫状态对其中医体质类型分布有一定影响,其在免疫耐受期多见平和质,在免疫清除期和低水平复制期多见气虚质。

Objective To explore the distribution feature of Chinese medicine constitution type in patients with chronic hepatitis B in different immune states,alanine aminotransferase（ ALT） levels,hepatitis B virus Deoxyribonucleic acid（ HBV DNA） viral load and hepatitis B e antigen（ HBe Ag） states. Methods One hundred and twentynine 129 patients with chronic hepatitis B were divided into an immunotolerant phase group（ 55 cases）,an immune clearance phase group（ 53 cases） and a low replication phase group（ 21 cases） according to immune state. Chinese medicine constitution types were judged by questionnaire survey. Relative laboratory indexes of patients were recorded. Distribution feature of Chinese medicine constitution types in different immune states,ALT level,HBV DNA viral load and HBe Ag states were analyzed and compared. Results All the constitution types in 129 patients appeared for 401 times in total,including the immunotolerant phase 141 times,the immune clearance phase 194 times,and the low replication phase 66 times. Based on their incidence,constitution types were ranked in order as Qi deficiency（ 18. 7%）,Yang deficiency（ 15. 2%）,dampness and heat（ 12. 5%）,phlegm and dampness（ 12. 2%）,moderate constitution（ 11. 5%）,Yin deficiency（ 10. 2%）,Qi stagnation（ 8. 7%）,blood stasis（ 7. 7%） and intrinsic constitution（ 3. 2%）. There were significant differences in distribution of 9 constitution types between different immune states groups. There were most moderate constitution types distributed in immunotolerant phase（ 21. 3%）,and most Qi deficiency types distributed in immune clearance phase（ 22. 2%） and low replication phase（ 21. 2%）（ P 〈0. 05）. There were significant differences in Chinese medicine constitution distribution between the patients with different ALT levels（ P〈 0. 05）. But there were no significant differences in Chinese medicine constitution distribution between patients with different HBV DNA viral load and HBe Ag states（ P 〉0. 05）. Conclusion Immune states of patients with chronic hepatitis B show definite effect on their Chinese medicine constitution. In immunotolerant phase,moderate constitution is more often seen,while Qi deficiency constitution is more common in immune clearance phase and low replication phase.