轻型慢性乙型肝炎湿热蕴结证与肝郁脾虚证肝组织纤维化分级及肝脏硬度值的比较

The Comparison of Liver Tissue Fibrosis Degree and Liver Stiffness Measurement in Mild CHB Patients with Damp-Heat Accumulation Syndrome and Liver Stagnation and Spleen Deficiency Syndrome

目的比较轻型慢性乙型肝炎(chronic hepatitis B,CHB)湿热蕴结证与肝郁脾虚证患者肝组织纤维化分级、肝脏硬度值的差异。方法回顾性分析161例轻型CHB患者的临床资料,依据中医辨证分型,分为湿热蕴结证组和肝郁脾虚证组,采用倾向得分匹配法(propensity score matching,PSM)按1∶1匹配后,比较两组间肝组织纤维化分级、肝脏硬度值的差异。结果 (1)倾向得分匹配后,共纳入116例轻度CHB,分为湿热蕴结证和肝郁脾虚证组,各58例,两组间临床基本特征差异无统计学意义(P>0.05);(2)89.7%(104/116)轻型CHB患者肝组织纤维化分级为S0-2,湿热蕴结证肝组织纤维化程度明显重于肝郁脾虚证(P<0.05);(3)湿热蕴结证组肝硬度值(LSM)明显高于肝郁脾虚证(P<0.05)。结论轻型CHB患者病程早期,湿热蕴结证较肝郁脾虚证其纤维化程度重,启动抗病毒治疗时,及时运用中医辨治抗肝纤维化,力求及早延缓、阻断纤维化进展。

Objective To compare the difference of liver tissue fibrosis degree and liver stiffness measurement value in mild chronic hepatitis B（CHB） patients with damp-heat accumulation syndrome and liver stagnation and spleen deficiency syndrome. Methods The cilnical data of 161 mild CHB patients were retrospective analysised. Based on TCM syndrome types differentiation, the invalids were divided into damp-heat accumulation syndromes（DAS） group and liver stagnation and spleen deficiency syndrome（LSS） group. The differences of liver tissue fibrosis stage and liver stiffness measurement value were analyzed by applying propensity score matching（PSM） method（1∶1）. Results（1） After PSM, 116 mild CHB patients were divided into DAS group and LSS group, 58 cases in each group. The clinical demographic characteristics were not statistically significant（P〈0.05）.（2） The liver tissue fibrosis stage of 89.66%（104/116） mild CHB patients was S0-2, liver tissue fibrosis of DAS was significantly higher than that of LSS（P〈0.05）.（3） The liver stiffness measurement value of DAS group was significantly higher than that of LSS group（P〈0.05）. Conclusion In the eraly course of mild CHB, the liver fibrosis degree of DAS was seriouser than LSS. Startting antiretroviral treatment in mild CHB patients, the operation of TCM syndrome differentiation should be timely applied to block the progression of liver fibrosis as early as possible.