慢性乙型肝炎中医辨证分型与肝组织内HBsAg、HBcAg表达的相关性研究

A study on correlation between the TCM differentiation and the expression of HBsAg and HBcAg of the liver tissue in patients with chronic hepatitis B

目的:观察不同中医证型慢性乙型肝炎患者肝组织内HBs Ag、HBc Ag表达的情况,为慢性乙型肝炎中医辨证论治提供客观依据。方法:对555例慢性乙型肝炎患者进行中医辨证分型,并对其肝组织进行常规HE染色及免疫组织化学染色,分析不同证型慢性乙型肝炎患者肝组织内HBs Ag、HBc Ag表达情况。结果:慢性乙型肝炎不同中医证型肝组织HBs Ag阳性表达差异无显著统计学意义(P=0.811),肝组织HBc Ag阳性表达在6个证型间分布的差异均有显著性统计学意义(P<0.01),以隐证型为对照,肝郁脾虚证、肝肾阴虚证、肝郁气滞证、湿热蕴结证、瘀血阻络证肝组织内HBc Ag(+++)表达患者明显增多,而其中肝郁气滞证、湿热蕴结证HBc Ag(+++)表达患者高于其余各证型。结论:有部分慢性乙型肝炎中医隐证患者炎症分级、纤维化分期高,应及早发现治疗;不同中医证型肝组织内HBs Ag表达差异无统计学意义(P>0.05),而肝组织内HBc Ag的表达存在显著性差异(P<0.01)。

Objective:To explore the correlation between the different syndrome in TCM and the expression of HBsAg and HBcAg of the liver issue in patients with CHB for the differential treatment.Methods:The expression of HBsAg and HBcAg in liver tissues of patients with CHB was analyzed by TCM differentiation,HE staining and immunohistochemistry in 555 cases.Results:There was no significant difference(P=0.811)in the positive expression of HBsAg in liver tissue among different TCM syndromes of CHB,but the positive expression of HBcAg in liver tissue of 6 kinds of TCM syndromes showed statistical differences(P<0.001).Compared with the Yin syndrome(隐证),the positive expression(+++)of HBcAg in liver tissue among the Ganyu Pixu syndrome(肝郁脾虚证),Ganshen Yinxu syndrome(肝肾阴虚证),Ganyu Qizhi syndrome(肝郁气滞证),Shire Yunjie syndrome(湿热蕴结证)and Yuxue Zhuluo syndrome(瘀血阻络证)were significantly increased,especially in the Ganyu Qizhi syndrome and Shire Yujie syndrome.Conclusion:Partial patients with CHB of Yin syndrome shows high degree of inflammation and high stage of fibrosis,and need early diagnosis and early treatment.The positive expression of HBsAg in liver tissue among different TCM syndromes of CHB shows no statistical differences,but the positive expression of HBcAg shows an opposite result.