300例丙氨酸氨基转移酶小于参考值上限2倍慢性乙型病毒性肝炎患者中医证型与肝组织病理关系研究

Study on Relationship Between Chinese Medicine Syndrome and Liver Pathology in 300 Patients with Chronic Viral Hepatitis B(ALT<2×ULN)

目的:引用肝脏病理学指标阐明中医证候实质,探索丙氨酸氨基转移酶(ALT)小于参考值上限2倍(ALT<2×ULN)的慢性乙型病毒性肝炎患者中医微观辨证要素。方法:对300例ALT<2×ULN的慢性乙型病毒性肝炎患者进行中医辨证分型及肝组织病理分级、分期,探讨中医证型与肝脏病理之间的关系。结果:全部患者肝组织结果显示,肝脏炎症分级≥G2者占46.00%,纤维化分期≥S2者占38.67%;肝组织病理≤G2或≤S2的患者以无证可辨型、肝郁脾虚型为主。不同中医证型患者的肝脏炎症分级(G)和(或)纤维化分期(S)比较,差异均有统计学意义(P<0.01)。瘀血阻络型较非瘀血阻络型在肝组织炎症程度及纤维化程度病变重,差异有统计学意义(P<0.01),瘀血阻络证肝组织炎症程度以G3、G4为主,肝组织纤维化程度以S4为主。结论:患者的中医证型与其肝组织病理具有一定的相关性。

Objective:To explore the microscopic factors that differentiate Chinese medicine syndrome in patients with chronic viral hepatitis B whose alanine aminotransferase(ALT)were less than twice the upper limit of reference value(ALT<2×ULN)by elucidating the essence of Chinese medicine syndromes through referring to liver pathological indexes.Methods:A total of 300 patients with chronic hepatitis B(ALT<2×ULN)were differentiated into Chinese medicine syndrome and were classified and staged their liver tissue pathology;the relationship between Chinese medicine syndrome and liver pathology was discussed.Results:According to the liver tissue of all patients,the grade of liver inflammation≥G2 accounted for 46.00%,and the liver fibrosis stage≥S2 accounted for 38.67%;patients whose hepatic tissue pathology≤G2 or≤S2 were mainly with no differentiated syndrome or syndrome of liver depression and spleen deficiency.The grading of liver inflammation(G)and/or grading of fibrosis stage(S)in patients with different Chinese medicine syndromes were statistically significant in differences(P<0.01).The degree of liver inflammation and fibrosis was more serious in the patients of static blood obstructing collaterals type than in the patients of non-static blood obstructing collaterals type,the difference being significant(P<0.01).The degree of liver tissue inflammation in the patients of static blood obstructing collaterals type was mainly G3 and G4,while the degree of liver tissue fibrosis was mainly S4.Conclusion:There is a certain correlation between Chinese medicine syndrome type and liver pathology.