HBV相关原发性肝癌患者中医证型与T淋巴细胞和生化指标的相关性分析

Correlation analysis of TCM syndrome types with T lymphocytes and biochemical indices in patients with HBV-related primary liver cancer

目的:探讨乙型肝炎病毒(hepatitis B virus,HBV)相关原发性肝癌(primary liver cancer,PLC)患者的T淋巴细胞和生化指标与中医辨证分型的相关性。方法:回顾性收集2018年1月~2019年12月就诊于河南中医药大学第一附属医院的HBV相关PLC患者263例,分为肝郁脾虚证(127例,48.3%)、脾虚湿困证(48例,18.3%)、肝胆湿热证(31例,11.8%)、肝热血瘀证(35例,13.3%)、肝肾阴虚证(22例,8.4%)共五种证型,统计其一般资料、T细胞亚群、肿瘤学和病毒学指标、肿瘤学特征、生化指标等数据,运用Epidata和Excel对数据进行采集整理,采用SPSS26.0软件对数据进行统计分析。结果:5种证型性别、年龄分布差异无统计学意义(P均>0.05);5种证型T淋巴细胞计数、CD4(+)T淋巴细胞计数、CD8(+)T淋巴细胞计数,差异具有统计学意义(P<0.001),肝肾阴虚证患者的T淋巴细胞计数、CD4(+)T淋巴细胞计数、CD8(+)T淋巴细胞明计数明显低于其余4组证型;5种证型AFP、CEA、CA199从肝郁脾虚证至肝肾阴虚证依次升高,差异具有统计学意义(P<0.001);5种证型门静脉主干内径、门静脉癌栓、肝外转移差异具有统计学意义(P均<0.001),门脉癌栓和肝外转移以肝胆湿热证和肝热血瘀证为主。各证型PLT、Alb、TBil、AST、PT差异具有统计学意义(P<0.001);PLT、Alb从肝郁脾虚证至肝肾阴虚证依次降低,肝郁脾虚证PLT、Alb明显高于其余四组;肝胆湿热证TBil、AST明显高于其余4组;肝肾阴虚的PT明显高于其余4组;淋巴细胞计数、CD4(+)淋巴细胞计数、CD8(+)淋巴细胞计数分别与AFP、PT、TBil呈负相关(P均<0.05),与PLT呈正相关(P<0.05)。T淋巴细胞计数与Alb呈正相关(P<0.05)。结论:本研究发现肝郁脾虚证患者细胞免疫功能更好,肝脏功能更好,预后较好;肝肾阴虚证患者细胞免疫更低,肝脏功能更差,病情和预后较差。门脉癌栓和肝外转移以肝胆湿热证和肝热血瘀证为主。患者的淋巴细胞计数越低,凝血功能越差,肝脏储备功能越差,进一步癌变风险更高。

Objective:To investigate the correlation between T lymphocytes and biochemical indices in patients with pri-mary liver cancer(PLC)associated with hepatitis B virus(HBV)and TCM syndrome differentiation.Methods:A total of 263 HBV-related PLC patients who were admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medi-cine from January 2018 to December 2019 were retrospectively collected. There were 127 cases of liver depression and spleen defi-ciency syndrome( 48.3%),48 cases of spleen deficiency and dampness syndrome(18.3%),31 cases of liver and gallbladder dampness and heat syndrome(11.8%),35 cases of liver and blood stasis syndrome(13.3%),and 22 cases of liver and kidney Yin deficiency syndrome(8.4%). The general data,T cell subsets,oncology and virology indicators,oncology characteristics, biochemical indicators and other data were counted. Epidata and Excel were used to collect and summarize the data,and SPSS26.0 software was used for statistical analysis. Results:There was no significant difference in gender and age distribution among the five syndrome types(all P>0.05). The differences among T lymphocyte count(P<0.001),CD4(+)T cell count(P<0.001) and CD8(+)T lymphocyte count(P<0.001)were statistically significant. The T lymphocyte count,CD4(+)T lymphocyte count and CD8(+)T lymphocyte explicit count in patients with liver and kidney Yin deficiency syndrome were significantly low - er than those in the other four syndrome types. AFP(P<0.001),CEA(P<0.001),CA199(P<0.001)of the five syndrome types increased successively from the syndrome of liver depression and spleen deficiency to the syndrome of liver and kidney Yin deficiency,and the difference was statistically significant. There were statistically significant differences in the inner diameter of main portal vein,portal vein cancer thrombin and extrahepatic metastasis among the five syndrome types(all P<0.001). The main symptoms of portal vein cancer thrombin and extrahepatic metastasis were liver-gallbladder dampness-heat syndrome and liv-er- blood stasis syndrome. The differences among PLT(P<0.001),Alb(P<0.001),TBil(P<0.001),AST(P<0.001),PT (P<0.001)were statistically significant. PLT and Alb decreased successively from the syndrome of liver depression and spleen de-ficiency to the syndrome of liver and kidney Yin deficiency. PLT and Alb of the syndrome of liver depression and spleen deficiency were significantly higher than those of the other four groups,and TBil and AST of the syndrome of liver and gallbladder dampness and heat were significantly higher than those of the other four groups. PT of liver and kidney Yin deficiency was significantly higher than that of the other four groups. The lymphocyte count,CD4(+)lymphocyte count and CD8(+)lymphocyte count were neg-atively correlated with AFP, PT and TBil(all P<0.05),and positively correlated with PLT(P<0.05). T lymphocyte count was positively correlated with Alb(P<0.05). Conclusion:This study found that patients with liver depression and spleen deficien-cy syndrome have better cellular immune function, liver function and prognosis. Patients with liver and kidney Yin deficiency have lower cellular immunity,worse liver function,and worse prognosis. Portal vein carcinoma embolus and extrahepatic metastasis were mainly characterized by dampness and heat of liver and gallbladder and blood stasis of liver. Patients with lower lymphocyte counts have poorer blood clotting;the worse the liver reserve function,the higher the risk of further cancer.