基于生化及免疫特征探讨原发性胆汁性胆管炎患者中医辨证规律

The law of TCM syndrome differentiation in patients with primary biliary cholangitis based on biochemical and immune characteristics

目的:基于生化及免疫特征探讨原发性胆汁性胆管炎(PBC)患者中医辨证规律。方法:选取杭州市西溪医院2021年临床资料完整的118例PBC患者为研究对象,对患者中医辨证分型,检测生化指标(ALP、GGT、TBil)及免疫指标(IgM、CD4^(+)T细胞绝对值、CD8^(+)T细胞绝对值、AMA、AMA-M2、抗sp100抗体、抗gp210抗体、ACA),通过多因素回归分析研究影响中医证型的相关生化及免疫因素。结果:肝郁脾虚证患者GGT水平显著低于瘀血阻络证患者;湿热中阻证患者IgM水平较其他三组显著升高;瘀血阻络证患者TB水平、gp210及ACA阳性率较其他三组均显著升高;湿热中阻证患者CD8^(+)T细胞数显著高于肝郁脾虚证患者;上述差异均有统计学意义(P<0.05)。多因素Logistics回归分析提示,低GGT、TBil、IgM、CD8^(+)T细胞水平及ACA阴性是肝郁脾虚证PBC患者的特征;TBil升高、ACA阳性是瘀血阻络证PBC患者的特征。结论:肝郁脾虚证是早期PBC的代表证型,以低GGT、TBil、IgM、CD8^(+)T细胞水平及ACA阴性为特征;瘀血阻络证是中晚期PBC的代表证型,以胆红素进行性升高、ACA阳性为特征。本研究对在熊去氧胆酸治疗基础上精准辨证具有积极的临床意义。

Objective:To explore the law of TCM syndrome differentiation in patients with primary biliary cholangitis(PBC)based on biochemical and immune characteristics.Methods:A total of 118 PBC patients treated in Hangzhou Xixi Hospital in 2021 with complete clinical data were studied.Based on TCM syndrome differentiation,certain biochemical indexes(ALP,GGT,TB)and immune indexes(IgM,absolute value of CD4^(+)T cells,absolute value of CD8^(+)T cells,AMA,AMA-M2,anti-SP100 antibody,anti-GP210 antibody,ACA)were detected.We tried to study the related biochemical and immune factors affecting TCM syndrome differentiation through multi-factor regression analysis.Results:The GGT level of patients with liver stagnation and spleen deficiency was lower than that of patients with blood stasis and collaterals obstruction.The level of IgM in patients with dampness and heat obstruction was significantly higher than that in the other three groups.The level of TBil,the positive rate of GP210 and ACA in the patients with blood stasis syndrome were significantly higher than those in the other three groups.The number of CD8^(+)T cells of dampness-heat obstruction syndrome was significantly higher than that of liver depression and spleen deficiency syndrome.All the above differences were with statistical significance(P<0.05).Multivariate logistic regression analysis indicated that low GGT,TBil,IgM and CD8^(+)T cell levels and ACA negative were the characteristics of PBC patients with liver depression and spleen deficiency syndrome.Elevated TB and positive ACA were the characteristics of PBC patients with blood stasis and collateral obstruction.Conclusion:Liver depression and spleen deficiency syndrome is the representative type of early PBC,characterized by low GGT,TBil,IgM and CD8^(+)T cell levels and ACA negative.Blood stasis and collateral-obstruction syndrome is the representative syndrome type of middle and late PBC,which is characterized by progressive elevation of bilirubin and positive ACA.On the basis of ursodeoxycholic acid treatment,it is of positive clinical significance to distinguish TCM syndrome types accurately.