PBC患者中医证型、EB病毒壳抗原IgA抗体表达情况与临床特征及病理分期的研究

A study on traditional Chinese medicine syndromes,expression of epstein-barr virus capsid antigen IgA antibodies,clinical characteristics,and pathological staging in patients with primary biliary cholangitis

目的:分析原发性胆汁性胆管炎(PBC)患者中医证型及EB病毒壳抗原IgA抗体(EB VCA-IgA)阳性表达情况,了解不同证型与EB病毒(EBV)感染对PBC患者病情影响及其与病理分期的关系。方法:分析2019年12月至2022年6月于江苏省中医院感染科住院的87例PBC确诊患者的临床资料,采集患者的症状体征等四诊资料进行辨证分型。同时行肝穿刺活组织检查、完善实验室检查包括血清EB VCA-IgA等检测。根据血清EB VCA-IgA是否阳性表达,将患者分为EB VCA IgA(+)组和EB VCA IgA(-)组,比较两组患者临床及病理资料差异。同时分析患者中医证型与血清EB VCA-IgA阳性表达、肝脏病理分期的关系。结果:气阴两虚证组中肝脏病理为进展期的EB VCA IgA(+)患者比例较肝郁脾虚证组显著升高(P<0.05)。与EB VCA IgA(-)组患者比较,EB VCA-IgA(+)组患者血清IgG、IgA水平升高,差异有统计学意义(P<0.05)。肝脏病理为进展期、炎症活动等级较高(G3)EBV VCA-IgA(+)患者比率高,差异有统计学意义(P<0.05)。多因素Logistic回归分析提示,中医证型为气阴两虚、肝脏病理分期为进展期、高IgG、高IgA水平是影响PBC患者EB VCA-IgA阳性表达的独立危险因素。结论:气阴两虚证PBC患者存在更严重的肝脏炎症及纤维化,更易合并EBV感染;气阴两虚证、肝脏病理进展期、高IgG、高IgA水平是PBC患者EB VCA-IgA阳性表达的独立危险因素。

Objective:Analyze the Traditional Chinese Medicine(TCM)syndrome types and the expression of Epstein-Barr Virus(EBV)viral capsid antigen IgA antibodies(EB VCA-IgA)in patients with Primary Biliary Cholangitis(PBC)to understand the impact of different syndrome types and EBV infection on the condition of PBC patients and their relationship with pathological staging.Methods:A total of 87 patients diagnosed with PBC and admitted to the Infectious Disease Department of Jiangsu Provincial Hospital between December 2019 and June 2022 were analyzed.The symptoms and signs of the patients were collected for syndrome differentiation and classification.Concurrently,liver biopsy for histological examination and comprehensive laboratory tests,including detection of serum Epstein-Barr Virus(EBV)related antibodies,were performed.Patients were categorized into EB VCA IgA(+)group and EB VCA IgA(-)group based on the positive expression of serum EB VCA-IgA.Differences in clinical and pathological data between the two groups were compared.Additionally,the relationship between the TCM syndrome types of the patients and the positive expression of serum EB VCA-IgA,as well as the liver pathological staging,was analyzed.Results:In the Qi Yin deficiency syndrome group,the proportion of patients with advanced liver pathology and positive expression of EB VCA IgA was significantly higher than that in the Liver Depression Spleen Deficiency syndrome group(P<0.05).Basic clinical data between EB VCA IgA(+)and EB VCA IgA(-)groups showed statistically significant differences in serum IgG and IgA levels,with elevated levels in the EB VCA-IgA(+)group(P<0.05).The proportion of patients with advanced liver pathology and higher inflammation activity grade(G3 group)was higher in the EB VCA-IgA(+)group,with statistically significant differences(P<0.05).Multifactor logistic regression analysis suggested that the TCM syndrome type of Qi Yin deficiency,advanced liver pathology stage,and high levels of IgG and IgA were independent risk factors affecting the positive expression of EB VCA-IgA in PBC patients.Conclusion:Patients with qi and yin deficiency syndrome have more severe liver inflammation and fibrosis,and are more likely to be co-infected with Epstein-Barr virus.Qi and yin deficiency syndrome,progressive liver pathology,high IgG and high IgA levels are independent risk factors for positive EB VCA-IgA expression in PBC patients.