原发性胆汁性胆管炎不同证型与肝组织病理相关性研究

Correlation study between different traditional Chinese medicine syndromes and liver pathology in primary biliary cholangitis

目的探讨原发性胆汁性胆管炎(PBC)不同证型与肝组织病理的相关性。方法将88例PBC患者进行辨证分型、实验室检查、肝组织活检,统计合并疾病情况,常规判定PBC患者炎症评分和肝纤维化分期。结果PBC患者的中医证型分布由高到低依次为肝肾阴虚证、肝郁脾虚证、湿热蕴结证、瘀血阻络证。统计结果显示,肝郁脾虚证、湿热蕴结证熊去氧胆酸(UDCA)应答率高于瘀血阻络证(P<0.05),肝肾阴虚证、瘀血阻络证肝硬化发生率高于肝郁脾虚证(P<0.05);瘀血阻络证血清碱性磷酸酶(ALP)、总胆红素(TBiL)、直接胆红素(DBiL)、总胆汁酸(TBA)水平高于肝郁脾虚证(P<0.05),肝肾阴虚证TBA水平高于肝郁脾虚证(P<0.05),湿热蕴结证血清总胆固醇(TC)水平高于肝郁脾虚证(P<0.05)。4种证型在合并高脂血症、干燥综合征(SS)上比较差异有统计学意义(P<0.05),其中湿热蕴结证PBC患者高脂血症发生率高于肝郁脾虚证(P<0.05),肝肾阴虚证PBC患者SS发生率高于湿热蕴结证(P<0.05)。4种证型在肝组织炎症分级及纤维化分级分布上有显著差异(P<0.01)。其中,肝肾阴虚证、瘀血阻络证的纤维化分级显著高于肝郁脾虚证(P<0.01)。结论PBC肝肾阴虚证、瘀血阻络证可能与肝纤维化的程度相关。

Objective To explore the correlation between different traditional Chinese medicine(TCM)syndromes and liver pathology in patients with primary biliary cholangitis(PBC).Methods Totally 88 patients with PBC were included based on different TCM syndrome,laboratory examination and liver biopsies.Its comorbidities were counted.The inflammation score and liver fibrosis stage in PBC patients were routinely determined.Results The TCM syndrome distribution in PBC patients from high to low was as follows:liver-kidney yin deficiency syndrome,liver spleen deficiency,damp-heat accumulation syndrome,blood stasis syndrome.The response to ursodeoxycholic acid(UDCA)in PBC patients with liver spleen deficiency and damp-heat accumulation syndrome was significantly higher than that in PBC patients with blood stasis syndrome(P<0.05).The incidence of hepatocirrhosis in PBC patients with liver-kidney yin deficiency syndrome and blood stasis syndrome was significantly higher than that in PBC patients with liver spleen deficiency(P<0.05).The levels of alkaline phosphatase(ALP),total bilirubin(TBiL),direct bilirubin(DBil),total bile acids(TBA)in PBC patients with blood stasis syndrome were significantly higher than those in PBC patients with liver spleen deficiency(P<0.05).The level of TBA in PBC patients with liver-kidney Yin deficiency syndrome was significantly higher than that in PBC patients with liver spleen deficiency(P<0.05).The level of total cholesterol(TC)in PBC patients with damp-heat accumulation syndrome was significantly higher than that in PBC patients with liver spleen deficiency(P<0.05).There was a statistically significant difference in the incidence of hyperlipidemia and Sjogren syndrome(SS)among the PBC patients with four different TCM syndrome types(P<0.05).The incidence of hyperlipidemia in PBC patients with damp-heat accumulation syndrome was significantly higher than that in PBC patients with liver spleen deficiency(P<0.05).The incidence of SS in PBC patients with liver-kidney yin deficiency syndrome was significantly higher than that in PBC patients with damp-heat accumulation syndrome(P<0.05).There were statistically significant differences in the liver inflammation and fibrosis grading among PBC patients with four different TCM syndrome types(P<0.01).The fibrosis grading in PBC patients with liver-kidney yin deficiency syndrome and blood stasis syndrome was significantly higher than that in PBC patients with liver spleen deficiency(P<0.01).Conclusion The syndromes of liver-kidney yin deficiency and blood stasis may be related to the degree of liver fibrosis.