慢性乙型肝炎中医辨证分型的论证——血清和肝组织HBV抗原、HBVDNA以及病理变化与证型关系的研究

Study on the Relationship Between TCM Differentiation of Syndromes and HBV Antigen,HBV DNA in Serum and Liver Tissues and Pathological Changes in Chronic Hepatitis B

应用分子生物学和免疫组化等技术,对131例慢性乙型肝炎中医辨证分型进行了论证,发现肝郁脾虚型临床符合慢性迁延性肝炎(CPH)者占94.6%,肝组织病理呈CPH改变者为69.2%;血清HBeAg和(或)HBVDNA阳性占61.5%,肝组织HBsAg阳性率为69.2%,其中呈弥漫型者占44.4%,HBVDNA阳性率为33.3%。肝肾阴虚型临床符合慢性活动性肝炎(CAH)者占75.5%,肝脏病理呈CAH改变者占88.5%;血清HBeAg和(或)HBVDNA和肝组织HBsAg阳性率均为80.8%,后者弥漫型占阳性病例85.7%,高于肝郁脾虚型(P<0.05);肝内HBcAg阳性率为34.6%,其中浆型占阳性者55.6%,HBVDNA阳性率63.2%,高于肝郁脾虚型(P<0.05)。气滞血瘀型临床属CAH伴早期肝硬化者占75.0%,病变较重,HBV复制程度与肝郁脾虚型相近。

TCM differentiation of syndrome in 131 cases of chronic hepatitis B has been studied with molecular-biological and immuno-histological techniques. The results showed that 94.6% cases of Gan-Yu Pi-Xu(肝郁脾虚, stagnancy in the liver leading to diminished function of the spleen) type belonged to chronic persistent hepatitis (CPH), whose coincidence rate of pathology of the liver biopsies with CPH was 69.2%; the positive rate of HBeAg and/or HBV DNA in sera was 61.5%, and the positive rates of HBsAg and HBV DNA in liver tissues were 69.2% (of which 44.4% appeared diffuse pattern morphologically) and 33.3% respectively. 75.5% cases of Gan-Shen Yin-Xu(肝肾阴虚, deficiency of Yin of the liver and kidney) type belonged to chronic active hepatitis (CAH) and 88.5%of the cases were pathologically described as CAH, the positive rates of HBeAg and/or HBV-DNA in serum and HBsAg in liver tissues were all 80.8%, among which the diffuse pattern of HBsAg accounted for 85.7%, which was higher than that in Gan-Yu Pi-Xu type (P<0.05), the positive rates of HBcAg and HBV DNA in liver tissues were 34.6% (of which 55.6% appeared cytoplasmic pattern) and 63.2% respectively, which was higher than that in Gan-Yu Pi-Xu type (P<0.05). 75.0%cases of Qi-Zhi Xue-Yu(气滞血瘀, stagnation of vital energy and stasis of blood) type belonged to CAH with early state cirrhosis, its pathological changes in liver tissues were obvious, replication levels of HBV corresponded to the cases of Gan-Yu Pi-Xu type.