【摘要】 目的:探讨慢性乙型肝炎(CHB)中医不同证型患者的肝纤维化特点。方法:纳入100例CHB住院患者,利用FibroTouch无创肝纤维化诊断系统,测定其肝脏硬度值(LSM)、肝功能指标、肝纤维化指标、血常规等;计算纤维化指数-4(FIB-4),分析各检测指标在中医各证型中的特点及相关性。结果:100例CHB患者中以肝郁脾虚证和肝胆湿热证分布最多(共76例)。肝胆湿热证和肝郁脾虚证患者丙氨酸氨基转移酶(ALT)明显高于肝肾阴虚组和瘀血阻络组患者(P<0.05);肝郁脾虚组患者FIB-4明显低于肝肾阴虚组和瘀血阻络组患者,而其LSM值明显低于瘀血阻络组患者(P<0.05)。相关性分析显示各证型组患者LSM值与FIB-4、Ⅳ型胶原、Ⅲ型前胶原N端肽均呈正相关(P<0.05或P<0.01),LSM与肝胆湿热组、肝郁脾虚组、肝肾阴虚组患者的层粘连蛋白呈正相关(P<0.01),与肝胆湿热组、肝郁脾虚组患者的透明质酸呈正相关(P<0.01)。结论:FibroTouch及FIB-4是无创高效的肝纤维化诊断方法,其结果在CHB患者不同中医证型中各有差异,CHB的肝纤维化程度以肝郁脾虚证患者最低,而瘀血阻络证患者较高。更多还原

【Abstract】 Objective:To investigate the characteristics of liver fibrosis degree in patients with chronic hepatitis B(CHB) in different TCM syndrome types.Methods:Including 100 patients with chronic hepatitis B in hospital, using FibroTouch non-invasive liver fibrosis diagnosis system, the liver hardness value(LSM), liver function index, liver fibrosis index and blood routine were measured, and the FIB 4 index was calculated, the characteristics and correlation of each test index in each syndrome type of TCM were analyzed. Results:In 100 patients with chronic hepatitis B, the most common types were stagnation of liver qi and deficiency of spleen qi and damp-heat of liver gallbladder(76%), and deficiency of spleen-yang and kidney-yang(0 cases). Liver-qi stagnation and spleen-deficiency syndrome ALT was significantly higher than liver-qi stagnation and kidney-yin Deficiency Group(P<0.05),FIB-4 index was significantly lower in liver-qi stagnation and spleen-deficiency group than that in liver-qi stagnation and kidney-yin deficiency group and blood stasis blocking collateral group, and LSM value was significantly lower than that in blood stasis blocking Collateral Group(P<0.05). The correlation analysis showed that LSMwas positively correlated with FIB-4 Index(P<0.05,P<0.01), and positively correlated with C Ⅳ, P Ⅲ PNP(P<0.01) LN was positively correlated with liver-gallbladder damp-heat Group, liver-stagnation and spleen-deficiency Group and liver-kidney yin-deficiency Group(P<0.01), and Ha was positively correlated with liver-gallbladder damp-heat Group and liver-stagnation and spleen-deficiency Group(P<0.01).Conclusion:FibroTouch and FIB 4 index are noninvasive and effective diagnostic methods for liver fibrosis. The degree of liver fibrosis is the lowest in the syndrome of stagnation of liver-qi and deficiency of spleen, but higher in the syndrome of blood stasis blocking collaterals.更多还原