【摘要】 目的探讨慢性乙肝病毒(HBV)携带者肝脏病理与中医证候、体质的相关性。方法以北京中医药大学王琦教授中医体质最新分类为标准,判断病理资料完整的80例慢性乙肝病毒携带者的体质类型,收集慢性乙肝病毒携带者的症状、体征、舌象、脉象等资料,总结其中医证候特征及证型分布,依据肝组织炎症分级(G)和纤维化分组(S)进行分组,比较各组间体质类型分布的差异。结果慢性乙肝病毒携带者无纤维化组平和质多见,而随纤维化程度增高,病理或异常体质类型出现频率明显增加,对S1、S2纤维化分级程度患者间的体质类型总体分布进行比较,差异具有统计学意义;无炎症组平和质多见,而随炎症程度增高,病理或异常体质类型出现频率明显增加,对G1、G2炎症程度患者间的体质类型总体分布进行比较,差异具有统计学意义。HBV病毒携带者中医证型以肝气郁结证、肝胃不和证、湿热中阻证、肝胆湿热证等实证为主,而肝肾阴虚证、脾气虚证、肾气虚证、肾阳虚证、气血亏虚证等虚证占少数,随纤维化程度增高,虚证出现频率逐渐减少;无炎症组实证多见,随炎症程度增高,虚证出现频率明显减少。结论肝脏病理结果提示随着组织炎症分级和纤维化分期加重,慢性乙肝病毒携带者的病理体质逐渐增多,中医辨证虚证出现频率明显减少。通过评价慢性乙肝病毒携带者的中医体质、中医证候,能够为间接评价患者肝脏病理组织炎症分级和纤维化分期提供一定的依据。更多还原

【Abstract】 Objective To discuss the correlation between liver pathological changes and TCM syndromes and constitutional types in carriers of chronic hepatitis B virus. Methods The constitutional types of 80 carriers of chronic hepatitis B virus were judged according to Professor WANG Qi’s new classification standard of TCM constitutional types. The data of symptoms,signs,tongue manifestations and pulse conditions were collected,and the characteristics of TCM syndromes and distribution of syndrome types were summed up. The carriers were divided into groups according to hepatic tissue inflammation grading( G) and hepatic fibrosis degrees,and the difference in distribution of constitutional types was compared among all groups. Results The type of normal constitution was common in non-fibrosis group,and with the increase of fibrosis degree the occurrence frequency of pathological or abnormal constitutional types increased significantly. The comparison in total distribution of constitutional types showed statistical significance between the carriers with S1 fibrosis grade or S2 fibrosis grade. The type of normal constitution was common in non-inflammation group,and with the increase of inflammation degree the occurrence frequency of pathological or abnormal constitutional types increased significantly. The comparison in total distribution of constitutional types showed statistical significance between the carriers with G1 inflammation grade or G2 inflammation grade. The constitutional types in the carriers were mainly liver qi depression syndrome,liver qi invading stomach syndrome,syndrome of damp-heat encumbering the middle energizer and liver-gallbladder damp-heat syndrome,while liver-kidney yin deficiency syndrome,spleen qi deficiency syndrome,kidney qi deficiency syndrome,kidney yang deficiency syndrome and qi-blood deficiency syndrome were less. With the increase of fibrosis degree, the occurrence frequency of deficient syndromes decreased gradually. In non-inflammation group,excess syndromes were common and occurrence frequency of deficient syndromes decreased gradually with the increase of inflammation degree. Conclusion The results of liver pathological changes indicated that pathological constitutional types increased and occurrence frequency of deficient syndromes decreased significantly with the increase of inflammation grading and exacerbation of fibrosis. The reviewing on TCM constitutional types and syndromes in the carriers of chronic hepatitis B virus will provide some evidences for reviewing indirectly the inflammation grading and fibrosis staging of liver pathological tissue.更多还原