慢性乙型肝炎中医辨证分型与肝组织内HBsAg、HBcAg表达的相关性研究
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摘要
目的:观察不同中医证型慢性乙型肝炎患者肝组织内HBs Ag、HBc Ag表达的情况,为慢性乙型肝炎中医辨证论治提供客观依据。方法:对555例慢性乙型肝炎患者进行中医辨证分型,并对其肝组织进行常规HE染色及免疫组织化学染色,分析不同证型慢性乙型肝炎患者肝组织内HBs Ag、HBc Ag表达情况。结果:慢性乙型肝炎不同中医证型肝组织HBs Ag阳性表达差异无显著统计学意义(P=0.811),肝组织HBc Ag阳性表达在6个证型间分布的差异均有显著性统计学意义(P<0.01),以隐证型为对照,肝郁脾虚证、肝肾阴虚证、肝郁气滞证、湿热蕴结证、瘀血阻络证肝组织内HBc Ag(+++)表达患者明显增多,而其中肝郁气滞证、湿热蕴结证HBc Ag(+++)表达患者高于其余各证型。结论:有部分慢性乙型肝炎中医隐证患者炎症分级、纤维化分期高,应及早发现治疗;不同中医证型肝组织内HBs Ag表达差异无统计学意义(P>0.05),而肝组织内HBc Ag的表达存在显著性差异(P<0.01)。
Objective: To explore the correlation between the different syndrome in TCM and the expression of HBs Ag and HBc Ag of the liver issue in patients with CHB for the differential treatment. Methods: The expression of HBs Ag and HBc Ag in liver tissues of patients with CHB was analyzed by TCM differentiation, HE staining and immunohistochemistry in 555 cases. Results: There was no significant difference(P=0.811) in the positive expression of HBs Ag in liver tissue among different TCM syndromes of CHB, but the positive expression of HBc Ag in liver tissue of 6 kinds of TCM syndromes showed statistical differences(P<0.001). Compared with the Yin syndrome( 隐证), the positive expression(+ + +) of HBc Ag in liver tissue among the Ganyu Pixu syndrome( 肝郁脾虚证), Ganshen Yinxu syndrome( 肝肾阴虚证), Ganyu Qizhi syndrome( 肝郁气滞证), Shire Yunjie syndrome( 湿热蕴结证) and Yuxue Zhuluo syndrome( 瘀血阻络证) were significantly increased, especially in the Ganyu Qizhi syndrome and Shire Yujie syndrome. Conclusion: Partial patients with CHB of Yin syndrome shows high degree of inflammation and high stage of fibrosis, and need early diagnosis and early treatment. The positive expression of HBs Ag in liver tissue among different TCM syndromes of CHB shows no statistical differences, but the positive expression of HBc Ag shows an opposite result.
Objective: To explore the correlation between the different syndrome in TCM and the expression of HBs Ag and HBc Ag of the liver issue in patients with CHB for the differential treatment. Methods: The expression of HBs Ag and HBc Ag in liver tissues of patients with CHB was analyzed by TCM differentiation, HE staining and immunohistochemistry in 555 cases. Results: There was no significant difference(P=0.811) in the positive expression of HBs Ag in liver tissue among different TCM syndromes of CHB, but the positive expression of HBc Ag in liver tissue of 6 kinds of TCM syndromes showed statistical differences(P<0.001). Compared with the Yin syndrome( 隐证), the positive expression(+ + +) of HBc Ag in liver tissue among the Ganyu Pixu syndrome( 肝郁脾虚证), Ganshen Yinxu syndrome( 肝肾阴虚证), Ganyu Qizhi syndrome( 肝郁气滞证), Shire Yunjie syndrome( 湿热蕴结证) and Yuxue Zhuluo syndrome( 瘀血阻络证) were significantly increased, especially in the Ganyu Qizhi syndrome and Shire Yujie syndrome. Conclusion: Partial patients with CHB of Yin syndrome shows high degree of inflammation and high stage of fibrosis, and need early diagnosis and early treatment. The positive expression of HBs Ag in liver tissue among different TCM syndromes of CHB shows no statistical differences, but the positive expression of HBc Ag shows an opposite result.
引文
[1]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
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[3]张相宏.潜证之辨证论治[J].辽宁中医药大学学报,2012,14(10):130-131.
[4]刘祖平.慢性乙型肝炎肝细胞HBs Ag、HBc Ag表达与肝组织病理学分析[J].中国卫生检验杂志,2015,15(10):1591-1593.
[5]马秋生.慢性乙型肝炎中医证型与临床检验指标相关性分析[J].中医临床研究,2016,8(3):22-23.
[6]刘世林,刘力萌.从中医伏邪学说探讨慢性乙型肝炎的发病机制及治疗[J].中国民间疗法,2017,25(5):4-6.
[7]黄道,朱韧,张欣欣.慢性乙型肝炎免疫发病机制及免疫治疗[J].中国病毒病杂志,2013,3(3):233-237.
[8]李红山,朱德东,傅琪琳,等.慢性乙型肝炎中同中医证候机体免疫功能的动态变化[J].中华中医药学刊,2013,31(11):2391-2393.
[9]Tang TJ,De Man RA,Kusters JG,et al.Intrahepatic CD8 T-lymphocytes and HBV core expression in relation to response to antiviral therapy for chornic hepatitis B patients[J].J Med Viral,2004,72(2):215-222.
[10]盛慧萍,杨岩,刘娅,等.慢性乙型肝炎肝组织HBs Ag和HBc Ag的表达[J].宁夏医学杂志,2009,31(3):198-200.
[11]叶芳萍,刘新玲,郑建红,等.慢性乙肝患者肝炎活动度、纤维化程度与肝组织HBc Ag关系[J].临床与实验病理学杂志,2011,27(3):326-327.
[12]高月求.慢性乙型肝炎的中医药防治策略[J].临床肝胆病杂志,2015,31(1):35-37.
[2]中医药学会内科肝胆病学组.慢性乙型肝炎中医诊疗专家共识(2012年1月)[J].临床肝胆病杂志,2012,28(3):164-168.
[3]张相宏.潜证之辨证论治[J].辽宁中医药大学学报,2012,14(10):130-131.
[4]刘祖平.慢性乙型肝炎肝细胞HBs Ag、HBc Ag表达与肝组织病理学分析[J].中国卫生检验杂志,2015,15(10):1591-1593.
[5]马秋生.慢性乙型肝炎中医证型与临床检验指标相关性分析[J].中医临床研究,2016,8(3):22-23.
[6]刘世林,刘力萌.从中医伏邪学说探讨慢性乙型肝炎的发病机制及治疗[J].中国民间疗法,2017,25(5):4-6.
[7]黄道,朱韧,张欣欣.慢性乙型肝炎免疫发病机制及免疫治疗[J].中国病毒病杂志,2013,3(3):233-237.
[8]李红山,朱德东,傅琪琳,等.慢性乙型肝炎中同中医证候机体免疫功能的动态变化[J].中华中医药学刊,2013,31(11):2391-2393.
[9]Tang TJ,De Man RA,Kusters JG,et al.Intrahepatic CD8 T-lymphocytes and HBV core expression in relation to response to antiviral therapy for chornic hepatitis B patients[J].J Med Viral,2004,72(2):215-222.
[10]盛慧萍,杨岩,刘娅,等.慢性乙型肝炎肝组织HBs Ag和HBc Ag的表达[J].宁夏医学杂志,2009,31(3):198-200.
[11]叶芳萍,刘新玲,郑建红,等.慢性乙肝患者肝炎活动度、纤维化程度与肝组织HBc Ag关系[J].临床与实验病理学杂志,2011,27(3):326-327.
[12]高月求.慢性乙型肝炎的中医药防治策略[J].临床肝胆病杂志,2015,31(1):35-37.