慢性乙型肝炎患者抗病毒治疗早期应答与中医体质的相关性研究
|
摘要
目的探讨慢性乙型肝炎(CHB)患者抗病毒治疗早期应答与中医体质的相关性。方法选取我院肝病科于2016年1月—2018年2月收治的204例CHB抗病毒初治患者为研究对象,依据中医体质分型标准将其分为平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、血瘀质、气郁质、特禀质9种类型。比较不同类型中医体质患者治疗早期ALT、HBeAg及HBV DNA等血清学指标差异及不同应答组间患者体质类型分布差异。结果204例抗病毒治疗CHB患者中医体质类型以湿热质(68例,33.33%)、气郁质(54例,26.47%)、血瘀质(24例,11.76%)为主,而特禀质(4例,1.96%)的类型最少。CHB患者抗病毒治疗24周时气郁质者疗效最好,各组HBeAg血清学转换率及HBVDNA转阴率比较差异有统计学意义(P<0.05),各组ALT正常率相比差异无统计学意义(P>0.05)。治疗48周时气郁质和湿热质体质疗效优于其他体质类型,而平和质疗效最差,各组HBeAg血清学转换率、HBVDNA转阴率及ALT正常率比较差异均有统计学意义(P<0.05)。结论中医体质可影响CHB患者抗病毒治疗早期应答,气郁质和湿热质最有利于应答。
Objective To analyze correlation between early response to antiviral therapy and TCM constitution in patients with chronic hepatitis B. Methods Two hundred and four patients with CHB admitted into our hospital from Janurary 2016 to February 2018 were selected as the objects. According to TCM constitution classification criteria, they were divided into 9 types: mild, Qi deficiency, Yang deficiency, Yin deficiency, phlegm-dampness, dampness and heat, blood stasis, Qi stagnation and specific intrinsic quality. To compare the differences in serum indexes such as ALT, HBeAg and HBV DNA in the early treatment of patients with different types of TCM constitutions and the differences in the distribution of constitutions among different response groups. Results In 204 patients with CHB treated with antiviral therapy, the types of TCM constitution were mainly damp-heat substance(68 cases, 33.33%), Qi stagnation substance(54 cases, 26.47%), blood stasis substance(24 cases, 11.76%), while the types of specific substance(4 cases, 1.96%) were the least. HBeAg serological conversion rate and HBV-DNA negative conversion rate were statistically significant(P<0.05), while normal ALT rates were not statistically significant(P>0.05). At 48 weeks, the therapeutic effect of Qi stagnation and damp-heat constitution was better than that of other constitution types, while the therapeutic effect of pinghe constitution was the worst. The comparison of HBeAg serological conversion rate, HBV DNA negative conversion rate and normal ALT rate in each group had statistical significance(P<0.05). Conclusion TCM constitution may affect the early response of patients with CHB to antiviral therapy, and Qi stagnation and damp-heat quality are most conducive to the response.
Objective To analyze correlation between early response to antiviral therapy and TCM constitution in patients with chronic hepatitis B. Methods Two hundred and four patients with CHB admitted into our hospital from Janurary 2016 to February 2018 were selected as the objects. According to TCM constitution classification criteria, they were divided into 9 types: mild, Qi deficiency, Yang deficiency, Yin deficiency, phlegm-dampness, dampness and heat, blood stasis, Qi stagnation and specific intrinsic quality. To compare the differences in serum indexes such as ALT, HBeAg and HBV DNA in the early treatment of patients with different types of TCM constitutions and the differences in the distribution of constitutions among different response groups. Results In 204 patients with CHB treated with antiviral therapy, the types of TCM constitution were mainly damp-heat substance(68 cases, 33.33%), Qi stagnation substance(54 cases, 26.47%), blood stasis substance(24 cases, 11.76%), while the types of specific substance(4 cases, 1.96%) were the least. HBeAg serological conversion rate and HBV-DNA negative conversion rate were statistically significant(P<0.05), while normal ALT rates were not statistically significant(P>0.05). At 48 weeks, the therapeutic effect of Qi stagnation and damp-heat constitution was better than that of other constitution types, while the therapeutic effect of pinghe constitution was the worst. The comparison of HBeAg serological conversion rate, HBV DNA negative conversion rate and normal ALT rate in each group had statistical significance(P<0.05). Conclusion TCM constitution may affect the early response of patients with CHB to antiviral therapy, and Qi stagnation and damp-heat quality are most conducive to the response.
引文
[1] YUEN M F,AHN S H,CHEN D S,et al.Chronic hepatitis B virus infection:disease revisit and management recommendations.[J].J Clin Gastroenterol,2016,50(4):286.
[2] 基于社区慢性乙型肝炎抗病毒治疗策略成本效果分析[J].中华流行病学杂志,2017,38(7):860.
[3] 罗彬,蒲静,李红钊.慢性乙型肝炎患者肝组织中程序性死亡分子-1表达与中医辨证分型及肝脏病理的关系[J].国际中医中药杂志,2016,38(3):212-215.
[4] 徐瑞芳,张红云,田怡,等.慢性乙型肝炎抗病毒治疗中监测乙肝大蛋白的临床价值[J].胃肠病学和肝病学杂志,2016,25(2):171-173.
[5] 占国清,李芳,李儒贵,等.非酒精性脂肪性肝病对慢性乙型肝炎肝纤维化及α-干扰素抗病毒疗效的影响[J].胃肠病学和肝病学杂志,2016,25(4):394-397.
[6] 吴取梅,赵久法.恩替卡韦治疗慢性乙型肝炎病毒感染的研究进展[J].中华全科医学,2016,14(10):1742-1744.
[7] 中华医学会肝病学分会.慢性乙型肝炎防治指南(2015年版)[J].中华实验和临床感染病杂志(电子版),2015,19(5):1-18.
[8] 王琦.中医体质三论[C].中华中医药学会全国中医体质学术研讨会暨国际传统医药创新与发展态势论坛,2008.
[9] 鲍旭丽,渠亚超,闾军.慢性乙型肝炎抗病毒及免疫调节治疗研究进展[J].中国中西医结合消化杂志,2016(6):484- 487.
[10] ZHANG W,WANG L Q,LIU Y B.Evaluation on quality of life and analysis on its correlation with TCM syndromes in patients of chronic hepatitis B.[J].Chin J Integr Med,2009,15(1):30-33.
[11] 范晔,于乐成.成人慢性乙型肝炎抗病毒治疗的系统评价和荟萃分析[J].肝脏,2016,21(8):679- 682.
[12] 王博,吴俊英,徐超.CD137表达与慢性乙型肝炎患者肝脏免疫病理损伤程度的相关性研究[J].蚌埠医学院学报,2016,41(9):1125-1128.
[13] 申弘,凌琪华,杨涛,等.慢性HBV感染相关疾病患者的中医体质分布规律研究[J].上海中医药杂志,2014(9):12-16.
[14] TULANDI T,LEUNG A,JAN N.Nonmalignant sequelae of unconfined morcellation at laparoscopic hysterectomy or myomectomy[J].J Minim Invasive Gynecol,2016,23(3):331-337.
[15] 张爱民,陈铿,谭行华,等.中医证候预测慢性乙型肝炎干扰素疗效的临床研究[J].中国当代医药,2013,20(7):92- 94.
[2] 基于社区慢性乙型肝炎抗病毒治疗策略成本效果分析[J].中华流行病学杂志,2017,38(7):860.
[3] 罗彬,蒲静,李红钊.慢性乙型肝炎患者肝组织中程序性死亡分子-1表达与中医辨证分型及肝脏病理的关系[J].国际中医中药杂志,2016,38(3):212-215.
[4] 徐瑞芳,张红云,田怡,等.慢性乙型肝炎抗病毒治疗中监测乙肝大蛋白的临床价值[J].胃肠病学和肝病学杂志,2016,25(2):171-173.
[5] 占国清,李芳,李儒贵,等.非酒精性脂肪性肝病对慢性乙型肝炎肝纤维化及α-干扰素抗病毒疗效的影响[J].胃肠病学和肝病学杂志,2016,25(4):394-397.
[6] 吴取梅,赵久法.恩替卡韦治疗慢性乙型肝炎病毒感染的研究进展[J].中华全科医学,2016,14(10):1742-1744.
[7] 中华医学会肝病学分会.慢性乙型肝炎防治指南(2015年版)[J].中华实验和临床感染病杂志(电子版),2015,19(5):1-18.
[8] 王琦.中医体质三论[C].中华中医药学会全国中医体质学术研讨会暨国际传统医药创新与发展态势论坛,2008.
[9] 鲍旭丽,渠亚超,闾军.慢性乙型肝炎抗病毒及免疫调节治疗研究进展[J].中国中西医结合消化杂志,2016(6):484- 487.
[10] ZHANG W,WANG L Q,LIU Y B.Evaluation on quality of life and analysis on its correlation with TCM syndromes in patients of chronic hepatitis B.[J].Chin J Integr Med,2009,15(1):30-33.
[11] 范晔,于乐成.成人慢性乙型肝炎抗病毒治疗的系统评价和荟萃分析[J].肝脏,2016,21(8):679- 682.
[12] 王博,吴俊英,徐超.CD137表达与慢性乙型肝炎患者肝脏免疫病理损伤程度的相关性研究[J].蚌埠医学院学报,2016,41(9):1125-1128.
[13] 申弘,凌琪华,杨涛,等.慢性HBV感染相关疾病患者的中医体质分布规律研究[J].上海中医药杂志,2014(9):12-16.
[14] TULANDI T,LEUNG A,JAN N.Nonmalignant sequelae of unconfined morcellation at laparoscopic hysterectomy or myomectomy[J].J Minim Invasive Gynecol,2016,23(3):331-337.
[15] 张爱民,陈铿,谭行华,等.中医证候预测慢性乙型肝炎干扰素疗效的临床研究[J].中国当代医药,2013,20(7):92- 94.