HBeAg阴性慢性乙型肝炎中医证型分布及与HBVDNA、肝纤四项关系的研究

目的探讨HBeAg阴性慢性乙型肝炎中医证型分布规律及各证型与实验室指标的关系。方法采用临床流行病学回顾性研究方法，从2008年1月-2009年5月就诊于广东省中医院门诊及住院患者中选取合格研究对象329例，观察其肝功能、HBVDNA、肝纤四项等实验室指标。结果各证型的分布为：肝郁脾虚〉湿热中阻〉肝肾阴虚〉瘀血阻络〉脾肾阳虚。湿热中阻证的血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平明显高于其他证型（P〈0．05）。当HBVDNA〈10^4 copies／mL时，湿热中阻证的频数明显高于其他证型（P〈0．05）；而当10^4≤HBVDNA〈10^7 copies／mL时则相反。湿热中阻证三型前胶原（PCIII）的异常率明显高于肝郁脾虚、肝肾阴虚证，肝肾阴虚证层粘连蛋白（LN）、透明质酸（HA）的异常率及瘀血阻络证HA的异常率均明显高于肝郁脾虚、湿热中阻证（P〈0．05）；而肝郁脾虚证IV型胶原（CIV）的异常率与湿热中阻证差异没有统计学意义（P〉0．05）。结论HBeAg阴性慢性乙型肝炎的中医证型分布具有一定的规律；各证型与转氨酶、HBVDNA、肝纤四项等实验室指标之间有一定的内在关系。

Study on Distribution Characteristic of TCM Syndrome Types and Its Relationship with HBVDNA and Hepatic Fibrosis Markers in Patients with HBe Antigen-Negative Chronic Hepatitis B

Objective To research the distribution characteristic of TCM syndrome types and their relationship with laboratorial tests in patients with HBe antigen-negative chronic hepatitis B. Method Clinical epidemiological retrospective investigation was adopted. 329 cases of Guangdong Provincial Hospital ofTCM frome January 2008 to May 2009 were involved, and their hepatic function, HBVDNA and hepatic fibrosis markers were tested. Result The proportions of TCM type of syndromes in 329 patients included the survey were： liver depression and insufficiency of the spleen （type A） 〉 dampness-heat accumulation （type B） 〉 liver-kidney yin deficiency （type C） 〉 obstruction of coUetarals by blood stasis （type D） 〉 insufficiency of both the spleen and the kidney （type E）. The serum levels of ALT and AST in type B were significantly more higher than the other syndromes （P〈0.05）. When the range of replication of HBVDNA below 10^4 copies/mL, the frequency of type B was remarkably less than that of the other types, which was opposite when the range of replication of HBVDNA between 10^4 copies/mL and 10^7 copies/mL （P〈0.05）. The percentage of type B with abnormal PCIII was higher than type A and type C, while the percentage of type C with abnormal LN or HA and the percentage of type D with abnormal HA were higher than type A and type B （P〈0.05）. There was no difference between the rate of abnormal CIV in type A and that in type B （P〉0.05）. Conclusion The distribution of TCM types of syndrome of the patients with HBeAg-negative chronic hepatitis B has its characteristic. There are some relationships between TCM types of syndrome and the levels of transaminases, HBVDNA, the abnormal rates of four hepatic fibrosis markers.