慢性乙型肝炎不同中医证型患者肝纤维化特点分析  

Characteristics of liver fibrosis in different TCM syndromes of chronic hepatitis B

作　　者：王伟芹[1] 高占华[1] 尹常健[1] 孙玉莉[1] 孙建光[1] 张永[1] WANG Wei-qin;GAO Zhan-hua;YIN Chang-jian(Department of Hepatology,Affiliated Hospital of Shandong University of TCM,Jinan Shandong,250014,China)

机构地区：[1]山东中医药大学附属医院肝胆内科,山东济南250014

出　　处：《中西医结合肝病杂志》2021年第2期135-137,共3页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：山东省中医药科技发展计划项目(No.2015-099)。

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。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 CⅣ,PⅢPNP(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.

关 键 词：慢性乙型肝炎 肝纤维化 中医证型 

分 类 号：R575.1[医药卫生—消化系统]