慢性乙型肝炎并非酒精性脂肪性肝病中医证素特点及与肝组织病理相关性  

Characteristics of traditional Chinese medicine syndrome elements of chronic hepatitis B with non-alcoholic fatty liver disease and correlation with liver histopathology

作　　者：王敏[1] 张婷[2] 邱洋佳 唐金模 詹潇潇 邹丹容 陆菁菁 黄源鹏 WANG Min;ZHANG Ting;QIU Yangjia;TANG Jinmo;ZHAN Xiaoxiao;ZOU Danrong;LU Jingjing;HUANG Yuanpeng(Xiamen Hospital,Beijing University of Chinese Medicine,Xiamen 361000,Fujian,China;The Second Clinical Medical College of Fujian University of Traditional Chinese Medicine,Fuzhou 350100,Fujian,China;Fujian Institute of Subtropical Botany,Xiamen 361000,Fujian,China)

机构地区：[1]北京中医药大学附属厦门医院,福建厦门361000 [2]福建中医药大学第二临床医学院,福建福州350100 [3]福建省亚热带植物研究所,福建厦门361000

出　　处：《现代中西医结合杂志》2023年第20期2829-2833,2838,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金面上项目(82074508);厦门市科技计划项目(3502Z20199133);第七批全国老中医药专家学术经验继承工作项目(国中医药人教函【2022】76号)。

摘　　要：目的研究慢性乙型肝炎(CHB)并非酒精性脂肪性肝病(NAFLD)患者中医证素特点及中医证素与肝组织病理的相关性。方法选择厦门市中医院肝病中心2020年7月-2021年11月收治的320例CHB合并NAFLD初诊患者,全部行肝组织活检病理检查,运用福建中医药大学“中医健康状态辨识系统”进行证素积分,分析中医证素特点及与肝组织病理的关系。结果出现频数高低病性证素依次是湿286次(89.4%)、痰283次(88.4%)、热189次(59.1%),病位证素依次是肝220次(68.8%)、胆104次(32.5%)、脾48次(15.0%)。经t检验或Wilcoxon Mann-Whitney U秩和检验,证素热、气虚、脾积分在不同肝组织炎症分级中差异均有统计学意义(P均<0.05),证素湿、热、气虚、血瘀、肝、脾积分在不同肝纤维化分期中差异均有统计学意义(P均<0.05)。结论CHB并NAFLD患者临床以湿热多见,病位在肝脾,初步提示肝脏不同炎症和纤维化分级中部分证素严重程度不一样,中医证素与肝组织病理存在一定相关性。Objective It is to study the characteristics of traditional Chinese medicine syndrome elements of chronic hepatitis B(CHB)with non-alcoholic fatty liver disease(NAFLD)and their correlation with liver histopathology.Methods A total of 320 cases of patients with CHB with NAFLD treated at the Liver Disease Center of Xiamen Hospital of Traditional Chinese Medicine from July 2020 to November 2021 were selected,all of which underwent liver tissue biopsy and pathological examination,and their traditional Chinese medicine syndrome elements were scored using the“TCM Health Status Recognition System”of Fujian University of Traditional Chinese Medicine to analyze the characteristics of the elements and their correlations with liver histopathology.Results The high and low frequency of occurrence of syndrome elements of disease nature were dampness 286 times(89.4%),phlegm 283 times(88.4%),and heat 189 times(59.1%),and the syndrome elements of disease location were lvier 220 times(68.8%),gallbladder 104 times(32.5%),and spleen 48 times(15.0%).After t test or Wilcoxon Mann-Whitney U rank-sum test,the differences in the scores of syndrome elements heat,qi deficiency,and spleen were statistically significant among different liver tissue inflammation grading(all P<0.05),and the differences in the scores of syndrome elements dampness,heat,Qi deficiency,blood stasis,liver and spleen were statistically significant among different liver fibrosis grading(all P<0.05).Conclusions The patients with CHB and NAFLD are characterized by dampness-heat,and the disease is located in the liver and spleen,which suggests that the severity of some of the syndrom elements in different inflammatory and fibrotic grades of the liver is not the same,and that there is a certain correlation between traditional Chinese medicine syndrome elements and liver histopathology.

关 键 词：慢性乙型肝炎 非酒精性脂肪性肝病 中医证素 肝组织病理 

分 类 号：R512.62[医药卫生—内科学] R575.5[医药卫生—临床医学]