慢性乙型病毒性肝炎湿热内蕴证不同亚型血清代谢组学研究  

Study on Serum Metabolomics of Different Subtypes of Damp-Heat Accumulation Syndrom in Chronic Hepatitis B

作　　者：惠登城 刘璐 宋敬茹[1,2,3] 黄燕萍 蒋康伟 孙明瑜 HUI Dengcheng;LIU Lu;SONG Jingru;HUANG Yanping;JIANG Kangwei;SUN Mingyu(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Liver Diseases,Key Laboratory of Liver and Kidney Diseases(Ministry of Education),Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院,上海201203 [2]上海中医药大学肝病研究所肝肾疾病病证教育部重点实验室,上海201203 [3]上海中医药大学,上海201203

出　　处：《新中医》2025年第3期59-67,共9页New Chinese Medicine

基　　金：山东省重点研发计划“重大科技创新工程”(2021CXGC010509);国家中医药管理局慢性肝病虚损重点研究室和上海市中医临床重点实验室项目(20DZ2272200);上海市临床重点专科建设项目(shslczdzk01201)。

摘　　要：目的:利用非靶向代谢组学技术,分析慢性乙型病毒性肝炎(CHB)湿热内蕴证不同亚型(湿热并重、湿偏重、热偏重)的潜在生物标志物,从小分子代谢物的角度为中医的精细辨证提供客观依据。方法:经过严格的纳排标准,纳入58例CHB患者(湿热并重21例,湿重于热16例,热重于湿21例),健康志愿者10例,采集清晨空腹血液,基于LC-MS代谢组学技术,比较各组与健康志愿者的差异代谢物。结果:经过筛选,CHB患者和健康志愿者的差异代谢物共有19个。其中,8个为CHB湿热内蕴证湿热并重组的差异代谢物,3个为湿重于热组的差异代谢物,3个为热重于湿组的差异代谢物,4个为CHB湿热内蕴证共性差异代谢物。这些差异代谢物涉及多条代谢通路,包括半乳糖代谢、花生四烯酸代谢、谷胱甘肽代谢等19条代谢通路。通过ROC分析,花生四烯酸(AUC=0.80)、硬脂四烯酸(AUC=0.81)、茉莉酮酸甲酯(AUC=0.84)以及L-丙氨酸(AUC=0.76)可能是湿热并重证型的诊断标志物。左旋肉碱(AUC=0.77)可能是湿重于热证型的诊断标志物。结论:CHB湿热内蕴证不同亚型之间存在差异代谢产物及共性代谢产物,深入了解不同亚型之间的代谢共性和偏性对于中医精细辨证具有重要意义,也为中医药的细化分型提供客观依据。Objective:Using non-targeted metabolomics techniques to analyze the potential biomarkers of different subtypes of damp-heat accumulation syndrome(equal severity of dampness and heat,heavier dampness,and heavier heat)in chronic hepatitis B(CHB),and provide an objective basis for fine syndrome differentiation in Chinese medicine from the perspective of small molecule metabolites.Methods:With strict inclusion and exclusion criteria,58 patients with CHB(21 with equal severity of dampness and heat,16 with heavier dampness,and 21 with heavier heat)and 10 healthy volunteers were included.Fasting blood samples were collected in the morning,and differential metabolites between each group and healthy volunteers were compared using LC-MS metabolomics technology.Results:After screening,there were a total of 19 differential metabolites between patients with CHB and healthy volunteers.Among them,eight were differential metabolites of the group of CHB with damp-heat accumulation syndrome with equal severity of dampness and heat,three were in the group of the heavier dampness,three were in the group of heavier heat,and four were common differential metabolites of CHB with damp-heat accumulation syndrome.These differential metabolites involved 19 metabolic pathways,such as galactose metabolism,arachidonic acid metabolism,and glutathione metabolism.Through ROC analysis,arachidonic acid(AUC=0.80),stearidonic acid(AUC=0.81),methyl jasmonate(AUC=0.84),and L-alanine(AUC=0.76)may be diagnostic markers for damp-heat accumulation syndrome with equal severity of dampness and heat.L-carnitine(AUC=0.77)may be a diagnostic biomarker for the heavier dampness syndrome type.Conclusion:There are differential metabolites and common metabolites among different subtypes of CHB with damp-heat accumulation syndrome.A deeper understanding of the metabolic commonalities and biases among different subtypes is of great significance for the fine differentiation of Chinese medicine and provides objective basis for the refinement of Chinese medicine classif

关 键 词：慢性乙型病毒性肝炎 湿热内蕴证 精细辨证 代谢组学 

分 类 号：R512.62[医药卫生—内科学]