基于证候积分的慢性乙型肝炎湿热证的中西医临床特征  

Clinical Characteristics of Traditional Chinese and Western Medicine for Chronic Hepatitis B with Dampness-heat Syndrome Based on Syndrome Score

作　　者：刘雅茹 胡义扬[1,2,3,4] 赵瑜 LIU Yaru;HU Yiyang;ZHAO Yu(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Hepatology,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Key Laboratory of Liver and Kidney Diseases,Ministry of Education,Shanghai 201203,China;Shanghai Clinical Key Laboratory 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,上海201203 [3]肝肾疾病病证教育部重点实验室,上海201203 [4]上海市中医临床重点实验室,上海201203

出　　处：《世界中医药》2024年第22期3523-3530,共8页World Chinese Medicine

基　　金：国家自然科学基金面上项目(82174249);国家自然科学基金重点项目(81830119)。

摘　　要：目的:依据湿热证证候积分探索慢性乙型肝炎(CHB)湿热证患者血清肝功能指标、病毒学指标、肝脏纤维化指标、炎症介质和趋化因子、细胞免疫指标及部分血常规指标的变化特征。方法:选取2009年11月至2014年5月团队临床样本库中上海中医药大学附属曙光医院、宁波市第二医院、绍兴市第六人民医院、南京市第二医院和淮安市第四人民医院收治的健康志愿者36例、CHB患者148例的临床资料作为研究对象进行回顾性分析,依据《中药新药临床指导原则》(2002版)中对肝胆湿热证的主次证进行判定,对肝胆湿热证进行评分。依据湿热证候积分及舌苔是否黄腻将患者分为典型湿热证组40例、非典型湿热证组108例。比较典型湿热证组和非典型湿热证组患者血清肝功能指标、病毒学指标、肝脏纤维化指标、炎症介质及趋化因子、细胞免疫指标及部分血常规指标。结果:与非典型湿热证组比较,典型湿热证组的血清谷草转氨酶(GOT)、碱性磷酸酶(ALP)和血小板比率指数(APRI)评分、血清单核细胞、单核细胞百分比,炎症相关细胞因子白细胞介素(IL)6、IL-8、IL-16、巨噬细胞游走抑制因子(MIF)、单核细胞趋化蛋白-1(MCP-1/CCL2)、肝细胞生长因子(HGF)的表达显著升高(P<0.05)。结论:典型湿热证CHB患者伴随肝脏损伤相关肝功能指标、肝脏纤维化指标、免疫指标和炎症介质及趋化因子水平升高的临床表象。Objective:To explore the changes in serum liver function indicators,virological markers,liver fibrosis indicators,inflammatory mediators and chemokines,cellular immune indicators,and certain blood routine parameters in chronic hepatitis B(CHB)patients with dampness-heat syndrome(DHS)based on DHS syndrome score.Methods:A retrospective analysis was conducted using clinical data from 36 healthy volunteers and 148 CHB patients treated at Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Ningbo No.2 Hospital,Shaoxing Sixth People′s Hospital,The Second Hospital of Nanjing,and Huai′an No.4 People′s Hospital between November 2009 and May 2014.Clinical Guiding Principles for New Chinese Medicines(2002 edition)was used to determine the primary and secondary symptoms of liver-gallbladder DHS and to calculate syndrome scores.Patients were divided into a typical DHS group(40 cases)and a non-typical DHS group(108 cases),based on their syndrome scores and whether their tongue coating was yellow and greasy.The differences in serum liver function,virological markers,liver fibrosis markers,inflammatory mediators and chemokines,cellular immune markers,and some blood routine parameters were compared between the two groups.Results:Compared to the non-typical DHS group,the typical DHS group showed significantly higher serum levels of glutamic oxalacetic transaminase(GOT),alkaline phosphatase(ALP),and aspartate aminotransferase to platelet ratio index(APRI),as well as higher percentages of monocytes and mononuclear cells.The expression of inflammatory cytokines,including interleukin-6(IL-6),IL-8,IL-16,macrophage migration inhibitory factor(MIF),monocyte chemoattractant protein-1(MCP-1/CCL2),and hepatocyte growth factor(HGF),were also significantly increased(P<0.05).Conclusion:Patients with typical DHS in CHB exhibit elevated clinical manifestations,including higher levels of liver function indicators,liver fibrosis markers,immune markers,and inflammatory mediators and chemokines,suggesting associ

关 键 词：慢性乙型肝炎 中医证候 辨证分型 湿热证 证候积分 肝损伤 免疫反应 炎症反应 

分 类 号：R259[医药卫生—中西医结合]