慢性乙型肝炎病毒脱氧核糖核酸基因型与中医辨证规律初探

作者	单位
李筠	解放军第302医院中西医结合肝病科
杨慧银	解放军第302医院中西医结合肝病科
王立福	解放军第302医院中西医结合肝病科
周双男	解放军第302医院中西医结合肝病科
张晓峰	解放军第302医院中西医结合肝病科
施建秀	解放军第302医院中西医结合肝病科

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中文摘要:

目的研究乙型肝炎病毒脱氧核糖核酸(HBV DNA)基因型与慢性乙型肝炎(CHB)中医辨证的相关性。方法采取开放平行对照法对177例CHB患者在中医辨证基础上,测定外周血HBVDNA基因型,观察其与辨证分型、肝炎诊断分度等指标的关联性。结果 (1)HBVDNA基因型分布特点:B型31例(17.51%),C型131例(74.01%),B/C型11例(6.21%),D型1例(0.56%),未测出3例(1.69%);C基因型明显高于其他基因型(P<0.01)。(2)中医证型分布特点:肝郁脾虚型98例(55.37%),肝肾阴虚型6例(3.39%),脾肾阳虚型2例(1.13%),湿热中阻型12例(6.78%),瘀血阻络型59例(33.33%)。诊断为重度的32例CHB患者中,瘀血阻络型16例(50.00%),与其他证型比较差异无统计学意义。瘀血阻络型患者HBeAg阴性率为62.71%(37/59)明显高于其他证型(P=0.00),提示有血瘀表现的患者肝脏炎症损害较重,炎症反应同时清除了部分病毒。(3)瘀血阻络型有CHB家族史者42.37%(25/59),与肝郁脾虚型比较,差异有统计学意义(P<0.05)。结论中国人感染乙型肝炎病毒,基因C型明显高于其他型;瘀血阻络型的CHB患者肝脏损伤较重;HBV基因型与CHB中医证型无明显相关性,但瘀血阻络型有CHB家族史者比例较高。

英文摘要:

Objective To study the relationship between genotype of HBV DNA and Chinese medicine(CM)syndrome pattern in patients with chronic hepatitis B(CHB).Methods With an open parallel-controlled method adopted,CM syndrome types of 117 CHB patients were differentiated and their genotypes of HBV DNA in peripheral blood were determined to observe the relationship with syndrome pattern and diagnostic degree of hepatitis.Results(1)The HBV DNA genotype distribution in CHB patients was:type B in 17.51%(31 cases)of the 117 patients,type C in 131(74.01%),type B/C in 11(6.21%)and type D in 1(0.56%),while the genotype in 3 cases was unable be determined.The proportion of patients with HBV DNA of type C was obviously higher than that with other types(P<0.01).(2)Distribution of CM syndrome pattern was:98 patients(55.37%)were differentiated as Gan-stagnation Pi-deficiency pattern(Ⅰ),6(3.39%)as Gan-Shen yin-deficiency pattern(Ⅱ),2(1.13%)as Pi-Shen yang-deficiency pattern(Ⅲ),12(6.78%)as damp-heat blocking pattern(Ⅳ)and 59(33.33%)as blood-stasis obstruction pattern(Ⅴ).Sixteen out of the 32 severe CHB patients were differentiated as pattern Ⅴ,accounting for 50.00%,but showed no statistical difference in comparing with that in patients of other patterns.However,the HBeAg negative rates in patients of pattern Ⅴ was 62.71%(37/59),significantly higher than that in patients of other patterns(P=0.00),suggesting that the inflammatory injury of liver was rather severer,and the virus were eliminated partially in the inflammatory reaction.(3)42.37%(25/59)in patients of pattern Ⅴ had family history of CHB,the percentage was significantly higher than that in patients of pattern Ⅰ(P<0.05).Conclusions HCV DNA of type C is predominant in CHB patients in China.Liver injury in CHB patients of CM syndrome pattern Ⅴ is severer than that in patients of other patterns.HBV genotype shows no obvious correlativity with CM syndrome pattern of patients,but the cases with family CHB infection history of pattern Ⅴ take a higher proportion.

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