慢性病毒性肝炎279例病理诊断与中医证型的关系

目的:探讨慢性病毒性肝炎病理组织学诊断与中医辨证分型之间的关系,为中医辨证提供客观依据。方法:279例均为住院患者,男227例,女52例。全部病例经肝活检证实,其中轻度142例,中度91例,重度46例。慢性乙型肝炎274例,慢性丙型肝炎5例。中医辨证:湿热中阻53例,肝郁脾虚64例,肝肾阴虚29例,脾肾阳虚7例,血瘀血热101例,气阴两虚25例。临床治疗以辨证施治为主。结果:(1)279例慢性肝炎在病理诊断分型中,轻度占50.9%、中度占32.6％、重度占16.4％。(2)在轻度慢性肝炎中,湿热中阻、肝郁脾虚及肝肾阴虚证明显高于血瘀血热证.P=0.01、P<0.05。(3)湿热中阻、肝郁脾虚证的病理诊断分布情况依次为轻度>中度>重度,P<0.01、P<0.05;血瘀血热证轻度与中度分别>重度,P<0.05。但该证在重度中的发生率高于其他证型。(4)脾肾阳虚与气阴两虚证在各病理分型中的分布均无显著差异,P>0.05。结论:(1)慢性肝炎患者以轻度居多,占半数以上。(2)慢性肝病的病变早期以湿热中阻、肝郁脾虚为主证特点,病变部位多在气分;随着肝脏病理损害加重,病变部位及主导证型渐由气分至血分,以血瘀血热为主证特点。(3)治疗上主张早期宜注重清解湿热,疏肝健脾;中、晚期宜重视活血化瘀,凉血解毒。

Relationship between Pathologic Diagnosis and TCM Type of Syndromes in 279 Patients with Chronic Virus Hepatitis

Aim: To study the relationship between pathologic diagnosis and Traditional Chinese Medicine (TCM) Type of syndromes, provide objective basis for TCM differentiation of symptoms and signs. Methods: 279 patients were all in-patients. male were 227 patients. female were 52 patients. Verified by the liver pathology in all of the patients. there were the low-grade 142. moderate 91 and the severe 46 patients. included chronic hepatitis B 274 and chronic hepatitis C 5 patients. TCM differentiation of symptoms and signs: Retention of damp-heat in the interior 53. stagnation of the liver-Qi and deficiercy of the spleen 64.deficiency of liver-Yin and kidney-Yin 29, insufficiency of both the spleen and the kidney 7. pathogenic heat accumulated in the blood system 101 and deficiency of both Qi and Yin 25 patients. Took the Bianzheng Shizhi as the priority in clinical treatment. Results: (1) In the pathologic diagnosis the low-grade 50. 9% moderate 32.6% and the severe 16.4% .among chronic hepatitis 279 patients: (2)Retention of damp-heat in the interior, stagnation of the liver-Qi and deficiency of the spleen and deficiency of liver-yin and kidney-Yin types higher obviously than pathogenic heat accumulated in the blood system types, among low-grade chronic hepatitis. t=0. 01. P<0. 05: (3) Pathologic diagnosis of retention of damp-heat in the interior and stagnation of the liver-Qi and deficiency of the spleen types were the low-grade>moderate>the severe in their given order; the low-grade and moderate>the severe of pathogenic heat accumulated in the blood system. P<0. 05. But the incidence rate was higher than other in the severe: (4) In each of pathologic diagnosis, the distributions of insufficiercy of both the spleen and the kidney and deficiency of both Qi and Yin had not distinct differences.P>0. 05. Conclusions: (1) The low-grade was more in chronic hepatitis, over the half; (2) Premature lesion of chronic hepatitis was characterized by the retention of damp-heat in the interior and stagnation of the liver-Qi and deficiency of the spleen.lesion was in Qi mostly: As the exacerbation of hepatic lesion. lesion and main syndromes moved from Qi to blood pathogenic heat accumulated in the blood system became main syndrome; (3) It was advocated to the treatment, early stage should pay more attention to eliminating dampness and heat and smoothing the liver and invigorating the spleen. Midperiod and advanced stage should pay more attention to promoting blood circulation to remover blood stasis and remove heat from the blood and toxic substances.