260例慢性乙型肝炎中医证型与肝组织病理改变的相关性研究

目的 探讨慢性乙型肝炎（简称乙肝）中医证型和肝组织病理改变的关系，为中医辨证提供依据。方法 对260例慢性乙肝患者进行中医辨证分型，并且所有病例均行肝穿刺检查，从而确定肝组织病理分级、分期，探讨中医证型与肝脏病理改变的相关性。结果 （1）肝组织炎症：肝郁脾虚型主要为G1、G2；湿热中阻型主要为G2；肝肾阴虚型和脾肾阳虚型主要为G3；瘀血阻络型主要为G4。（2）肝组织纤维化分期：肝郁脾虚型和湿热中阻型主要为S1和S2；肝肾阴虚型、脾肾阳虚型主要为S3；瘀血阻络型主要为S3和S4。（3）肝组织病理程度：瘀血证以G3～G4、S3～S4为主，非瘀血证以G1～G2、S1～S2为主。结论 慢性乙肝的肝组织病理改变与中医证型有一定相关性，其中瘀血证、非瘀血证与肝组织病理关系最为密切。随着肝组织病理损害的加重，中医证型由实至虚，由气及血，瘀血阻络是其最终的病理转归。治疗中要注重活血化瘀，并结合三期分治。

Study on Correlation between TCM Syndrome Type and Pathological Changes of Liver Tissue in 260 Patients with Chronic Hepatitis B

OBJECTIVE: To study the correlation between TCM syndrome type and liver tissue pathological changes in patients with chronic hepatitis B (CHB) in order to provide evidence for syndrome differentiation. METHODS: Syndrome typing as well as liver pathological grading and staging of liver biopsy were performed on 260 patients with CHB, then the relationship between them was analyzed. RESULTS: (1) The grade of liver inflammation was mainly G1 and G2 in patients of Gan-qi stagnation and Pi-deficiency type (type 1); G2 in patients of inner damp-heat retention type (type II); G3 in patients of Gan-Shen yin-deficiency type (type lII) and Pi-Shen yang-deficiency type (type IV); while G4 occurred mainly in patients of blood stasis blocking collateral type (type V), showing significant difference as compared with other syndrome types. (2) The liver pathological stage in patients of type I and II was mainly S1 and S2, while S3 and S4 occurred mainly in patients of type III and type IV. (3) The pathological change was mainly G3-G4 and S3-S4 in blood stasis syndrome, while it was mainly G1-G2 and S1-S2 in non-blood stasis syndrome. CONCLUSION: The TCM syndrome type is correlated with liver tissue pathological change to certain extent, among them, syndrome with or without blood stasis showed the closest correlation. The syndrome type of CHB patients developed, along with the aggravating of liver pathological injury, from sthenia to asthenia, from qi to blood, and finally to the blood stasis blocking collateral. So the treatment should be lay stress on activating blood circulation to remove stasis, and be implemented by 3 stages.