慢性乙型肝炎后肝硬化患者中医证候与血清TGF-β1、HA、LN、IV-C、PC-Ⅲ水平相关性研究

目的:观察慢性乙型肝炎后肝硬化患者中医证候与血清TGF-β1、HA、LN、IV-C、PC-Ⅲ水平的相关性。方法:选取147例慢性乙型肝炎后肝硬化患者作为观察组,另选同期健康成人30例作为对照组。空腹抽取静脉血液,检测并记录不同中医证候患者和正常成人血清中转化生长因子-β1(transforming growth factor-β,TGF-β1)、透明质酸((hyaluronic acid,HA)、层黏连蛋白(laminin,LN)、IV型胶原(type IV-collagen,IV-C)以及前胶原蛋白Ⅲ(before collagenⅢ,PC-Ⅲ)含量,对患者进行肝功能分级,综合分析比较。结果:肝硬化患者TGF-β1含量显著高于正常成人(P0.05),且各证候肝硬化患者血清内TGF-β1由低到高依次为:肝气郁结证水湿内阻证湿热内蕴证瘀血内阻证肝肾阴虚证脾肾阳虚证。肝硬化患者HA、PC-Ⅲ、LN以及IV-C含量显著高于正常成人,差异有统计学意义(P0.05),且瘀血内阻证肝硬化患者各项肝纤维化指标均较高。瘀血内阻证、肝肾阴虚证以及脾肾阳虚证患者血清内HA和PC-Ⅲ水平显著高于水湿内阻证和湿热内阻证患者,差异有统计学意义(P0.05)。除瘀血内阻证患者LN含量较高以外,其余各证候肝硬化患者血清内LN水平比较,差异无显著差异(P0.05)。肝气郁结证患者血清中IV-C含量相对较低,与其他各证候肝硬化患者比较,差异有统计学意义(P0.05)。肝气郁结证和水湿内阻证肝硬化患者肝功能分级A级较为常见,显著高于其他证候患者,差异有统计学意义(P0.05);湿热内蕴证和瘀血内阻证患者肝功能分级B级明显高于其他证型患者,差异有统计学意义(P0.05);肝肾阴虚证和脾肾阳虚证患者肝功能C级患者较多,与其他证型患者比较,差异有统计学意义(P0.05)。结论:通过对慢性乙型肝炎后肝硬化患者进行中医证候判定,结合肝纤维化指标可大致了解患者肝功能分级和肝硬化程度,有助于临床诊治,阻止病情恶化,有利于判断预后,提高患者生活质量。

Correlation Between TCM Syndromes and Serum TGF-β1, HA,LN, Ⅳ-C and PC-Ⅲ Level of Chronic Hepatitis B After Liver Cirrhosis Patients

Objective:To observe the correlation between TCM syndromes and serum TGF-β1,HA,LN,Ⅳ-C and PC-Ⅲ levels in patients with chronic hepatitis B after cirrhosis.Methods:147 patients with chronic hepatitis B were selected as the observation group and 30 healthy adults were selected as the control group.The levels of transforming growth factor-β (TGF-β1),hyaluronic acid (HA),laminin,type Ⅳ-collagen and pre-collagen Ⅲ were measured.The patients were divided according to the liver functions,and the comprehensive analysis and comparison were made.Results:The content of TGF-β1 in cirrhotic patients was significantly higher than that in normal adults (P ＜ 0.05).The levels of TGF-β1 in serum of patients with cirrhosis from high to low were:Liver Qi Stagnation Syndrome ＜ Internal Dampness Syndrome ＜ Internal Dampness and Heat Syndrome ＜ Blood Stasis Syndrome ＜ Liver and Kidney Yin Deficiency Syndrome ＜ Spleen and Kidney Yang Deficiency Syndrome.The levels of HA,PC-Ⅲ,LN and Ⅳ-C in patients with liver cirrhosis were significantly higher than those in normal adults (P ＜ 0.05),and the indexes of liver fibrosis were higher in patients with Blood Stasis Syndrome.The levels of HA and PC-Ⅲ in serum of patients with Blood Stasis Syndrome,Liver and Kidney Yin Deficiency Syndrome and Spleen and Kidney Yang Deficiency Syndrome were significantly higher than those of Internal Dampness Syndrome and Internal Dampness and Heat Syndrome (P ＜ 0.05).There was no significant difference in serum LN level between the other patients with syndrome cirrhosis (P ＞ 0.05),except for the high levels of LN in patients with Blood Stasis Syndrome.The level of Ⅳ-C in serum of patients with Liver Qi stagnation Syndrome was significantly low (P ＜ 0.05).Patients of Liver function grade A in Dampness and Heat Syndrome and Blood Stasis Syndrome were significantly more than those of other syndromes (P ＜ O.05).Patients of Liver function grade B with Liver Qi Stagnation Syndrome and Internal Dampness Syndrome were significantly more than those of other syndromes (P ＜ 0.05).Patients of Liver function C in Liver and Kidney Yin Deficiency Syndrome and Spleen and Kidney Yang Syndrome were significantly more than that of other syndromes (P ＜ 0.05).Conclusion:It is helpful to judge the prognosis of patients with chronic hepatitis B with posthepatitic cirrhosis with reference to the TCM syndromes to determine the degree of liver function and the degree of liver cirrhosis,to help the clinical diagnosis and treatment,to prevent the disease from deteriorating,and to improve the quality of life of patients.