慢性乙型肝炎中医证型临床分析

目的：探讨慢性乙型肝炎中医证型与机体免疫状况、乙型肝炎病毒的相互关系。方法：将156例慢性乙型肝炎按中医辨证分成湿热中阻、肝郁脾虚、瘀血阻络、肝肾阴虚和脾肾阳虚五个证型,观察各证型与病程、肝功能、细胞免疫功能、病毒基因分型及复制状况、脾脏大小的关系。结果：肝郁脾虚证是慢性乙型肝炎最多见的证型,肝损害较轻;湿热中阻证譬车度肝损害较多;瘀血阻络证伴有轻至中度转氨酶升高,脾大;脾肾阳虚证、肝肾阴虚证CD4,CD4／CD8均值低于正常。结论：正气不足反应了细胞免疫功能下降。

Clinical Analysis of Traditional Chinese Medicine Classifications of Chronic Hepatitis B

Objective:To investigate the relationship between the traditional Chinese medicine classifications of chronic hepatitis B,cellular immune function of the patients and the hepatitis B virus.Methods:156 chronic hepatitis B patients were divided into 5 groups according to their traditional Chinese medicine classifications which include 1) the blocking of dampness and heat,2) the depressed liver with the insufficient spleen,3) the blood stasis in collaterals,4) the deficiency of liver-Yin and kidney-Yin,and 5) deficiency of spleen-Yang and kidney-Yang.We collected the following information of each patient,such as the course of disease,liver function,cellular immune function,virus genotype,virus replication makers and spleen size,and investigated the relationship between these information and the traditional Chinese medicine classifications.Results:In the chronic hepatitis B patients,classification-the "depressed liver with the insufficient spleen" had the highest occurrence frequency(41%);and the patients with this classification usually had a light liver injury.The patients with "blocking of dampness and heat" usually had a severe aminopherase increasing.The patients with "blood stasis in collaterals" often had splenomegalia and light to middle increasing level of aminopherase.The CD_4 T lymphocyte subset counts and the ration of CD_4/CD_8 in both the "deficiency of liver-Yin and kidney-Yin" and the "deficiency of spleen-Yang and kidney-Yang" were lower than the normal.Conclusion:The patients with insufficient "Zhengqi" had a lower cellular immune function.