84例不同中医证型慢性乙型肝炎患者肝穿刺活检回顾性研究

目的 探讨慢性乙型肝炎（chronic hepatitis B，CHB）病理分级与中医证型的关系。 方法 对84例经彩超引导下行肝穿刺活检的CHB患者的中医证型、肝脏病理分级、临床分级、肝功能指标进行回顾性研究。 结果 84例CHB患者中，湿热蕴结证21例，肝郁气滞证34例，肝肾阴虚证7例，瘀血阻络证13例，脾肾阳虚证9例。肝脏炎症活动度与纤维化分期呈明显正相关（r=0.662，P=0.000）；临床分级与病理分级呈显著正相关（r=0.556，P=0.000）；不同证型CHB患者的病理分级比较，差异无统计学意义（P>0.05）；不同证型CHB患者血清谷丙转氨酶、谷草转氨酶、直接胆红素水平比较，差异均无统计学意义（P>0.05），不同证型患者血清总胆红素水平比较，差异具有统计学意义（P＜0.05）。 结论 肝郁气滞证和湿热蕴结证是CHB患者的主要证型，病理分级和肝功能检查尚不能用于CHB的辨证分型。

Liver Biopsy for Chronic Hepatitis B Patients with Different TCM Syndrome Types: A Retrospective Analysis of 84 Patients

Objective To investigate the association between pathological classification and traditional Chinese medicine (TCM) syndrome types in patients with chronic hepatitis B (CHB). Methods The TCM syndrome types, liver pathological classification, clinical classification, and liver function parameters were analyzed retrospectively for 84 patients with CHB who underwent liver biopsy under the guidance of color Doppler ultrasound. Results Of all the patients, 21 had damp-heat accumulation, 34 had liver qi stagnation, 7 had liver-kidney yin deficiency, 13 had blood stasis blocking collaterals, and 9 had spleen-kidney yang deficiency. Liver inflammatory activity was positively correlated with fibrosis stage (r=0.662, P=0.000); clinical classification was correlated with pathological classification (r=0.556, P=0.000). Pathological classification showed no significant differences between the CHB patients with different TCM syndrome types (P>0.05). There were no significant differences between the CHB patients with different TCM syndrome types in serum levels of alanine aminotransferase, aspartate aminotransferase, and direct bilirubin (P>0.05), but a significant difference was observed in the serum level of total bilirubin (P<0.05). Conclusion Liver qi stagnation and damp-heat accumulation are major TCM syndrome types in patients with CHB, and pathological classification and liver function examination cannot be applied for syndrome differentiation of CHB.