乙型肝炎病毒感染相关疾病不同阶段中医证候变化特点分析

目的 分析乙型肝炎病毒（hepatitis B virus，HBV）感染后人群不同疾病阶段的中医证候特点。方法 采用前瞻性队列研究的方法，将2007年6月至2017年12月江苏省启东市辖区内8个城镇既往在门诊或其他普查中显示乙型肝炎表面抗原（hepatitis B surface antigen, HBsAg）阳性的居民纳入研究队列，从研究队列中筛选出HBV携带发展至慢性乙型肝炎（chronic hepatitis B, CHB）患者691例，从CHB发展至肝硬化患者143例，以首次确诊CHB为时间点，同时辨识该时间点1年前、2年前和1年后、2年后的中医证候；以首次确诊肝硬化为时间点，同时辨识该时间点1年前、2年前和1年后、2年后的中医证候，观察在不同的时间点，HBV携带至CHB、CHB至肝硬化病变进展过程中的中医证候分布特征。结果 在HBV携带至CHB的发展过程中，气滞证在疾病的不同阶段出现频次均大于25%，随着疾病发展，血瘀证、实热证、气虚证病例数明显增加，而且中医证候构成越发复杂。从CHB到肝硬化的发展过程中，气滞证、血瘀证、实热证、气虚证在每个阶段出现的频次均大于25%，随着疾病发展，血瘀证、实热证、气虚证、阴虚证病例数明显增加，肝硬化患者中医证候组成含有3个和3个以上基本证候者最为常见。结论 随着病情由HBV携带向CHB、肝硬化演变，患者中医证候日趋复杂，由以实证（气滞、血瘀、实热）为主向虚实夹杂证候（夹气虚、阴虚、阳虚）转化，气滞血瘀、瘀而化热酿毒为HBV感染相关疾病的核心病机。

Changes in TCM Syndromes of Hepatitis B Virus related Diseases in Different Stages

Objective To investigate the features of traditional Chinese medicine (TCM) syndromes in patients with hepatitis B virus (HBV) infection in different stages. Methods We carried out a prospective cohort study in the residents from 8 towns of Qidong, Jiangsu province, China, who tested positive for HBsAg in check ups from June 2007 to December 2017. Among the subjects, 691 patients carried HBV and developed into chronic hepatitis B (CHB) and 143 patients developed from CHB into liver cirrhosis. With the time of initial confirmed diagnosis of CHB as the time point for evaluation, TCM syndromes at 1 and 2 years before and after this time point were evaluated; with the time of initial confirmed diagnosis of liver cirrhosis as the time point for evaluation, TCM syndromes at 1 and 2 years before and after this time point were evaluated. The distribution characteristics of TCM syndromes at different time points from HBV carrying to CHB and from CHB to liver cirrhosis were observed. Results From HBV carrying to CHB, Qi stagnation syndrome had a frequency of >25% in different stages of the disease; along with disease progression, there were significant increases in the numbers of patients with blood stasis syndrome, excessive heat syndrome, and Qi deficiency syndrome, and the composition of TCM syndromes became more complicated. From CHB to liver cirrhosis, Qi stagnation syndrome, blood stasis syndrome, excessive heat syndrome, and Qi deficiency syndrome had a frequency of >25% in each stage of the disease; along with disease progression, there were significant increases in the numbers of patients with blood stasis syndrome, excessive heat syndrome, Qi deficiency syndrome, and Yin deficiency syndrome, and most patients with liver cirrhosis had three or more basic syndromes. Conclusion With disease progression from HBV carrying to CHB and liver cirrhosis, TCM syndromes become more complicated and change from excess syndromes (Qi stagnation, blood stasis, and excessive heat) to deficiency and excess combined syndromes (Qi deficiency, Yin deficiency, and Yang deficiency). Qi stagnation and blood stasis and toxin due to stasis and heat are core pathogenesis of HBV related diseases.