Zhang Guo-liang, Wu Qi-kai, Lin Qiao
Shenzhen Donghu Hospital, Shenzhen.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2007 Jul;27(7):613-5.
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.
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.
(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.
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.
探讨慢性乙型肝炎(CHB)患者中医证型与肝组织病理变化的相关性,为辨证论治提供依据。
对260例CHB患者进行中医辨证分型及肝穿刺活检肝病理分级、分期,分析两者之间的关系。
(1)肝郁脾虚型(Ⅰ型)患者肝脏炎症分级以G1、G2为主;湿热内蕴型(Ⅱ型)以G2为主;肝肾阴虚型(Ⅲ型)和脾肾阳虚型(Ⅳ型)以G3为主;瘀血阻络型(Ⅴ型)以G4为主,与其他证型比较差异有统计学意义。(2)Ⅰ型、Ⅱ型患者肝脏病理分期以S1、S2为主,Ⅲ型、Ⅳ型以S3、S4为主。(3)瘀血证患者病理改变以G3 - G4、S3 - S4为主,非瘀血证以G1 - G2、S1 - S2为主。
中医证型与肝组织病理变化有一定相关性,其中瘀血与否相关性最密切。CHB患者证型随肝脏病理损伤加重,由实转虚,由气及血,最终发展为瘀血阻络,治疗应注重活血化瘀,并分3阶段进行。