Xie He-Ping, Liu Zhi-Ping, Zhang Jiong-Shan, Dai Min, Xiao Ge-Min, Wu Wei-Kang, Yang Hong-Zhi
Department of Integrative Chinese and Western Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
Evid Based Complement Alternat Med. 2018 Oct 2;2018:7482593. doi: 10.1155/2018/7482593. eCollection 2018.
The aim of this study is to investigate traditional Chinese medicine syndrome (TCMS) patterns and their association with hepatitis B surface antigen (HBsAg) levels during the natural history of chronic hepatitis B virus infection (CHB). Patients were categorized according to the phase of CHB, as follows: immune tolerance (ITP); immune clearance (ICP); low or nonreplication (LRP); reactivation (RAP); hepatic cirrhosis (HC); and primary liver cancer (PLC). TCMS patterns were classified among the following types: spleen-kidney deficiency (SKD); liver-qi depression (LQD); damp-heat in liver-gallbladder (LGDH); liver-kidney deficiency (LKD); and blood stasis blocking collateral (BSBC). HBsAg levels and other serological indicators were quantified for all patients and their association with TCMS was statistically analyzed and determined. Two hundred and eighty-nine patients with CHB were included. During the natural history of CHB, TCMS patterns were statistically different among the different phases ( 0.001). The most frequently occurring syndromes among the six progressive phases were SKD, LGDH, LKD, LGDH, BSBC, and LGDH, respectively. The predominant patterns in the inactive stage (ITP + LRP), active stage (ICP + RAP), and late or advanced stage (HC + PLC) were SKD (31%), LGDH (51.8%) and BSBC (34.4%), respectively. Median HBsAg levels were also statistically different among the five patterns of TCMS ( 0.001). The highest HBsAg levels were observed in SKD (4.48 log IU/mL). Medium levels were in LQD (3.91 log IU/mL) and LGDH (3.90 log IU/mL). The lowest HBsAg levels were in LKD (3.60 log IU/mL) and the second lowest levels in BSBC (3.81 log IU/mL). In addition, HBsAg levels in LKD and BSBC were significantly lower than those in SKD, LQD, and LGDH ( < 0.05 or 0.001). TCMS was altered during the natural history of CHB and correlated with HBsAg titers. This study could provide further insight into the therapy of CHB.
本研究旨在探讨慢性乙型肝炎病毒感染（CHB）自然史过程中的中医证候类型及其与乙肝表面抗原（HBsAg）水平的关系。根据CHB的阶段对患者进行分类，如下：免疫耐受期（ITP）；免疫清除期（ICP）；低复制或非复制期（LRP）；再激活期（RAP）；肝硬化（HC）；以及原发性肝癌（PLC）。中医证候类型分为以下几种：脾肾亏虚（SKD）；肝郁气滞（LQD）；肝胆湿热（LGDH）；肝肾亏虚（LKD）；以及瘀血阻络（BSBC）。对所有患者的HBsAg水平和其他血清学指标进行量化，并对其与中医证候的相关性进行统计分析和判定。纳入了289例CHB患者。在CHB自然史过程中，不同阶段的中医证候类型存在统计学差异（P<0.001）。六个进展阶段中最常见的证候分别为SKD, LGDH, LKD, LGDH, BSBC和LGDH。非活动期（ITP + LRP）、活动期（ICP + RAP）和晚期或终末期（HC + PLC）的主要证候类型分别为SKD（31%）、LGDH（51.8%）和BSBC（34.4%）。五种中医证候类型的HBsAg水平中位数也存在统计学差异（P<0.001）。SKD患者的HBsAg水平最高（4.48 log IU/mL）。LQD（3.91 log IU/mL）和LGDH（3.90 log IU/mL）患者的HBsAg水平中等。LKD患者的HBsAg水平最低（3.60 log IU/mL），BSBC患者的HBsAg水平次之（3.81 log IU/mL）。此外，LKD和BSBC患者的HBsAg水平显著低于SKD、LQD和LGDH患者（P<0.05或P<0.001）。CHB自然史过程中中医证候发生改变，并与HBsAg滴度相关。本研究可为CHB的治疗提供进一步的见解。
