| 1.ObjectivesTo explore the relationship between different TCM evidence patterns and liver pathology and physicochemical indicators in CHB patients by analyzing the relationship between different TCM evidence patterns and liver biochemical indicators in peripheral blood,HBV-DNA,liver inflammation activity grade,fibrosis stage and the detection rate of HBsAg and HBcAg in liver tissues,so as to provide a basis for TCM identification and treatment of CHB patients.2.MethodsFrom July 2010 to September 2019,941 patients with chronic hepatitis B hospitalized in the Department of Infection of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine were selected as the study subjects.941 patients with CHB included in the study were classified into Chinese medicine evidence types,which were liver-depression and spleen-deficiency evidence,damp-heat-internal knot evidence,blood-stasis and blood-blocking evidence,spleen-kidney-yang deficiency evidence and liver-kidney-yin deficiency evidence,and all patients underwent pathological examination by liver tissue aspiration biopsy.The expression of HBsAg and HBcAg in liver tissues was detected by immunohistochemistry,and the relationship between TCM evidence and clinical indicators,liver pathology and the expression of HBsAg and HBcAg in liver tissues was analyzed.3.Results941 patients with CHB were included in this study.(1)The relationship between the TCM syndromes and peripheral blood levels of ALT,AST,TBiL and HBV-DNA viral load in CHB patients was analysed: one-way ANOVA revealed that the differences in ALT,AST,TBiL and HBV-DNA viral levels among the five syndromes were statistically significant(P<0.05),and serum ALT levels were highest in patients with Damp-Heat Internal Nodules syndrome(133.65±97.45),compared with other syndromes.(P<0.05);serum AST level was the highest in patients with Damp-Heat Internal Nodules(68.88±50.02),which was statistically significant when compared with other types of symptoms(P<0.05);serum TBiL level was the highest in patients with Damp-Heat Internal Nodules(21.94±14.94),which was statistically significant when compared with other types of symptoms(P<0.05).The highest serum HBV-DNA viral load level(7.17±0.88)was found in damp-heat internal junction evidence,and the difference was statistically significant when compared with other evidence types(P<0.05).(2)Correlation between grading of liver histopathological inflammatory activity and fibrosis staging: Spearman’s rank correlation analysis showed that liver inflammatory activity was positively correlated with the degree of fibrosis(rs=0.660,P<0.001),indicating that the degree of liver tissue fibrosis showed a tendency to increase as the degree of liver inflammation increased.(3)Relationship between the TCM evidence types and liver pathology: the degree of inflammatory activity and fibrosis in the cases of liver-depression and spleen-deficiency evidence and damp-heat-internal knot evidence were milder,with the distribution dominated by G1 to G2 and S0 to S2,and there was no statistical difference between the two groups(P>0.05);the degree of inflammation and necrosis and fibrosis in the cases of stasis-blood blockage evidence were the most severe,with the distribution dominated by G3 to G4 and S3 to S4,and there was a statistical difference compared with the other evidence types(P<0.05).(4)HBsAg detection rate in liver tissues was 89.9%,and the difference in HBsAg detection rate among different evidence types was not statistically significant(P>0.05);HBcAg detection rate in liver tissues was 39.9%,and the difference in HBcAg detection rate among different evidence types was statistically significant(P<0.05).The detection rate of HBcAg in liver tissues was statistically significant(P<0.05),with the highest detection rate of damp-heat internal nodules(54.7%)and the lowest detection rate of liver-depression and spleen-deficiency(34.6%),and the difference in the positive detection rate between the two types of evidence was statistically significant(P<0.05).(5)Relationship between the detection rate of HBV markers in liver tissues and liver pathology: The relationship between the detection rate of HBcAg in liver tissues and the grade of inflammatory activity was analyzed and found by chi-square test(χ~2=7.631,P=0.006<0.05),indicating that the difference between the detection rate of HBcAg and different grades of inflammatory activity was statistically significant,and the positive expression rate of G3-G4 was higher;liver tissues There was no correlation between the detection rate of HBsAg and HBcAg in liver tissue and the stage of CHB fibrosis(P>0.05).4.ConclusionThere is a relationship between the TCM evidence pattern of CHB patients and the peripheral blood biochemical indexes(ALT,AST,TBiL)and HBV-DNA levels,the detection rate of HBcAg in liver tissues,the inflammation activity and the fibrosis degree.The combination of the relevant western medical tests and the immune function status of patients in Chinese medicine is helpful to improve the accuracy of the diagnosis and provide a reference basis for clinical treatment. |
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