The Cross-sectional Study Of TCM Syndrome Types Distribution And HBV Gene Common Mutations Characteristics In 572 Chronic Hepatitis B Patients

Objective Subject to the clinical treatment of 572 cases of chronic hepatitis Bpatients with clinical detection of HBV BCP/previous C/C/P area common genemutations sites for research, a retrospectively and prospectively analysis of the patients with HBV about the distribution of TCM syndrome types and gene common mutation characterristies. Preliminary discussion on the distribution of CHB patients with TCM syndrome type and HBV gene common mutations and the correlation between the TCM syndrome type of patients with CHB and HBV gene common mutations and the between TCM syndrome type, to lay foundation for Chinese medicine diagnosis and treatment of HBV and intervention of Chinese medicine HBV gene mutation/resistant mutations, for the future clinical HBV gene mutations in patients with CHB treatment provides guidance significance.Methods ①From November 2010 to January 2015,choose 572 cases from the First Affiliated Hospital of Henan University of TCM in spleen and stomach hepatology outpatient and the inpatient pacjents who were diagnosed CHB to apply cross-sectional survey research.From November 2010 to April 2013 before the hospital outpatient and the inpatient cases information of the patient data,using the method of retrospective study, patients from April 2013 to January 2015 using prospective study method.②ased on the principle of convenience sampling,then collected the basic information of patients(age,gender,course of disease,family hi story, etc.), medical history,clinical symptoms,signs and antiviral medication),tongue veins(tongue,tongue coating,pulse condition) and detection index(BCP/previousC/C/P district,hepatic functional test and HBV-DNA gene common mutations,five items of hepatitis B).③According to the standard of syndromes of TCM by a chief physician,and a doctor of traditional Chinese medicine syndrome differentiation of cases back-to-back.④Then carried on the general statistical descriptions,chi-square test,the Mann-Whitney U rankand other statistical methods for data analysis with SPSS 19.0 statistical software.Results 1 the TCM syndrome type distribution characteristics of CHB patientsThis subject’s collection of 572 cases of patients with chronic hepatitis B,438 cases of men, female 134 cases,gender ratiowas 3.27:1.The onset age was 30～34 most,the average age was 40.2±11.7 years old.Duration distribution in 5～14 years,average duration in 10.6±6.9 years.With or without family history was the ratio of 1:2.TCM syndrome type distribution of the syndrome of hot and humid resistance was 208 cases,the syndrome of liver-depression and spleen-deficient was 284 cases, 31 cases wasthe syndrome of liver and kidney Yin defic-iency,static blood blocking collaterals syndrome was 49 cases,none of spleen and kidney Yang deficiency syndrome.The syndrome of hot and humid resistan-ce and liver-depression and spleen-deficient were the most common,accounted for 36.36% and 49.65% respectively,the two accounted for 86.01%,syndrome of static blood blocking collaterals and deficiency of liver-yin and kidney-yin wereless proportion,8.57% and 5.42% separatel.Wet and heat resistance of the group of ALT and AST levels were the most in 81 200,the number of HBV-DNA distribution in 107 were most.The ALT,AST level distribution of the syndrome of liver-depression and spleen-deficient were largest in 41～80,HBV-DNA quantitative distribution in 106～were most;Liver and kidney Yin deficiency syndrome and blood stasis resistance of the group of ALT and AST in 41 80 and 40 more than others,HBV-DNA level in 105～.HBeAg positive rate in change the highest,accounting for 31.29%,followed by wet and heat resistance, syndrome of static blood blocking collate-rals andliver and kidney Yin deficiency were lower.By the statistical tests, ALTand AST,HBV-DNA quantitative and HBeAg positive incidence in CHB betweendifferent TCM syndrome types have significant difference(P<0.05).2 The distribution of HBV BCP/previousC/C/P area common gene mutationsThis topic in 572 patients with CHB, in area C gene mutation detection of a total of 239 cases of HBV,no mutation 60 cases,due to lack of BCP area heterozygote,cannot be detected 3 cases,176 cases of mutation,HBV gene C area whole mutation ratio is 73.64%.The mutation rate of BCP gene area accounted for 73.30%,previous Cgene area 51.14%,48.30%was Carea.The mutations of A1762T,G1764A,G1896A,I97L locus mutation were frequency.HBV C P/previousC/C common gene mutations and the differences between the sexes(P<0.05),and age, course of diseasehad no significant statistical difference(P>0.05).For common resistance loci mutation in HBV P gene region detection of 480 cases,no mutation 219 cases,261 cases exist the location of the resistance gene.The whole mutation rate was 54.38%.The numerial numberof the subject with testing HBV-DNA were all over 103IU/mL.HBV drug resistance related gene mutation sequencing the success rate was 100%. In the detection of 12 common resistance loci,rtM204V/I/L locus mutation frequency are the most resistant,anti-HBV drug resistance situation of corresponding with LAM,resistance to highest,ETV resistance to a minimum.HBV genotyping in our province isgiven priority to with C,accounted for 91.25%,type B center,accounted for 8.33%.Check before taking antiviral drugs 391 cases,89 cases;not taking drugs Antiviral drugs of 253 cases of drug resistance loci mutation,138 cases didn’t happen;Not taking antiviral drugs,8 cases of drug-resistant variant of 81 cases didn’t happen.8 natural variability,HBV mutation rate is 8.99%.In CHB patients with HBV gene area C mutation,it can be divided into mutation and not mutations group, results showed that the mutation of ALT and AST level and HBeAg positive group were higher than no mutations,and had sense in statistic(P<0.05).HBV gene C area differences in the incidence ofHBeAg various mutations also have statistical significance(P<0.05).But ALT andAST level,HBV-DNA quantitative in each single HBV C gene mutations were no significant sense(P>0.05). HBV P gene region common resistance loci a single base mutation and ALT and AST level,HBV-DNA quantitative,HBeAg positive ratio and no significant difference between the genotyping of (P>0.05).But before taking antiviral drugs and detected have obvious statistical significance (P<0.05).3 The relations between the TCM syndrome type and HBV gene common mutationHBV common gene area mutations between different TCM syndrome types had no obvious statistical significance(P>0.05).Conclusion 1 This study found that the onset of chronic hepatitis B patients in middle-aged and young men was common.The ALT and AST level,HBV-DNA quantitative,HBeAg positive incidence with CHB patients in the TCM syndrome type distribution had a certain correlation, providing clinical basis for syndrome differentiation of traditional Chinese medicine.2 This study thought that male patients with CHB prone to C HBV gene mutation,the mutation canbe elevated ALT and AST levels and HBeAg positive rate increased.3 This study preliminary found that the HBV of CHB patients with untreated has mutated, hemutation has nothing to do with antiviral drugs. And HBV P gene area resistance loci mutation and no correlation between the kinds of antiviral drugs.4 This study found that it’s no obvious correlation between TCM syndrome type and common mutations.