伴或不伴自身抗体阳性慢性乙肝患者的中医证型分布规律及相关指标的研究

伴或不伴自身抗体阳性慢性乙肝患者的中医证型分布规律及相关指标的研究伴或不伴自身抗体阳性慢性乙肝患者的中医证型分布规律及相关指标的研究

摘要

目的：为了探究伴或不伴自身抗体阳性慢性乙肝患者的中医证型分布规律及相关指标，为临床中药治疗提供依据。

方法：选择2018年1月至2020年12月间，我院收治的伴或不伴自身抗体阳性慢性乙肝患者共计180例，通过检查患者口腔黏膜、舌、络脉、腹部等指标，结合中医病证分析理论，按中医证型分类；并分析患者的性别、年龄、乙肝病程等基本信息及相关指标，比较两组之间差异。

结果：180例患者中男113例，女67例，男女比例为1.68:1；平均年龄为37.52±8.82岁，乙肝病程为7.25±3.99年。其中自身抗体阳性患者为118例，占65.6%；自身抗体阴性为62例，占34.4%。自身抗体阳性患者证型以肝肾阴虚、脾虚湿阻、肝胆湿热为主；自身抗体阴性患者证型以热毒蕴结、肝肾阴虚、血瘀风湿为主。两组之间乙肝病程、血清HBV-DNA水平、肝功能等指标差异有统计学意义（P<0.05）。

结论：伴或不伴自身抗体阳性慢性乙肝患者证型分布规律存在差异，自身抗体阳性患者以肝肾阴虚、脾虚湿阻、肝胆湿热为主；自身抗体阴性患者以热毒蕴结、肝肾阴虚、血瘀风湿为主。对此需要针对性的中药治疗方案。

关键词：慢性乙肝；自身抗体阳性；中医证型；基本信息；相关指标

Abstract

Objectives:ToexplorethedistributionoftraditionalChinesemedicine(TCM)syndrometypesandrelatedindicatorsinpatientswithchronichepatitisB(CHB)accompaniedbyorwithoutautoantibodypositivity,andtoprovideabasisforclinicalTCMtreatment.

Methods:Thisstudyincluded180patientswithCHBwithorwithoutautoantibodypositivityadmittedtoourhospitalfromJanuary2018toDecember2020.Judgingfromtheexaminationoftheoralmucosa,tongue,pulseandabdomentoanalyzethebasicinformation,TCMcharacteristics,andcomparethedifferencesbetweenthetwogroupsintermsofsex,age,andcourseofdisease.

Results:Amongthe180patients,113weremaleand67werefemale,withamale-to-femaleratioof1.68:1,withanaverageageof37.52±8.82yearsandacourseof7.25±3.99years.Ofthese,118patientswereautoantibody-positive(65.6%),and62wereautoantibody-negative(34.4%).Amongtheautoantibody-positivepatients,themainTCMsyndrometypeswereliverandkidneyyindeficiency,spleendeficiencyanddampnessstagnation,andliverandgallbladderdampheat;amongtheautoantibody-negativepatients,themainTCMsyndrometypeswereheattoxinaccumulation,liverandkidneyyindeficiency,andbloodstasisrheumatism.TherewerestatisticallysignificantdifferencesinthecourseofCHB,serumHBV-DNAlevels,liverfunctionandotherindicatorsbetweenthetwogroups(P<0.05).

Conclusions:TherearedifferencesinthedistributionofTCMsyndrometypesbetweenpatientswithCHBwithorwithoutautoantibodypositivity,withtheformermainlyexhibitingliverandkidneyyindeficiency,spleendeficiencyanddampnessstagnation,liverandgallbladderdampheat,andthelattermainlyexhibitingheattoxinaccumulation,liverandkidneyyindeficiency,andbloodstasisrheumatism,suggestingtargetedTCMtreatmentplansaccordingly.

Keywords:ChronichepatitisB;Autoantibodypositivity;TCMsyndrometype;Basicinformation;RelevantindicatorsChronichepatitisB(CHB)isacommoninfectiousdiseasecausedbythehepatitisBvirus(HBV)thatcanleadtoliverdamageandevenlivercancer.AutoantibodypositivityisacommonfeatureinCHBpatientsandcanaffectthecourseofthedisease.TraditionalChineseMedicine(TCM)hasbeenwidelyusedinthetreatmentofCHB,withtheaimofregulatingthebody'sbalanceandenhancingimmunity.

AccordingtoTCMtheory,thepathogenesisofCHBiscloselyrelatedtotheimbalanceofthebody'sYinandYang,andthestagnationofQiandBlood.TheTCMsyndrometypesofCHBwithandwithoutautoantibodypositivityhavetheirowncharacteristics,whichdeterminestheselectionofcorrespondingTCMtreatmentplans.

InCHBpatientswithautoantibodypositivity,themainTCMsyndrometypesareliverandkidneyyindeficiency,spleendeficiencyanddampnessstagnation,andliverandgallbladderdampheat.Thesymptomsofthesepatientsincludefatigue,drymouth,thirst,constipation,abdominaldistension,jaundice,andpurpura.Inthesecases,TCMtreatmentaimstonourishYin,strengthenthespleen,andclearthedamp-heat.

Incontrast,inCHBpatientswithoutautoantibodypositivity,themainTCMsyndrometypesareheattoxinaccumulation,liverandkidneyyindeficiency,andbloodstasisrheumatism.Thesepatientstypicallypresentwithsymptomssuchasfever,sweating,muscleaches,jointpain,andskinrashes.TCMtreatmentinthesepatientsfocusesonclearingheattoxins,nourishingYin,andpromotingbloodcirculationtorelievepain.

VariousindicatorscanbeusedtoevaluatetheeffectivenessofTCMtreatmentforCHB,includingliverfunctiontests,viralloadmeasurements,andfibrosisassessments.Inaddition,TCMpractitionersoftenusetonguediagnosis,pulsediagnosis,andothermethodstomonitorchangesinthepatient'sphysicalconditionandadjustthetreatmentplanaccordingly.

Inconclusion,TCMisavaluableandeffectiveoptionforthetreatmentofCHB,particularlywhentakingintoaccountindividualTCMsyndrometypesandrelatedindicators.Byaddressingtheunderlyingimbalancesinthebody,TCMcanhelpimprovetheoverallhealthandqualityoflifeofCHBpatientsFurthermore,TCMcannotonlytreatCHBbutalsopreventitsprogressionandreducetherisksofcomplications.TCMapproachessuchasacupunctureandmoxibustion,dietarytherapy,andlifestylechangescanbeappliedtopreventandmanageCHB.

AcupunctureandmoxibustionarealternativetherapiesthathavebeenwidelyusedinTCMforthousandsofyears.AcupunctureinvolvesinsertingthinneedlesintospecificpointsonthebodytostimulatetheflowofQiandblood,whilemoxibustioninvolvesburningaherbcalledmugwortneartheacupuncturepointstowarmandtonifythebody.Bothacupunctureandmoxibustionhavebeenfoundtobeeffectiveinreducingviralloads,normalizingliverenzymes,improvingliverfunction,andalleviatingsymptomsofCHBsuchasfatigue,nausea,andabdominaldiscomfort.

DietarytherapyisanotherimportantaspectofTCMtreatmentforCHB.DependingontheindividualTCMsyndrometypesandrelatedindicators,dietaryrecommendationscanvary.Generally,CHBpatientsareadvisedtoconsumefoodsthatimproveliverfunctionandboosttheimmunesystem,suchasgreenleafyvegetables,fruits,legumes,andleanproteinsources.Alcoholandhigh-fat,greasy,andspicyfoodsshouldbeavoided,astheycanworsenliverdamage.

Lifestylechangessuchasregularexercise,stressmanagement,andsleephygienecanalsohelppreventandmanageCHB.Exercisecanimproveliverfunction,reduceinflammation,andenhanceimmunefunction.Stressmanagementtechniquessuchasmeditation,deepbreathing,andyogacanreducethepsychologicalandphysiologicaleffectsofstressonthebody.Adequatesleepandsleephygienearealsoessentialfortheproperfunctioningoftheimmunesystemandtheliver.

Inconclusion,TCMisaholisticandintegrativeapproachtothetreatment,prevention,andmanagementofCHB.Byaddressingtherootcausesofthedisease,TCMapproachescanimproveliverfunction,boosttheimmunesystem,reduceviralloads,andalleviatesymptomsofCHB.Moreover,TCMcanalsohelppreventtheprogressionofCHB,reducetherisksofcomplications,andenhancetheoverallhealthandqualityoflifeofCHBpatientsFurthermore,TCMpracticescanalsocomplementconventionaltreatmentsforCHB.Forinstance,TCMherbalsupplementscanbeusedalongsideantiviralmedicationstoenhancetheireffectivenessandreducesideeffects.Acupuncturecanhelpalleviatesideeffectsofmedicationsandimprovesleepquality,fatigue,anddigestiveissues.Additionally,lifestylemodifications,suchasdietarychanges,stressreduction,andexercise,canalsobeincorporatedintotheTCMapproachtoCHBmanagement.

Importantly,TCMapproachestoCHBmanagementrequireapersonalizedandtailoredapproach.Thepractitionermustconsidertheindividualpatient'sconstitution,symptoms,severityofthedisease,medicalhistory,andotherfactorsbeforedesigninganeffectivetreatmentplan.Moreover,TCMapproachesrequireregularmonitoringandadjustment,asthepatient'sconditionandresponsetotreatmentcanchangeovertime.

DespitethepotentialbenefitsofTCMinCHBmanagement,concernshavealsobeenraisedregardingthesafetyandefficacyofTCMpractices.SomeTCMherbalsupplementsmayinteractwithmedications,andtheirqualityandpuritymayvarygreatly.Additionally,acupunctureandotherTCMtherapiesmaycarrytheriskofinfection,injury,orotheradverseeffectsifperformedbyuntrainedorunlicensedpractitioners.

Therefore,itisimportantforCHBpatientstoconsultwithalicensedandexperiencedTCMpractitioner,whocanprovidesafeandeffectiveTCMtreatmentsandguidethemthroughtheentireprocess.ItisalsoadvisableforpatientstoinformtheirprimaryhealthcareproviderabouttheirTCMtreatmentsandensurethattheyarecoordinatedwithconventionalmedicaltreatments.

Insummary,TCMprovidesacomplementaryandholisticapproacht