伴或不伴自身抗體陽性慢性乙肝患者的中醫(yī)證型分布規(guī)律及相關(guān)指標(biāo)的研究

伴或不伴自身抗體陽性慢性乙肝患者的中醫(yī)證型分布規(guī)律及相關(guān)指標(biāo)的研究伴或不伴自身抗體陽性慢性乙肝患者的中醫(yī)證型分布規(guī)律及相關(guān)指標(biāo)的研究

摘要

目的：為了探究伴或不伴自身抗體陽性慢性乙肝患者的中醫(yī)證型分布規(guī)律及相關(guān)指標(biāo)，為臨床中藥治療提供依據(jù)。

方法：選擇2018年1月至2020年12月間，我院收治的伴或不伴自身抗體陽性慢性乙肝患者共計(jì)180例，通過檢查患者口腔黏膜、舌、絡(luò)脈、腹部等指標(biāo)，結(jié)合中醫(yī)病證分析理論，按中醫(yī)證型分類；并分析患者的性別、年齡、乙肝病程等基本信息及相關(guān)指標(biāo)，比較兩組之間差異。

結(jié)果：180例患者中男113例，女67例，男女比例為1.68:1；平均年齡為37.52±8.82歲，乙肝病程為7.25±3.99年。其中自身抗體陽性患者為118例，占65.6%；自身抗體陰性為62例，占34.4%。自身抗體陽性患者證型以肝腎陰虛、脾虛濕阻、肝膽濕熱為主；自身抗體陰性患者證型以熱毒蘊(yùn)結(jié)、肝腎陰虛、血瘀風(fēng)濕為主。兩組之間乙肝病程、血清HBV-DNA水平、肝功能等指標(biāo)差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。

結(jié)論：伴或不伴自身抗體陽性慢性乙肝患者證型分布規(guī)律存在差異，自身抗體陽性患者以肝腎陰虛、脾虛濕阻、肝膽濕熱為主；自身抗體陰性患者以熱毒蘊(yùn)結(jié)、肝腎陰虛、血瘀風(fēng)濕為主。對此需要針對性的中藥治療方案。

關(guān)鍵詞：慢性乙肝；自身抗體陽性；中醫(yī)證型；基本信息；相關(guān)指標(biāo)

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