| Objective1. To investigate the pathological and immunohistochemical features of chronic hepatitis B virus carriers over 30 years old in our country, and make sure the related factors of pathology in chronic hepatitis B virus carriers over 30 years old, both of which will provide the evidence for the clinical treatment strategies of chronic HBV carriers.2. Though the development of the clinical study of traditional Chinese Bushen Qingtou prescription and Bushen Jianpi prescription, to evaluate the influence of traditional Chinese tonifying kidney therapy on pathology in chronic hepatitis B virus carriers over 30 years old, and further clarify the correlation between liver histological response and clinical curative indexes, and assess the curative effect of tonifying kidney therapy intervention in high age chronic hepatitis B virus carriers.Methods1.600 chronic hepatitis B virus carriers over 30 years old were enrol led from all over the country as the research object.2. With the multi-center, randomized,double-blinded and placebo-contro lled methods,600 cases chronic hepatitis B virus carriers were divided in to three groups randomly according to the proportion of 1:1:1,200 cases in each group, and Bushen Qingtou prescription, Bushen Jianpi prescription and placebo prescription were taken in each group respectively for 52 we eks. The liver biopsy was done in 459 patients,and were double-blind read ed to score by two pathologist.106 cases were taken liver biopsy examina tion before and after treatment, observation indexes including the patholo gical and immunohistochemical changes of the liver biopsy, as well as the changes of serum markers of HBsAg and the DNA quantitative of serum HBV, the relationship between liver histological response and serum markers of HbBsAg and the DNA quantitative of serum.Results1. The liver histological features of 459 chronic HBV carriers over 30 years old.The 459 chronic hepatitis B virus carriers over 30 years old includin g 290 cases men (63.18% of the total population),169 cases female (36.8 2% of the total population);the average age was 34.82±6.36; 94 cases wer efrom the east district (20.48% of the total population),41 cases were fr om the west district(8.93% of the total population),231 cases were from t he south district(50.33% of the total population),46 cases of north distr ict(10.02% of the total population),47 cases were from the the middle di strict(10.24% of the total population). The results of liver biopsy of 459 chronic hepatitis B virus carriers show that 165 cases Knodell HAI≥4(35. 95% of the total population),294 cases Knodell HAI<4(64.05% of the total population); 183 cases Ishak≥2(39.87% of the total population),286 cases Ishak<2(60.13% of the total population).Chronic HBV carriers liver tissue Knodell HAI score can be classified as level 1,level 2,level 3 and level 4,respectively correspongding to the 0 to 3,4 to 6 points,7 to 9 points and 10 to 18 points. Male cases in liv er tissue inflammation activity classification (percentage) were 190 (65. 5%),54(18.6%),31(10.7%),15 cases(5.2%) respectively, and female cases in t he classification(%) is respectively 104(61.5%),34(20.1%),25(14.8%),6 cases(3.6%). Chronic HBV carriers liver tissue Ishak fibrosis score can be divided into level 1,2,3,4,5,6 respectively correspongding to the 0 ,1,2,3,4,5 and 6 points. Male cases in fibrosis grading (percentage) were 180(62.1%),81(27.9%),12(4.1%),12(4.1%),4(1.4%),1(0.3%), respect ively, and female cases in the fibrosis grading (percentage) were 96(56. 8%),56(33.1%),12(7.1%),4(2.4%),1(0.6%), and 0 cases (0.0%), and the di fference in gender was no statistical significance in liver tissue Knodel 1 rating, HAI Ishak fibrosis score of over 30 years old(P>0.05).459 cases of chronic HBV carriers over 30 years old were divided into three layers by age 30 to 39,40 to 49 and over 50 years old, including 376 cases of 30-39 age carriers,64 cases fo 40 to 49 age carriers and 1 9 cases of over 50 years old. The difference in liver tissue Knodell HAI score and Ishak fibrosis score in three ages layers had statistical significance (P<0.01), and in the Knodell score the differences between three age groups had statistical significance (P<0.01);Ishak fibrosis sc ore of 30 to 39, compared with over 50 years old, P=0.004, the differen ce was statistically significant,30 to 39 age compared with 40 to 49 gag, and 40 to 49 age compared with over 50 yesrs, there were no statistica lly significant difference (P>0.05), the results showed that as the grow th of the age, liver tissue inflammation activity and fibrosis degree wer e gradually aggravated in chronic HBV carriers over 30 years old.Liver tissue HBsAg, HBcAg expression of chronic HBV carriers, can be divided into five grades according to the microscopic shaded cells, and th e grades are "-", "+", "++", "+++", "++++".Male cases in HBsAg expr ession level cases of liver tissue were 13,98,50,27,2 cases, HBcAg exp ression levels were 37,115,100,37 and 1 respectively. Females cases in HBsAg expression levels were 3,123,30,10 and 3 cases, HBcAg expression levels were 10,77,56,26 cases, and 0 cases respectively. The sex diffe rence in the liver tissue HBsAg, HBcAg expression level of chronic HBV ca rriers was not statistically significant (P>0.05). The cases of 30-39 ye ars old in HBsAg, HBcAg expression level were respectively 39,158,130, 48,1 case, and 13,267,64,28,4 cases; cases in aged 40 to 49 were 27,19,11,0, and 2 cases,43,11,7,1; cases over 50 years old were 1,7,7,4,0, and 1,11,5,2,0 case, the differences in age stratific ation of liver tissue HBsAg, HBcAg expression were no statistical signifi cance (P>0.05).The correlation coefficient value(r) of Chronic HBV carriers Knodell HAI grading with Ishak fibrosis score was 0.599, and there was moderate p ositive correlation between them, with statistical significance (P<0.01). The correlation coefficient of Knodell HAI scores and ALT was 0.245, P = 0.000, weak positive correlation existed between them; and weak negati ve correlation was in Knodell HAI score and serum HBsAg, HBV DNA. The cor relation had no statistical significance in Knodell HAI scores grading a nd HBsAg, HBcAg expression levels of liver tissue(P>0.05).The correlation coefficient of Ishak fibrosis score and ALT was 0.181, P=0.000, weak positive correlation existed between them; weak negative c orrelation existed in Ishak fibrosis score and serum HBsAg, HBV DNA; the c orrelation coefficient of Ishak fibrosis score grading and HbsAg expressi n levels of liver tissue was 0.116, P=0.007, weak positive correlation ex isted between them; the correlation between Ishak fibrosis score grading sand HBcAg expression levels had no statistical significance (P>0.05).2. The pathologic changes of 106 cases chronic HBV carriers over 30 y ears old after tonifying kidney therapy.The clinical research showed:after the 52 weeks treatment of, the n umber of decreasing more than 2 points on Knodell HAI in Bushen Qingtou p rescription group, Bushen Jianpi prescription group and control group was 21,18,6 respectively,there were significant differences between groups, P<0.05 (P=0.008).The number of increasing more than 2 points on Knodell HAI in three groups was 3,2,8 respectively, there were significant diffe rences between groups, P<0.05 (P=0.024), the curative effect of Bushen Qi ngtou prescription, Bushen Jianpi prescription were significantly obvious ly better than control group, there were no significant difference between these two treatment groups.The number of decreasing more than 1 points on Knodell HAI in Bushen Qingtou prescription group, Bushen Jianpi prescription group,control gro up wasl3,12,9 respectively, there were no significant differences betwee n three groups, P>0.05 (P=0.805), which meant there were no significant i mprovement on the liver tissue fibrosis in three groups. The number of in creasing more than 1 points on Ishak in Bushen Qingtou prescription group, Bushen Jianpi prescription group,controlled group was 8,3,11 respective ly,there was significant difference between Bushen Jianpi prescription gr oup and controlled group, P<0.01 (P=0.011), there was no significant dif ference between Bushen Qingtou prescription group and control group, P>0. 05 (P=0.114), which meant the Bushen Jianpi prescription could prevent the deterioration of liver tissue fibrosis more significantly than placebo p rescription did, while there was no significant difference between Bushen Qingtou prescription group and control group, in conclusion,the Bushen Jianpi prescription could prevent the deterioration of liver tissue fibro sis.After 52 weeks treatment, the number of decreasing more than 1 point on HBsAg in Bushen Qingtou prescription group, Bushen Jianpi prescription group, control group was 6,6,6 respectively, the number of decreasing mo re than 1 point on HBcAg in Bushen Qingtou prescription group, Bushen Ji anpi prescription group.control group was 16,11,11 respectively, there w ere no significant differences between three groups (P>0.05)The result of HBsAg expression showed:there were significant differe nce between before and after the treatment of Bushen Qingtou prescription, Bushen Jianpi prescription (P<0.01), there were no significant differen ce between before and after the treatment of placebo prescription (P>0.0 5), and there were no significant difference between the difference value comparison of treatment groups (P>0.05). The result of HBV DNA showed: there were significant difference between before and after the treatment of Bushen Qingtou prescription, Bushen Jianpi prescription (P<0.01), the re were no significant difference between before and after the treatment of placebo prescription (P>0.05), there were significant difference betw een Bushen Qingtou prescription group, Bushen Jianpi prescription group an d placebo prescription group (P<0.01, P<0.05), and there were no signif icant difference between the difference value comparison of treatment gro ups (P>0.05). In conclusion, tonifying kidney therapy could reduce the s erum markers of HBsAg expression, as well as inhibit the replication of H BV DNA effectively.The result of Knodell HA showed:in Bushen Jianpi prescription group, the improvement of Knodell HAI showed a strong positive correlation with serum markers of HBsAg (r=0.554, P=0.017), no correlation with HBV DNA.le vel (P>0.05). In Bushen Qingtou prescription group and placebo prescript ion group.there were no correlation between Knodell HAI and serum marker s of HbsAg, HBV DNA. There were no correlation between the improvement of I shak and serum markers of HBsAg, HBV DNA, there were no statistically significant of correlation coefficient (P>0.05).Conelusion1. More than 30 percent chronic HBV carriers over 30 years old have the risk of inflammatory activity and fibrosis progression, which have nothing to do with gender but age. The expression of HBsAg and HBcAg in liver tissue have nothing to do with gender and age, while have a weak correlation with serum HBsAg、HBV DNA, but ALT is the important factor to influence the inflammatory activity and fibrosis progression.2. Tonifying kidney therapy,including Bushen Qingtou and Bushen Jianpi, can help chronic HBV carriers over 30 years old to inhibit the inflammatory activity and slow down the fibrosis progression, but the influence on immunohistochemistry index is not obvious. There is some correlation between pathological improvement and serological decline in those chronic HBV carriers over 30 years old. |
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