| ObjectiveTo analyze the distribution of TCM constitution and the characteristics of liver pathological changes in patients with chronic HBV infection with ALT<2ULN,to explore the relationship between clinical data and the relationship between liver pathology and age,ALT,HBeAg,HBVDNA etc.to change the constitution of traditional Chinese medicine and liver tissues of patients with pathology,the pathological changes in liver tissues from clinical data of the patient's physical and the assessment,revealing the pathogenesis of chronic hepatitis B from the perspective of TCM Constitution,which provides new ideas and theoretical basis for the clinical treatment of different types of physiques.MethodsA total of 134 chronic HBV-infected patients with ALT<2ULN were selected from the Department of Infectious Diseases of our hospital.After exclusion of contraindication,liver biopsy was performed to record the degree of liver tissue pathological inflammation(G)and fibrosis(S)results,as well as the patient's clinical data,including gender,age,liver function,hepatitis B five,HBV-DNA and so on.Using the“Chinese Medicine Constitution Classification and Judgment Form”compiled by Wang Qi and others,a questionnaire survey was conducted on all subjects to determine their constitutional types.The observations were entered into the database and SPSS 19.0 was used for statistical analysis.The data were distributed using the frequency descriptive method.The rates were compared using the chi-square test.The graded data were nonparametric,and the correlation was analyzed by Spearman correlation.P<0.05 was considered statistically significant.Results1?General and clinical features:Of the 134 patients,90 were male(67.2%)and 44were female(32.8%).The oldest was 70 years old,the youngest was 20 years old,and the average age was(37.9311.338)years old;79 cases(59%)were younger than 40years old,and 55 cases(41%)were younger than 40 years old.The highest ALT was94 U/L,the lowest was 10 U/L,and the average was(39.036±20.3230)U/L;91 cases(67.9%)had normal ALT;43 cases(32.1%)had mild elevated ALT.Serum HBeAg-negative cases were 80 cases(59.7%);HBeAg-positive cases were 54 cases(40.3%).The highest HBV DNA level was 3.480×108 copies/ml,of which 17(12.7%)had HBV DNA lower than the detection limit(<1.0×10~3 copies/ml)and 20(1.0×10~3-1.0×10~4 copies/ml)were low levels(14.9%);63 cases(47.0%)of moderate to high levels(1.0x10~4-1.0x10~7copies/ml);34 cases(25.4%)of very high levels(>1.0x10~7 copies/ml).2?The distribution of TCM Constitution:The number of Chinese Medicine Constitution in 134 patients and the proportion from more to less in order for 32 cases of qi deficiency(23.9%),28(20.9%)cases of damp heat,phlegm dampness in 21 cases(15.7%),qi stagnation,19 cases(14.2%),13(9.7%)cases of yin deficiency and blood stasis 9 cases(6.7%),and 7 cases(5.2%),quality of Yang deficiency in 5 cases(3.7%).3?The distribution of liver tissue pathology:134 cases of patients with liver inflammation grades were 15 cases of G1(11.2%),109 cases of G2(81.3%),10 cases of G3(7.5%),15 cases of G<2(11.2%),119 cases of G?2(88.8%);liver fibrosis stages were 1 cases 0f S0(0.7%),63 cases of S1(47%),55 cases of S2(41%),14 cases of S3(10.4%),1 cases of S4(0.7%),64 cases of S<2(47.7%),70 cases of S?2(52.3%).4?The correlation between liver inflammation grade and fibrosis stage:there was a moderate positive correlation between the degree of liver inflammation and fibrosis degree(r=0.517,P<0.01),that is,the degree of liver fibrosis was aggravated with the aggravation of liver inflammation.5?The relationship between liver tissue pathology and TCM constitution:The grading of hepatic inflammation in patients with Ping-He(Heping)was mainly G1,and the yang-deficient mass was mainly G1,G2.Qi depression,qi deficiency,phlegm-dampness,yin deficiency and damp-heat were mainly G2.The blood stasis was mainly G2 and G3.There was a statistically significant difference in liver inflammation grades between different TCM constitution types(P<0.01).The liver fibrosis staging of Pinghe and Yang deficiency was mainly S1,Qi deficiency,and stasis.The main factors of wet,hot and humid qi,qi and qi were S1 and S2.The main yin deficiency and deficiency were S2 and S3.The main blood stasis was S3.There was a significant difference in the stage of fibrosis among different TCM constitution types(P<0.01).6?The relationship between the liver pathology and age:<40 years old and aged40 and two age grades of liver tissue inflammation were dominated by G2,there was no significant difference in different age patients with dirty inflammation tissue(P>0.05);<40 years old and above 40 years of age two stage of liver fibrosis by S1 and S2.,no statistically significant differences between the two different ages of the liver fibrosis degree(P>0.05).7?The relationship between liver pathology and ALT levels:There is a weak positive correlation between ALT levels and liver inflammation(r=0.171,P<0.05).The higher the ALT level,the heavier the liver inflammation;the ALT level and liver tissue fibers.There is no obvious linear correlation between the degree of physiology(P>0.05).8?The relationship between liver histopathology and HBeAg status:The proportion of patients with moderate or moderate inflammation(G?2)in the liver tissue in the HBeAg-positive group was greater than that in the HBeAg-negative group.There was a statistically significant difference in the level of inflammation of the liver tissue in different HBeAg states(P<0.05).There was no significant difference in liver fibrosis with different HBeAg status(P>0.05).9?The relationship between liver pathology and HBV DNA levels:the degree of inflammation of the liver with different HBV DNA levels were dominated by G2,no significant linear correlation between them(r=0.145,P>0.05);HBV DNA in liver tissue of different levels of fibrosis were dominated by S1 and S2,no significant linear correlation between them(r=0.137,P>0.05).Conclusion1?In this study,there are more male cases than female cases;most of them are younger than 40 years old;those with normal ALT are more common than those with mild ALT;HBeAg-negative people are more than HBeAg-positive ones;most of HBV replication is active,and HBV DNA levels are mostly high.2?The physical type of ALT<2ULN chronic HBV infection is mainly biased constitution.The distribution of all kinds of constitution is from high to low in order:Qi deficiency,damp heat,phlegm dampness,qi stagnation,yin deficiency,blood stasis,mild and yang deficiency.3?ALT<2ULN of chronic HBV infection liver tissue inflammation grades were mainly G2,fibrosis staging is mainly S1 and S2,of which more than moderate inflammation(G?2)and moderate fibrosis(S?2)accounted for most of the patients?It can be seen that most of these patients have significant pathological changes in liver tissue.It is suggested that liver biopsy should be used to clarify the degree of injury and to be treated actively.4?The pathological grade of liver histopathology of ALT<2ULN chronic HBV infection is positively related to the stage of fibrosis,and the degree of fibrosis is aggravated with the aggravation of the degree of inflammation.5?Those patients with TCM Constitution and liver tissue inflammation and fibrosis have a certain relationship with ALT<2ULN infection in chronic HBV,liver tissue and pathological quality of patients is mainly G1 and S1,Yang deficiency mainly for G1,G2 and S1,S2,Qi deficiency,phlegm dampness and dampness heat,qi stagnation is mainly G2 and S1,S2 Yin deficiency,mainly G2 and S2,S3,blood stasis mainly for G2,G3 and S3;Yin deficiency and blood stasis in patients with severe liver inflammation and fibrosis in a higher proportion,more prone to liver cirrhosis.6?The pathological changes of liver tissue and the age of the patients with chronic HBV infection of ALT<2ULN were no obvious Relationship.7?The degree of liver inflammation in patients with mild ALT with ALT<2ULN in chronic HBV infection was heavier than those with normal ALT;ALT could not reflect the degree of hepatic fibrosis.Comprehensive evaluation of the patient's condition should be performed and liver biopsy should be performed in time.8?HBeAg-positive patients with ALT<2ULN in chronic HBV infection are more likely to have moderate to moderate hepatic inflammation than HBeAg-negative patients,and patients with HBeAg-positive patients should be closely monitored.There was no significant relationship between the degree of liver fibrosis and serum HBeAg status.9?For patients with chronic HBV infection with ALT<2ULN,the level of HBV DNA does not reflect the extent of liver tissue inflammation and fibrosis. |
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