| Objective To observe the characteristics of TCM syndrome distribution,liver pathology,liver stiffness(LSM)and cellular immunity levels of chronic HBV infected patients with ALT<2ULN in different stages of HBV carriers,chronic hepatitis B,and liver cirrhosis.To explore the correlation between the level of cellular immunity and the above-mentioned indicators in this part of the patient,to provide a scientific theoretical basis for further understanding of the characteristics of chronic HBV infection,and to provide reasonable basis for further optimization of the diagnosis and treatment of this disease.Methods A retrospective study was conducted to collect basic data,clinical symptoms,liver pathological findings,liver stiffness,biochemical and immunological indicators and other laboratory-related indicators of chronic HBV infected patients with ALT<2ULN in the inpatient department of Guangdong Provincial Hospital from January 2012 to January 2018.The observation indexes were entered into the database and data were collected.The correlation between TCM syndromes,liver pathology,liver stiffness values and cellular immunity of ALT<2ULN chronic HBV-infected patients was analyzed.Results1.Basic conditions: 726 cases of chronic HBV infected patients with ALT<2ULN without antiviral therapy were included in this study,including 43 cases of HBV carriers,643 chronic hepatitis B patients,and 40 cases of hepatitis B liver cirrhosis.The patient's minimum age was 15 years and the maximum age was 65 years.33.6%(244/726)of patients had a history of family clustering.In view of the small number of patients with HBV carriers and patients with hepatitis B liver cirrhosis,no further statistical analysis was included in the later period.2.Distribution of TCM Syndromes of chronic Hepatitis B Patients with ALT<2ULN:There were 422 cases(65.63%)of liver stagnation,spleen deficiency and wet sputum;208 cases(32.35%)of liver stagnation,spleen deficiency,dampness and heat syndrome;11 cases(1.7%)of liver stagnation and spleen deficiency syndrome;liver and kidney yin deficiency blood stasis syndrome and spleen and kidney deficiency syndrome were 1 case(0.16%).Among patients with HBe Ag-positive chronic hepatitis B,there were 204 cases(60.7%)of liver stagnation,spleen deficiency and wet sputum,125 cases(37.2%)of liver stagnation,spleen deficiency,dampness and heat syndrome,5 cases(1.5%)of liver stagnation and spleen deficiency syndrome,liver and kidney yin deficiency blood stasis syndrome and spleen and kidney deficiency syndrome were 1 case(0.3%).In patients with HBe Ag-negative chronic hepatitis B,there were 218 cases(71%)of liver stagnation,spleen deficiency and wet sputum,83cases(27%)of liver stagnation,spleen deficiency,dampness and heat syndrome,6 cases(1.2%)of liver stagnation and spleen deficiency syndrome.3.Relationship between TCM syndrome type and liver pathology(1)The Relationship between TCM Syndromes and Hepatic Inflammation:In patients with liver stagnation,spleen deficiency and wet sputum,the degree of inflammation was mainly in G1 and G2.G1 accounted for 44.4%,G2 accounted for 44.9%,and G3-G4 accounted for only 10.7%.The degree of inflammation in patients with liver stagnation,spleen deficiency,dampness and heat syndrome was mainly concentrated in G2,accounting for 49.5%,G1 and G3-G4 were 29.3%and 21.2%,respectively.The distribution of the inflammation levels of the two syndromes was compared and the difference was statistically significant(P<0.001).Between the two groups,G1 and G3-4 showed statistically significant differences in the distribution of the two syndromes(The former P<0.001,the latter P=0.001).(2)The relationship between TCM syndrome type and liver fibrosis:In patients with liver stagnation,spleen deficiency and wet sputum,the stage of fibrosis was 5.7% for S0,32% for S1,42.1% for S2,16.2% for S3,and 4.0% for S4.In patients with liver stagnation,spleen deficiency,dampness and heat syndrome,the stage of fibrosis was 2.5% of S0,24.2% of S1,45% of S2,19.2% of S3,and 9.1% of S4,the fibrosis stages of two groups are all concentrated in S1 and S2.Between the two groups,S4 was statistically significant in the distribution of the two syndromes(P=0.011).4.Relationship between TCM Syndromes and Liver stiffness:There were 147 chronic hepatitis B patients completed the Fibroscan examination.Among them,there were 32 cases of liver stagnation,spleen deficiency,dampness and heat syndrome and the liver stiffness was 9.14±8.65 Kpa;114 cases of liver stagnation,spleen deficiency and wet sputum,their liver stiffness value was7.01±3.69 Kpa.The former was higher than the latter,and comparison between groups was performed,the difference was not statistically significant(P=0.184).5.The relationship between HBV-DNA load and the level of T lymphocyte subsets(1)In patients with HBe Ag-positive chronic hepatitis B,the percentages of TC?Th and Th/Ts in patients with HBV-DNA?105IU/ml were 68.03%±8.19%?36.51%±8.38% and 1.47±0.63,respectively,all were lower than HBV-DNA<105IU/ml group;the percentage of Ts was 28.10%±13.51%,higher than that of HBV-DNA <105IU/ml group.However,there was no significant difference between the two groups(P>0.05).(2)In patients with HBe Ag-negative chronic hepatitis B,the percentages of TC?Th and Ts in patients with HBV-DNA ?104IU/ml were 68.25%±9.10%?38.93%±9.13%?24.91%±8.11%,respectively,Lower than HBV-DNA <104IU/ml group;the ratio of Th/Ts were 1.78±0.84,which were higher than the HBV-DNA<104IU/ml group.Between the two groups,there was a statistically significant difference in the percentage of Ts and ratio of Th/Ts among different DNA groups(P =0.002?0.003,respectively),there was no significant difference in the percentage of TC and Th(P =0.069?0.499,respectively).6.The relationship between liver pathology and the level of T lymphocyte subsets(1)The relationship between liver inflammation and the level of T lymphocyte subsets:With liver inflammation graded from G1 to G4,the corresponding percentages of TC cells were 69.58%±9.14%?68.01%±7.76%?66.58%±8.23%?70.95%±12.50%,respectively;the average Ts lymphocyte percentages were 27.73%±7.92%?25.88%±7.78%?25.08%±7.05%?26.29%±6.57%,respectively;the mean Th cell percentages were 38.49%±8.61%?38.09%±8.65%?36.68%±8.52%?40.12%±8.50%,respectively;the Th/Ts values were 1.53±0.66?1.65±0.74?1.61±0.58?1.58±0.41,respectively.It can be seen that as the degree of liver inflammation increases,the percentages of TC?Ts and Th basically show a downward trend.However,there was a statistically significant difference in the percentage of TC and Ts cells,but was no significant difference in the percentage of Th cells between the two groups.The Th/Ts values did not show a clear increase or decrease trend.(2)The relationship between liver fibrosis and the level of T lymphocyte subsets:With the progression of liver fibrosis from S0 to S4,the corresponding percentages of TC cells at each stage were 72.08%±7.90%?69.20%±9.13%?68.06%±8.01%?67.78%±8.41%?67.06%±8.66%,respectively;the mean percentages of Ts cells were 27.69%±6.33%?27.25%±7.91%?26.37%±8.10%?26.03%±7.49%?24.31%±6.16%,respectively;the mean Th cell percentages were41.12%±7.26%?38.49%±8.85%?37.79%±8.36%?37.52%±8.66%?37.40%±10.01%,respectively;Th/Ts values were 1.57±0.50?1.57±0.70?1.61±0.74?1.58±0.60?1.70±0.68,respectively.It can be seen that with the increase of liver fibrosis,the percentages of TC?Ts and Th all showed a decreasing trend.The differences between the each groups were statistically significant,and the trend of Th/Ts values was not obvious.7.The relationship between liver stiffness(LSM)and the level of T-lymphocyte subsets:With the increase of LSM from F1 to F4,the average percentage of TC cells was 71.33%±6.91%?71.81%±5.69%?66.32%±8.93%,69.34%±11.54%,respectively;the mean Ts percentages were 29.29%±7.60%?29.23%±7.19%?26.71%±6.67%,32.57%±5.64%,respectively;the percentages of Th percentages were 39.34%±7.64%?39.95%±6.51%?37.41%±9.96%,32.1%±9.81%,respectively;Th/Ts values were 1.48±0.7?1.49±0.52?1.52±0.78,1.04±0.45,respectively.It can be seen that as the LSM rises,the percentages of Th tend to decrease,the percentages of TC and Ts show a decreasing trend in F1-F3,while F4 is higher than before.After further comparison between groups,the difference in TC percentage between F3 and F1 and F2 was statistically significant;P was 0.04 and 0.038,respectively.The difference in Th percentages between F4 and F1 and F2 was statistically significant,P was 0.04 and 0.034,respectively.Compareing other indicators in the other groups,the P was greater than 0.05,and the difference was not statistically significant.Conclusion1.There are five different syndromes in chronic hepatitis B patients with ALT<2ULN,the syndromes were liver stagnation,spleen deficiency and wet sputum syndrome;liver stagnation,spleen deficiency,dampness and heat syndrome;liver stagnation and spleen deficiency syndrome;liver and kidney yin deficiency blood stasis syndrome and spleen and kidney deficiency syndrome.The first two are common types of syndromes,indicating that TCM syndrome differentiation of chronic hepatitis B patients with ALT<2ULN presents a complex pattern.2.The disorder of cellular immune status in patients with chronic hepatitis B may be related to high HBV-DNA load.In HBe Ag-positive patients,the TC?Th and Th/Ts values of patients with HBV-DNA?105IU/ml were lower than HBV-DNA<105IU/ml,and the percentage of Ts was higher than the latter,but the difference was not statistically significant.In HBe Ag-negative patients,the percentages of TC?Th and Ts in patients with HBV-DNA?104IU/ml were lower than those in HBV-DNA <104IU/ml group,and the ratio of Th/Ts was higher than the latter.3.The increase in liver inflammation and fibrosis and liver stiffness suggest progression and worsening of the disease,the level of T lymphocyte-mediated cellular immunity will be disordered during this process,when the pathological changes of the liver were progressed,the percentages of TC?Th and Ts decreased,and there was no significant change in the Th/Ts value;when LSM rises,the percentages of TC?Th?Ts decrease,and there was no significant change in the Th/Ts value.It shows that monitoring the body's cellular immune level has certain guiding significance for assessing the severity of illness. |
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