目的:研究不同中医证型的慢性乙型肝炎(CHB)轻度患者肝组织病理特点,并探讨其临床意义.方法:将310例CHB轻度患者进行中医辨证分型,采用Menshini法1秒钟经皮肝穿取肝组织进行炎症和纤维化程度判断,并与车祸死亡正常人作对照,同时荧光定量PCR法检测患者血清HBV DNA水平.结果:①肝组织炎症≥G2、肝纤维化≥S2等级的患者年龄明显高于肝组织炎症＜G2、肝纤维化＜S2等级的年龄;②各中医证型患者肝组织炎症级别≥G2的比率明显高于正常组,但证型间比较差异均无显著性意义;③各中医证型患者肝组织纤维化程度≥S2的比率明显高于正常组,但证型间比较仅肝肾阴虚和脾肾阳虚两型明显高于肝郁脾虚和湿热中阻型;④各中医证型间HBV DNA水平比较,肝肾阴虚和脾肾阳虚两证型明显低于肝郁脾虚型,其他证型之间差异无显著性意义.结论:CHB轻度患者至少有1/3的患者需要抗病毒治疗,而且年龄越大越有必要;在控制肝脏炎症方面,辨证治疗应多加倡导,在抗纤维化治疗方面应重视补肾法研究.

目的：观察聚乙二醇干扰素α-2a治疗慢性乙型肝炎不同中医证型的疗效。方法：对62例HBeAg阳性慢性乙型肝炎患者进行聚乙二醇干扰素α-2a治疗，观察治疗第24周、第48周及停药随访第24周时不同证型患者对药物的应答情况。结果：治疗第48周及随访第24周时不同证型患者生化学应答率及血清学应答率差异有统计学意义（P<0.05），其中肝郁脾虚型疗效显著，湿热中阻型、肝肾阴虚型次之。治疗第24周、第48周及随访第24周时不同证型间病毒学应答率差异有统计学意义（P<0.05，P<0.01），其中肝郁脾虚型疗效最佳，湿热中阻型、肝肾阴虚型次之。结论：聚乙二醇干扰素α-2a治疗肝郁脾虚型慢性乙型肝炎患者疗效最优，湿热中阻型、肝肾阴虚型次之，瘀血阻络型疗效欠佳。

Objective To investigate the relationship between serum HBV DNA loads and hepatic pathologi-cal changes in patients with mild chronic hepatitis B. Methods Three hundred and ten patients with CHB were divided into HBeAg-positive and HBeAg-negative group. Serum HBV DNA loads were determined by fluorescence quantitative polymerase chain reaction, and pathological changes in liver biopsies were examined by HE staining. The relationship between serum HBV DNA load and hepatic histological grades and fibrosis stages was analyzed. Results Inflammatory grade of G0 and fibrosis stage of S0 accounted for 42.0% and 58.0% in HBeAg-positive patients,respectively,However,G0,G1 and G2 and S0 accounted for 29.1%,30.2%,34.9%,and 51.2% in HBeAg-neg-ative patients,respectively;There was no significant correlation between serum HBV DNA load and inflammatory grade (r=-0.098,P>0.05),while a negative correlation was found between serum HBV DNA load and the fibrosis stage (r=-0.309,P<0.01)in HBeAg-positive group;There was a positive correlation between serum HBV DNA load and inflammatory grade (r=0.306,P<0.01),while no obvious correlation was found between serum HBV DNA load and the fibrosis stage (r=0.112,P>0.05)in HBeAg-negative group . Conclusions Relationship between HBV DNA loads and hepatic pathological changes differs as serum HBeAg status different in patients with hepatitis B virus infection.

[Objective]Analysis of chronic hepatitis B(hereinafter referred to as b) distribution in liver tissue pathology and TCM syndrome type, provide the objective material to determine the chronic hepatitis B fibrosis degree of TCM use. [Method] From 2011 November to 2013 March in Zhejiang Chinese Medicine University First Affiliated Hospital and Lishui People's Hospital hospital infection 310 cases of patients with chronic hepatitis B, monitoring the liver biopsy and liver fibrosis indexes, to investigate the relationship between the above indexes and the TCM syndrome types. [Results] 310 cases of chronic hepatitis B with liver stagnation and spleen deficiency type, are fol owed by the damp heat type, liver kidney yin deficiency, spleen kidney yang deficiency, blood stasis type. And liver stagnation and spleen deficiency type, damp heat type, liver kidney yin deficiency, spleen kidney yang deficiency type are of mainly stage S2 fibrosis, blood stasis blocking col ateral type in fibrosis stage S4; 212 cases of mild chronic hepatitis B patients with liver qi stagnation and spleen deficiency, damp heat group relatively flat and vitrinite in fibrosis≥S2 have differences, with statistical significance. [Conclusion] Pathology and TCM syndrome type distribution in liver tissue of patients with chronic hepatitis B have some regularity; TCM syndrome type has correlation with the pathologic change of liver tissue objective.