不同中医体质类型的慢性HBV感染者与HLA-A2、特异性CTL、PD-1相关性研究

发布时间：2018-11-25 09:08

【摘要】：目的:探讨不同中医体质类型的慢性HBV感染者HLA-A2等位型、特异性CTL及PD-1的变化;阐明HLA-A2等位型、特异性CTL及PD-1在慢性HBV感染中的状态;明确慢性HBV感染者不同中医体质分型与特异性CTL、HLA-A2等位型、PD-1、HBeAg、HBV-DNA载量等指标的相关性。方法:应用王琦教授设计的的《中医体质分类与判定表》,对本院收治的152例慢性HBV感染者进行一般资料调查(包括性别、年龄及发病时间、病史等)和中医体质类型判定。检测受试者肝功能、HBeAg、HBV-DNA、HLA-A2等位型、特异性CTL及PD-1等指标。应用统计数据进行分析,探讨慢性HBV感染者的中医体质类型分布的规律,以及不同中医体质类型与肝功能、HBeAg、HBV-DNA、HLA-A2等位型、特异性CTL及PD-1等指标的关系。结果:符合纳入标准的慢性HBV感染者共152例,其中湿热质有60例(25.4%),其次为气虚质54例(22.9%),气郁质52例(22.1%),痰湿质40例(17.0%),瘀血质18例(7.6%),阴虚质10例(4.2%),阳虚质2例(0.8%),无平和质及特禀质患者。不同中医体质类型的分布与患者的性别及年龄有关,且差异有统计学意义(P0.05)。不同中医体质类型的慢性HBV感染者,其HBeAg阳性阴性分布及HBV-DNA载量分布也不相同,且差异有统计学意义。但不同中医体质类型的肝功能指标之间差义无明显意义(P0.05)。本研究中,95%的患者HLA-A2等位型阳性,故未将其与中医体质类型、PD-1等指标进行详细分析。特异性CTL与肝功能之间未显示显著相关性,PD-1与HBV-DNA载量呈正相关,四种主要体质类型中特异性CTL与PD-1分布不同,且差异具有统计学意义(P0.05)。结论:慢性HBV感染者的中医体质类型主要为湿热质、气虚质、气郁质、痰湿质,其次是瘀血质、阴虚质、阳虚质,本研究中未见平和质和特禀质,且男性多于女性。青壮年慢性HBV感染者的中医体质主要以湿热质、痰湿质为主,而中老年慢性HBV感染者的中医体质主要以气虚质、气郁质为主。本研究中慢性HBV感染者中医体质类型的分布与HLA-A2等位型未见明显相关性,慢性HBV感染者中医体质类型的分布与HBeAg、HBV-DNA、特异性CTL及PD-1具有相关性。总之,通过对慢性HBV感染者进行中医体质分型,了解该患者的中医体质特征,深入了解不同中医体质慢性HBV感染者的免疫应答状况,对于丰富、拓展中西医结合治疗肝病的研究内涵有着重要理论和应用价值。
[Abstract]:Objective: to investigate the changes of HLA-A2 allele, specific CTL and PD-1 in chronic HBV infected patients with different TCM physique types, and to elucidate the status of HLA-A2 allele, specific CTL and PD-1 in chronic HBV infection. To determine the correlation between different TCM constitution types and specific CTL,HLA-A2 allele and PD-1,HBeAg,HBV-DNA load in chronic HBV infected patients. Methods: general data (including sex, age, time of onset, history of disease) and type of constitution of TCM were investigated in 152 cases of chronic HBV infection in our hospital by using the classification and judgement table of TCM constitution designed by Professor Wang Qi. Liver function, HBeAg,HBV-DNA,HLA-A2 allele, specific CTL and PD-1 were detected. The distribution rule of TCM constitution type of chronic HBV infection and the relationship between different TCM constitution type and liver function, HBeAg,HBV-DNA,HLA-A2 allele, specific CTL and PD-1 were analyzed by statistical data. Results: there were 152 cases of chronic HBV infection, including 60 cases of dampness and heat (25.4%), 54 cases of deficiency of qi (22.9%), 52 cases of stagnation of qi (22.1%), 40 cases of phlegm and dampness (17.0%). There were 18 cases of blood stasis (7.6%), 10 cases of yin deficiency (4.2%), 2 cases of yang deficiency (0.8%). The distribution of different TCM physique types was related to gender and age of patients, and the difference was statistically significant (P0.05). The positive and negative distribution of HBeAg and the distribution of HBV-DNA load in chronic HBV infected patients with different physique types of TCM were different, and the difference was statistically significant. However, there was no significant difference between liver function indexes of different TCM physique types (P0.05). In this study, 95% of the patients were positive for HLA-A2 allele, so they were not analyzed in detail with TCM physique type and PD-1. There was no significant correlation between specific CTL and liver function, but there was a positive correlation between PD-1 and HBV-DNA load. The distribution of specific CTL and PD-1 was different among the four main physique types, and the difference was statistically significant (P0.05). Conclusion: the main types of TCM constitution of chronic HBV infection are dampness and heat, qi deficiency, qi stagnation, phlegm and dampness, followed by blood stasis, yin deficiency and yang deficiency. The Chinese medicine constitution of the young and middle-aged patients with chronic HBV infection is mainly dampness and heat, phlegm and dampness, while that of the middle-aged and aged chronic HBV infection is mainly qi deficiency and qi stagnation. In this study, there was no significant correlation between the distribution of TCM constitution type and HLA-A2 allele in chronic HBV infection, but there was a correlation between the distribution of TCM constitution type and HBeAg,HBV-DNA, specific CTL and PD-1 in chronic HBV infection. In short, through the TCM constitution classification of chronic HBV infected persons, to understand the TCM physique characteristics of this patient, and to deeply understand the immune response status of chronic HBV infected persons with different TCM constitutions, It is of great theoretical and practical value to expand the research connotation of integrated traditional Chinese and western medicine in the treatment of liver diseases.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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