慢性乙型肝炎中医证型与IL-21、IL-35水平的关系研究

慢性乙型肝炎中医证型与IL-21、IL-35水平的关系研究慢性乙型肝炎中医证型与IL-21、IL-35水平的关系研究

摘要：本研究旨在探讨慢性乙型肝炎患者中医证型与IL-21、IL-35水平的关系。选择50例经临床确诊为慢性乙型肝炎的患者作为研究对象，采用中医证型辨识方法将患者分为肝郁脾虚证型、肝肾阴虚证型、湿热内蕴证型和气血不足证型4种类型，采取ELISA方法检测患者血清中IL-21、IL-35的水平。结果显示，肝郁脾虚证型患者的IL-21、IL-35水平均显著高于其他三种中医证型的患者（P<0.05），而湿热内蕴证型患者的IL-21、IL-35水平均显著低于其他三种中医证型的患者（P<0.05）。这说明在慢性乙型肝炎患者中，不同的中医证型和免疫因子水平之间存在着一定的关联性，肝郁脾虚证型患者免疫功能相对较强，而湿热内蕴证型患者的免疫功能相对较弱。

关键词：慢性乙型肝炎；中医证型；IL-21；IL-35；免疫功能

Abstract:ThisstudyaimstoexploretherelationshipbetweenTCMsyndrometypesandthelevelsofIL-21andIL-35inpatientswithchronichepatitisB.50patientswithconfirmeddiagnosisofchronichepatitisBwereselectedasstudyobjects.TCMsyndromeidentificationmethodwasusedtodividepatientsintofourtypes:liverdepressionandspleendeficiencysyndrome,liverandkidneyyindeficiencysyndrome,dampnessandheataccumulationsyndrome,andQi-blooddeficiencysyndrome.ELISAmethodwasusedtodetectthelevelsofIL-21andIL-35inpatients'serum.TheresultsshowedthatthelevelsofIL-21andIL-35inpatientswithliverdepressionandspleendeficiencysyndromeweresignificantlyhigherthanthoseintheotherthreetypesofpatients(P<0.05),whilethelevelsofIL-21andIL-35inpatientswithdampnessandheataccumulationsyndromeweresignificantlylowerthanthoseintheotherthreetypesofpatients(P<0.05).ThisindicatesthatthereisacertaincorrelationbetweendifferentTCMsyndrometypesandthelevelsofimmunefactorsinpatientswithchronichepatitisB,andpatientswithliverdepressionandspleendeficiencysyndromehaverelativelystrongimmunefunction,whilepatientswithdampnessandheataccumulationsyndromehaverelativelyweakimmunefunction.

Keywords:chronichepatitisB;TCMsyndrometype;IL-21;IL-35;immunefunctionThesefindingssuggestthatdifferentTCMsyndrometypesinpatientswithchronichepatitisBmayrequiredifferenttreatmentstrategiesaimedatregulatingimmunefunction.

InTCM,theliverandspleenareconsideredtoplayimportantrolesinthebody'simmunefunction.Theliverstoresbloodandregulatesthesmoothflowofqi(lifeenergy),whilethespleengovernsthetransformationandtransportationoffoodandfluidsinthebody.Whentheliverandspleenarenotfunctioningproperly,itcanleadtovarioussymptomsandsyndromes,suchasliverdepressionandspleendeficiencysyndrome.

Ontheotherhand,dampnessandheataccumulationsyndromeisusuallycausedbyacombinationofexternalfactors(suchasheatandhumidity)andinternalfactors(suchaspoordietandlifestylehabits).Thissyndromeischaracterizedbysymptomssuchasfatigue,lossofappetite,andabdominaldistension.

ThestudyalsofoundthatIL-21andIL-35levelswerehigherinpatientswithliverdepressionandspleendeficiencysyndrome.IL-21isacytokinethatplaysakeyroleinregulatingtheimmunesystem'sresponsetoinfections,whileIL-35isanimmunomodulatorycytokinethatcansuppressinflammationandpromoteimmunetolerance.

Overall,thesefindingshighlighttheimportanceofconsideringTCMsyndrometypeswhentreatingpatientswithchronichepatitisB.Byidentifyingthespecificsyndrometypeineachpatient,practitionerscantailortreatmentstrategiestoaddressboththeunderlyingpathologyandthepatient'suniqueimmuneprofileMoreover,thesefindingsalsosupporttheideathatTCMcanplayasignificantroleinthemanagementofchronichepatitisB.TCM'sholisticapproachtohealthanddiseaserecognizesthatthebody'svarioussystemsinteractwithoneanotherandthatimbalancesinonesystemcanaffectthefunctionofothers.InthecaseofchronichepatitisB,TCMtheorysuggeststhatliverfunctionisintimatelytiedtootherorgansandsystemsinthebody,suchasthespleen,kidneys,andimmunesystem.

TCMtreatmentforchronichepatitisBtypicallyinvolvesacombinationofacupuncture,herbalmedicine,anddietarychanges.Acupuncturecanstimulatespecificpointsonthebodytopromotehealingandbalance,whileherbalmedicinecanhelpsupportliverfunction,reduceinflammation,andstrengthenthebody'sdefenses.Dietarychangesmayinvolveavoidingcertainfoodsthatareknowntoexacerbateliverinflammationandchoosingfoodsthatpromoteliverhealth,suchasleafygreens,cruciferousvegetables,andleanproteins.

Inconclusion,thestudyofTCMsyndrometypesinpatientswithchronichepatitisBcanprovidevaluableinsightsintotheunderlyingpathologyandimmuneprofileofthesepatients.Byidentifyingthespecificsyndrometypeineachpatient,TCMpractitionerscantailortreatmentstrategiestoaddressboththeunderlyingpathologyandthepatient'suniqueimmuneprofile.FurtherresearchisneededtovalidatethesefindingsandexplorethepotentialbenefitsofTCMasanadjuncttherapyforchronichepatitisBChronichepatitisBinfectionisasignificantglobalhealthconcern,withover240millionsufferersworldwide.Thediseasecancauseliverfibrosis,cirrhosis,andhepatocellularcarcinoma,leadingtomortalitywhenleftuntreated.WhileWesternmedicineprimarilytreatsthisinfectionwithantiviralmedications,TraditionalChineseMedicine(TCM)hasdevelopedauniqueapproachbasedonasyndromedifferentiationsystemthatcategorizespatientsbasedonthevariousTCMsyndromespresent.

SyndromedifferentiationisanessentialcomponentofTCMdiagnosticprocedures,whichallowspractitionerstoidentifysyndrometypesbyanalyzingvariousclinicalmanifestations,includingsymptoms,pulsepalpations,andtonguediagnosis.Thisapproachhelpspreventmisdiagnosisandtheuseofinappropriatetreatments,ensuringapersonalizedandtargetedtherapyforeachpatient.

AgrowingbodyofresearchhasshownthatTCMsyndromedifferentiationcanbehelpfulintreatingchronichepatitisBinfection.Forexample,astudyconductedinChinain2019foundthatpatientswiththedampness-heatsyndromeexhibitedsignificantlymoresevereliverinflammation,fibrosis,andhigherserumviralloadthanthosewithoutthesyndrome,indicatingthatthespecificTCMsyndromecouldbeusedasaprognosticfactorindiagnosingchronichepatitisB.TheresearchalsoshowedthatTCMherbalmedicinecouldameliorateliverinflammationandfibrosis,suppresstheviralload,andimprovesymptomscores,suggestingthatTCMmaybeusedasanadjuncttreatmentforchronichepatitisB.

Similarly,asystematicreviewconductedin2020foundthatpatientswithTCMdampness-heatsyndromehadsignificantlyhigherviralloads,moresevereliverpathology,anddecreasedliverfunctioncomparedtothosewithoutthesyndrome.ThereviewalsoshowedthatTCMtreatmenttargetingdampness-heatsyndromecouldreduceviralloadandimproveliverpathology,indicatingthatTCMmaybeusefulintreatinghepatitisBinfection.

AnotherstudyconductedinTaiwanin2020reportedthatTCMdifferentiation-basedprescriptionpatternscouldpredicttheefficacyofinterferontreatmentforchronichepatitisB.PatientswhoweretreatedwithTCMprescriptionswithanti-inflammatoryandimmune-stimulatingpropertieshadhigherratesofvirologicalresponseandlowerliverfibrosisscoresthanthosewhoreceivedotherTCMprescriptions.TheseresultssuggestthatincorporatingTCMdifferentiation-basedprescriptionpatternsintothetreatmentofchronichepatitisBcouldbeusefulinimprovingpatientoutcomes.

Inconclusion,TCMsyndromedifferentiationprovidesanintegratedapproachtoindividualizeddiagnosisandtreatmentofchroniche