Traditional Chinese Medicine Syndrome Element,Evolutionary Patterns of Patients with Hepatitis B Virus-Related Acute on Chronic Liver Failure at Different Stages:A Multi-Center Clinical Study
Objective To explore the syndrome elements and evolving patterns of patients with hepatitis B virus-related acute on chronic liver failure(HBV-ACLF)at different stages.Methods Clinical information of 1,058 hospitalized HBV-ACLF patients,including 618 in the early stage,355 in the middle stage,and 85 in the late stage,were collected from 18 clinical centers across 12 regions nationwide from January 1,2012 to February 28,2015.The"Hepatitis B-related Chronic and Acute Liver Failure Chinese Medicine Clinical Questionnaire"were designed to in-vestigate the basic information of the patients,like the four diagnostic information(including symptoms,tongue,pulse)of traditional Chinese medicine(TCM),and to count the frequency of the appearance of the four diagnostic in-formation.Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome ele-ments and patterns of HBV-ACLF patients at different stages.Results There were 76 four diagnostic information from 1058 HBV-ACLF patients,and 53 four diagnostic information with a frequency of occurrence≥5％were used as factor analysis entries,including 36 symptom information,12 tongue information,and 5 pulse information.Four types of TCM patterns were identified in HBV-ACLF,which were liver-gallbladder damp-heat pattern,qi deficiency and blood stasis pattern,liver-kidney yin deficiency pattern,and spleen-kidney yang-deficiency pattern.In the early stage,heat(39.4％,359/912)and dampness(27.5％,251/912)were most common,and the pattern of the disease was dominated by liver-gallbladder damp-heat pattern(74.6％,461/618);in the middle stage,dampness(30.2％,187/619)and blood stasis(20.7％,128/619)were most common,and the patterns of the disease were dominated by liver-gallbladder damp-heat pattern(53.2％,189/355),and qi deficiency and blood stasis pattern(27.6％,98/355);and in the late stage,the pattern of the disease was dominated by qi deficiency(26.3％,40/152)and yin defi-ciency(20.4％,31/152),and the patterns were dominated by qi deficiency and blood stasis pattern(36.5％,31/85),and liver-gallbladder damp-heat pattern(25.9％,22/85).Conclusion There are significant differences in the distribution of syndrome elements and patterns at different stages of HBV-ACLF,presenting an overall trend of evolving patterns as"from excess to deficiency,transforming from excess to deficiency",which is damp-heat → blood stasis → qi-blood yin-yang deficiency.
acute on chronic liver failurehepatitis B virussyndromesyndrome elementscross-sectional study
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