Distribution Of Syndrome Differentiation Of AIDS Among MSM In Beijing

BackgroundThe full name of AIDS is acquired immune deficiency syndrome, which is caused by human immunodeficiency virus infection, resulting in immune function partial or complete loss, and followed multi-system, multi-organ, multi-pathogen complex infection (opportunistic infection), and tumors. Clinical manifestations of AIDS can be various. AIDS is a disease with a high mortality and rapid spreading. Although this disease can not be cured, it has become a chronic controllable disease with antiviral therapy used.We have done a lot of clinical research, and achieved good clinical results in the guidance of conception of holism and treatment based on syndrome differentiation, yet a complete system of treating AIDS in TCM is not formed because of hysteretic work in this area. Researches in symptoms and signs, at present, are limited to clinicians' experience and clinical summary. Because of lack of comparability and objectivity, it is difficult to generalize and evaluate. Therefore, researching characteristic and variation of symptoms and signs of AIDS is a currently pressing problem.ObjectiveThis research is aims to research distribution of syndrome differentiation of AIDS among MSM in Beijing (including correlation with clinical stage and immune function.MethodsThis study, which is a part of symptoms and signs research of AIDS (major projects of National Science and Technology, project number:2008ZX10005-001),is mainly composed of three parts:The first part introduces literature review, including collection and analysis of literature on HIV/AIDS TCM symptoms and signs. The second part introduces formation of AIDS Four diagnostic Information Form (including formulating content and technology route of symptoms and signs questionnaire of AIDS; constructing frame and item pool of questionnaire; analyzing items, reliability and validity of questionnaire; formulating and implementing interview outline of symptoms and signs of AIDS;) The third part introduce distribution of syndrome differentiation of AIDS among MSM in Beijing (including correlation with clinical stage and immune function; the application of PRO scale in symptoms and signs research;) Summarize as follows:ResultsPart one:Literature reviewWe retrieved a total of more than 500 AIDS&TCM-related articles. It involves 44 articles of symptoms and signs research, Symptoms recorded in these literatures are few, more over, each article applies different methods of syndrome differentiation, leading to more than 143 kinds of syndrome types are described simultaneously in Literature, only 21 syndrome types are recorded by twice. Syndromes of asymptomatic stage refers to 14, including dampness and heat retention, stagnated qi turning to phlegm retention, qi and yin deficiency, impeded flow of liver-qi lead to qi stagnation. Syndromes of AIDS stage refers to 12, including dampness and heat retention, phlegm heat retention in lung, stagnated qi turning to phlegm retention, phlegm and blood stasis retention. The symptoms focused by all literature are almost the same, some of them has high frequency are listed as follows:fatigue, fever, skin rash, cough, diarrhea et al.Part two:Development of AIDS Four diagnostic Information FormThis part mainly introduce the formation of AIDS Four diagnostic Information Form, including formulating the planned content, designing technology route, constructing frame and item pool, screening and normalizing items, analyzing reliability and validity of items etc. 1 Formation of AIDS Four diagnostic Information FormAccording to the literature, the results of expert consultation, "the guiding principles of Chinese medicine drug", "The People's Republic of China National Standard GB/T 16751.2-1997" and "Diagnostics of Chinese Medicine", we select 61 symptoms. The frame of AIDS Four diagnostic Information Form is initially founded. 2 Expert Consultation:We consult 57 experts by way of questionnaire, the questions are installed on the basis of syndrome types refined in literature and "three stage of 12 type" of intervention project. By way of semi-quantitative approach, experts judge the importance, specificity and frequency of syndrome types in the process of AIDS. Expert consultation provides important basis for screening items. The syndrome types are sorted according to the following manners:major keywords:arithmetic mean (by descending order), secondary keywords:coefficient of variation (by ascending order), standard deviation(by ascending order). I consider removing "stagnation of qi and phlegm" ranking the final at HIV Positive Stage. Some syndrome types, at times, ranked the final in different literature, In view of the complexity of AIDS stage, "stagnation of qi and phlegm", "phlegm accumulating with stagnation" and "heat invading blood phase" were reserved.3 Items StandardizationThere are three aspects of symptom standardization, including term and meaning of symptoms, quantitation and grading, meaning of syndrome differentiation. Symptom terms and its meaning refer to "The People's Republic of China, Clinical Diagnosis'term for TCM", Total 8 items were splited,10 Normalized, and 4 deleted. Grading of Symptoms were divided into mild, moderate and severe according to symptoms' character, frequency, condition, duration, accompanying symptoms, dependence on drugs and so on. Standardization of meaning of syndrome differentiation:for example, character of bellyache, shape and properties of stool.4 Reliability and validityResults showed that reliability and validity is good.Part three:Distribution of syndrome differentiation of AIDS among MSM in Beijing 1 Distribution of symptomsOverall impression:main symptoms are fatigue, amnesia, dysphoria, sexual need receding, depression, lumbar genu ache et al, fever, cough and diarrhea have been detected with low level, which is different from literature review, may caused by living condition and transmission routes. The distribution showed MSM HIV/AIDS patients are mainly harmed by liver, spleen, kidney organ in TCM's point of view, while less connected with lung (in TCM). More than 50% patients have disorder in emotion such as dysphoria and depression.2 Distribution of syndrome differentiationOverall impression:asthenia of qi is intrinsic factor(41.3%), involving yang-asthenia or yin-asthenia, combining asthenia of essence; pathogenic is external factor, combining stagnation of qi, phlegm, fluid retention, blood stasis; the location of AIDS is spleen, liver and spleen accounts a large proportion, involving lung and kidney; most syndrome differentiation are internal syndrome.darkish red tongue and yellowish greasy tongue coating are common, combining teeth-marked tongue or petechia, roughly the same as reported in the literature. Thin pulse accountss most, slippery pulse and taut pulse take second place, weak pulse is common types. This prove that AIDS is a chronic wasting disease combining stagnation of liver or phlegm-dampness.Experience of clinical physician:The main syndrome differentiation is internal accumulation of damp-heat, combining stagnation of qi and phlegm, phlegm-heat obstructing lung, asthenia of splenic qi, asthenia of both qi and yin, blood stasis due to asthenia of qi; General characteristics are asthenia of healthy qi and sthenia of pathogenic factors and mixture of cold and heat.Results of discriminant analysis:asthenia-syndrome is the main type, combining asthenia complicated by sthenia. There are kinds of 15 syndrome differentiations of greater than 10 cases, among those, kinds of 12 are asthenia-syndrome. Sthenia of pathogenic factors fasten on damp-heat in liver and gallbladder, accumulation of damp-heat in spleen and blood stasis etc.Results of factor Loading Matrix analysis:We totally extracted 19 Factors, which mainly involve spleen, liver complicated spleen, lung complicated spleen, kidney complicated spleen and cardiac, indicating the complexity of AIDS.Recognition of the roots of HIV/AIDS in TCM is the same, although Distribution of syndrome differentiation acquired by three methods mentioned above has differences, still need to be explored.3 Correlation between clinical stages and syndrome differentiation3.1 SymptomsPatients at asymptomatic stage has main symptoms such as thirsty, fatigue, amnesia, dysphoria, sexual need receding, with 5 symptoms has frequency more than 50%. Patients at AIDS stage has main symptoms such as fatigue, thirsty, amnesia, dysphoria, edema in head, depression, night urine increase, lumbar genu ache, with 8 symptoms has frequency more than 50%, which implicated that disease process go deeper.3.2 SyndromesPatients at asymptomatic stage showed almost the same percentage of single syndrome and compound syndrome, while compound syndrome turns to be the main implication at AIDS stage. Location lies spleen at asymptomatic stage, asthenia of spleen is main syndrome differentiation. Location lies liver, spleen and kidney at AIDS Stage, main syndrome differentiation are asthenia of renal qi and insufficiency of renal-yin.4 Correlation between immunity and syndrome differentiation4.1 symptoms4.1.1 19 cases with CD4>500/mm3 has main symptoms such as sexual need receding, fatigue, amnesia, lumbar genu ache, spontaneous sweating,5 symptoms has frequency =50%,which implicated stable disease condition, few symptoms was found.4.1.2 16 cases with CD4 351-500/mm3 has main symptoms such as fatigue, thirsty, amnesia, dysphoria, short and yellow urine,15 symptoms has frequency=50%, which implicated increased symptoms as decline of CD4.this stage is the best intervention time point.4.1.3 38 cases with CD4 201-350/mm3 has main symptoms such as fatigue, thirsty, amnesia, dysphoria, short and yellow urine,6 symptoms has frequency=50%, which implicated decreased symptoms as the use of western medicine.4.1.4 7 cases with CD4≤200/mm3 has main symptoms such as fatigue, thirsty, amnesia, dysphoria, short and yellow urine,16 symptoms has frequency=50%, fatigue was detected 100%, which implicated kidney organ had been affected.4.2 SyndromesCD4 counts and stagnation of qi and phlegm are negative correlation. Correlation coefficient:-0.326, (P<0.001); reverse to insufficiency of qi and yin, Correlation coefficient:0.712 (P<0.001), patients with spleen deficiency had high CD4 count (434.75±170.51),patients with kidney yin deficiency had lowest CD4 count (331.20±153.94)5 Application of PRO scalePRO scale and AIDS Four diagnostic Information Form was used simultaneously. The former was filled by patients and the latter was filled by clinicians. Two of them can be testified mutually and supplemented each other. The results showed that outcome of the two form are almost the same, which implicated symptoms of spleen (TCM) systems and had obvious change in emotion.Conclusion1 Distribution of symptoms:main symptoms are fatigue, amnesia, dysphoria, sexual need receding, depression, lumbar genu ache et al, fever, cough and diarrhea have been detected with low level, which is different from literature review, may caused by living condition and transmission routes. The distribution showed MSM HIV/AIDS patients are mainly harmed by liver, spleen, kidney organ in TCM's point of view, while less connected with lung (in TCM). More than 50% patients have disorder in emotion such as dysphoria and depression.2 Distribution of syndrome differentiation:asthenia of qi is intrinsic factor(41.3%), involving yang-asthenia or yin-asthenia, combining asthenia of essence; pathogenic is external factor, combining stagnation of qi, phlegm, fluid retention, blood stasis; the location of AIDS is spleen, liver and spleen accounts a large proportion, involving lung and kidney; most syndrome differentiation are internal syndrome.darkish red tongue and yellowish greasy tongue coating are common, combining teeth-marked tongue or petechia, roughly the same as reported in the literature. Thin pulse accountss most, slippery pulse and taut pulse take second place, weak pulse is common types. This prove that AIDS is a chronic wasting disease combining stagnation of liver or phlegm-dampness.