The Study Of The Correlation Between Sublingual Collaterals And Syndrome Types Of Traditional Chinese Medicine Of Liver Cirrhosis And Its Manifest Under Gastroscope

ObjectiveTo study the correlation between cirrhosis Sublingual Collaterals and syndrome types of Traditional Chinese Medicine(TCM) and its manifest under gastroscope.MethodUsing the method of clinical epidemiology and designing questionaires, which covered general information, liver cirrhosis etiology, child-pugh grading for liver function, four diagnostic methods of TCM, sublingual collaterals grading, the manifest under gastroscope, such as the degree of esophageal varix, the instance of gastric varices, the degree of portal hypertensive gastric disease, the incidence rate of combined ulcer and etc. TCM syndromes of liver cirrhosis were divided into 6 types:stagnation of liver-QI, internal resistance of dampness, internal accumulation of dampness-heat, liver kidney yin insufficiency, spleen-kidney yang defficiency and obstruction of collaterals by blood stasis. The questionaires were filled in by the specialists, and the syndrome types of TCM were finally approved by 2 experts with senior-medium professional titles according to differentiation standards. The clinical observation was carried out after the specialists amending the questionaires. Statistical method:Data was collected and a database was setup, which was imported into a statistical package of SPSS 18.0 for data analysis. The purpose was to study the correlation between each sublingual collaterals grading and syndrome types of TCM of liver cirrhosis and its manifest under gastroscope. The comparison of rate was used byχ2(chi-square) test, the comparison of ranked data was used by rank test, and the comparison of average was used by analysis of variance or T-test, or rank test in the condition of variance heterogeneity. Test level was designated as a=0.05. Furthermore, the thesis covered the study of 180 liver cirrhosis patients, who underwent Zheng differentiation-classification, classified sublingual collaterals and routine gastroscopy according to the methods mentioned above. Record of the condition of esophageal varix, gastric varices, portal hypertensive gastric disease and the ulcer were taken, investigate the sublingual collaterals grading and the distribution law of TCM syndrome types of liver cirrhosis and the relationship between each sublingual collaterals grading and different syndrome types of TCM and the manifest of liver cirrhosis under under gastroscope, such as the degree of esophageal varix, instance of gastric varices, portal hypertensive gastric disease and the incidence rate of ulcer.Results1. The correlation between sublingual collaterals grading and zheng differentiation-classification of Traditional Chinese Medicine (TCM) of liver cirrhosis.The sublingual collaterals grading for the group of stagnation of liver-QI and the group of internal resistance of dampness was normal and Level I mostly, Among that, the sublingual collaterals grading of normal for group of stagnation of liver-QI accounted for 83.3%; the sublingual collaterals grading of normal and LevelⅠfor group of internal resistance of dampness both accounted for 36.4%; the sublingual collaterals grading for the group of internal accumulation of dampness-heat was LevelⅠand LevelⅡmostly, accounted for 40.0% and 35.6%; the sublingual collaterals grading for the group of liver kidney yin insufficiency, spleen-kidney yang deficiency and obstruction of collaterals by blood stasis was LevelⅢmostly, accounted for 51.7%,42.9% and 80.9%;the different constitute of sublingual collaterals grading for each group of syndrome types of TCM had statistical significance by comparison (P<0.05); by further comparison of the constitute of sublingual collaterals grading between every two group of syndrome types of TCM, it was no statistical significance by comparison of the group of liver kidney yin insufficiency and the group of spleen-kidney yang deficiency(P>0.05), the others had statistical significance (P<0.05). It prompted that, sublingual collaterals of the group of stagnation of liver-QI and internal resistance of dampness changed more slight; sublingual collaterals of the group of liver kidney yin insufficiency, spleen-kidney yang defficiency and obstruction of collaterals by blood stasis changed more obvious, among them, sublingual collaterals of the group of obstruction of collaterals by blood stasis changed the most obvious; sublingual collaterals of the group of internal accumulation of dampness-heat changed between the group of stagnation of liver-QI, internal resistance of dampness and the group of liver kidney yin insufficiency, spleen-kidney yang defficiency, obstruction of collaterals by blood stasis.2. The correlation between sublingual collaterals grading and child-pugh grading for liver function.The child-pugh grading for liver function of the group of sublingual collaterals grading of normal was level A mostly, accounted for 84.6%; in the child-pugh grading for liver function of the group of sublingual collaterals grading of Level I,level A accounted for 62.2%, level B accounted for 26.7%, level C accounted for 11.1%; in the child-pugh grading for liver function of the group of sublingual collaterals grading of levelⅡ, level A accounted for 43.8%, level B accounted for 31.3%, level C accounted for 25.0%; the child-pugh grading for liver function of the group of sublingual collaterals grading of levelⅢwas level C mostly, accounted for 47.5%;the different constitute of child-pugh grading for liver function for each group of sublingual collaterals grading had statistical significance by comparison (P<0.05); by further comparison of the child-pugh grading for liver function between every two group of sublingual collaterals grading, it had statistical significance (P<0.05). It prompted that, between sublingual collaterals grading and child-pugh grading for liver function, it presented positive correlation.3. The correlation between zheng differentiation-classification of Traditional Chinese Medicine(TCM) of liver cirrhosis and child-pugh grading for liver function.The child-pugh grading for liver function of the group of stagnation of liver-QI, internal resistance of dampness and internal accumulation of dampness-heat was level A mostly, in the child-pugh grading for liver function of the group of stagnation of liver-QI, level A accounted for 77.8%, in the child-pugh grading for liver function of the group of internal resistance of dampness, level A accounted for 63.6%, in the child-pugh grading for liver function of the group of internal accumulation of dampness-heat, level A accounted for 63.3%; the child-pugh grading for liver function of the group of liver kidney yin insufficiency, spleen-kidney yang defficiency and obstruction of collaterals by blood stasis was level B and level C mostly, in the child-pugh grading for liver function of the group of liver kidney yin insufficiency, level B accounted for 14.3%, level C accounted for 85.7%; in the child-pugh grading for liver function of the group of spleen-kidney yang defficiency,level B accounted for 14.3%, level C accounted for 71.4%;in the child-pugh grading for liver function of the group of obstruction of collaterals by blood stasis,level B accounted for 27.7%, level C accounted for 46.8%. The different constitute of child-pugh grading for liver function for each group of syndrome types of TCM had statistical significance by comparison (P<0.05); by further comparison of the child-pugh grading for liver function between every two group of syndrome types of TCM, it had statistical significance by comparison of the group of stagnation of liver-QI and liver kidney yin insufficiency, stagnation of liver-QI and spleen-kidney yang defficiency, stagnation of liver-QI and obstruction of collaterals by blood stasis, internal resistance of dampness and liver kidney yin insufficiency, internal resistance of dampness and spleen-kidney yang defficiency, internal resistance of dampness and obstruction of collaterals by blood stasis, internal accumulation of dampness-heat and liver kidney yin insufficiency, internal accumulation of dampness-heat and spleen-kidney yang defficiency, internal accumulation of dampness-heat and obstruction of collaterals by blood stasis (P<0.05). It prompted that, the condition of the group of liver kidney yin insufficiency, spleen-kidney yang defficiency and obstruction of collaterals by blood stasis was more serious than the group of stagnation of liver-QI, internal resistance of dampness and internal accumulation of dampness-heat.4. The correlation between sublingual collaterals grading and the degree of esophageal varix, incidence rate of gastric varices under gastroscope.The esophageal vein of the group of sublingual collaterals grading of normal was no varix mostly, accounted for 69.2%, and the gastric vein was no varix;the esophageal vein of the group of sublingual collaterals grading of LevelⅠwas slight varix mostly, accounted for 71.1%, and incidence rate of gastric varices is 15.6%; the esophageal vein of the group of sublingual collaterals grading of levelⅡwas mezzo varix mostly, accounted for 64.5%, and incidence rate of gastric varices is 33.3%; the esophageal vein of the group of sublingual collaterals grading of levelⅢwas severe varix mostly, accounted for 90.2%, and incidence rate of gastric varices is 52.5%; the different constitute of the degree of esophageal varix and incidence rate of gastric varices under gastroscope for each group of sublingual collaterals grading had statistical significance by comparison (P<0.05); by further comparison of the degree of esophageal varix and incidence rate of gastric varices under gastroscope between every two group of sublingual collaterals grading, it had statistical significance (P<0.05). It prompted that, between sublingual collaterals grading and the degree of esophageal varix, incidence rate of gastric varices under gastroscope, it presented positive correlation.5. The correlation between sublingual collaterals grading and portal hypertensive gastric disease.None of the group of sublingual collaterals grading of normal appeared portal hypertensive gastric disease; 20% of sublingual collaterals grading of levelⅠappeared slight portal hypertensive gastric disease; 52.1% of sublingual collaterals grading of levelⅡappeared slight portal hypertensive gastric disease, and 8.3% appeared severe portal hypertensive gastric disease; 67.2% of sublingual collaterals grading of levelⅢappeared slight portal hypertensive gastric disease, and 24.6% appeared severe portal hypertensive gastric disease;the different constitute of the degree of the portal hypertensive gastric disease for each group of sublingual collaterals grading had statistical significance by comparison (P<0.05); by further comparison of the degree of the portal hypertensive gastric disease between every two group of sublingual collaterals grading,it had statistical significance (P<0.05). It prompted that, in the liver cirrhosis patient of sublingual collaterals grading of normal, probability of portal hypertensive gastric disease was very small, the higher sublingual collaterals grading would have bigger probability and severer degree, and the sublingual collaterals grading of the patient who had severe portal hypertensive gastric disease is levelⅢmostly.6. The correlation between sublingual collaterals grading and hepatogentic ulcer.The research prompted that, the different constitute of ulcer's incidence rate for each group of sublingual collaterals grading had no statistical significance by comparison(P>0.05).ConclusionsSublingual collaterals grading of the patient of liver cirrhosis was related to the Syndrome types of TCM, the child-pugh grading for liver function, the degree of esophageal varix, the incidence rate of varix of fundus of stomach, the degree of esophageal varix and the degree of portal hypertensive gastric disease. Therefore, it can be infered that, clinically, we can preliminary estimate the degree of esophageal varix, varix of fundus of stomach and portal hypertensive gastric disease indirectly by the dynamic observation of the manifest of sublingual collaterals, and assessment the risk of the upper gastrointestinal hemorrhage be complicated by cirrhosis of liver, and provide prevention and cure of the upper gastrointestinal hemorrhage be complicated by cirrhosis of liver provide according to that, the method is easy, fast and noinvasive, the patient can tolerate easily, but, it need to enlarge sample size for further study to verify.