Professor Qian Ying’s Experience And Clinical Efficacyin The Treatment Of Minimal Hepatic Encephalopathywith Blood Method

Introduction:Minimal hepatic encephalopathyis a very hidden stage in the course of hepatic encephalopathy,it is defined as neuropsychological/neurophysiological abnormalities without orientation disorders or flapping tremorin patients withliver cirrhosis,namely,their cognitive function is normal;the morbidity is as high as 25%-39.9%,the incidence is not related to age,sex.smoking and education,but it is closely related to Child-Pugh classification.Wang et al discovered that the incidence of MHE was 24.8%,39.4%and 56.1%in Child-Pugh A,B and C cirrhosis patients.MHE patients have no abnormal personality,behavior and biochemical indexes in clinic,diagnosis can only be made by neuropsychological testing of MHE patients by professionals with expertise.They are a very neglectable group.However,clinical follow-up showed that MHE was more likely to develop obvious hepatic encephalopathy(OHE),the incidence and mortality of other complications also increased significantly.MHE can last for a long time,it can also affect the quality of life,driving ability,work efficiency and social status of patients.Studies showed thatpatients can have varying degrees of depression and anxiety which will seriously affectthe quality of work and life of patients.Early routine screening of MHE patients is necessary.Timely diagnosis and treatment can avoid OHE and other complications,it can avoid accidents in patients working at high altitude or driving,it can also reduce the number of repeated hospitalizations,reduce mortality and improve the prognosis of patients.Several studies have shown that lactulose has therapeutic value for MHE patients and can prevent HE recurrence.However,many patients with hepatic encephalopathy still suffer from repeated attacks of HE even they take lactulose for a long time after recovery,and some patients can’t tolerate the side effects of lactulose.The purpose of this study is to observe Professor Qian Ying’s experience and clinical efficacy in the treatment of MHE with HEXUE therapy.We hope to summarize Professor Qian Ying’s clinical experience in treating MHE withHexue therapy through prospective cohort clinical research.And we want to observe the clinical efficacy of Professor QianYing’sproved recipe Hegankaiqiao Yin in the treatment of MHE.Objective:1.We want to search for MHE’s TCM syndrome specific syndrome,therapeutic principle and method,core prescription and medication rulemainly through collecting and collating the clinical data of Professor Qian Ying’s treatment of MHE with Hexuetherapy,and we hope we can provide data reference for early identification and differentiation of symptoms and signs in TCM,and medical evidence for clinical work.2.We observed the clinical efficacy of Professor Qian Ying’s application of Hegankaiqiao Yin in the treatment of MHE with prospective analysis,and we want to provide a theoretical basis for the efficacy of TCM in the treatment of MHE.Methods:We collected the clinical data of all outpatients or inpatients in Beijing Youan Hospital Affiliated to Capital Medical University for diagnosis of MHEfrom 1 May 2013 to 31 July 2015,we used MISCR technology to analyse the characteristics of syndrome differentiation,symptom distribution,medication rule,core prescription,relationship between drugs and syndromes,drug compatibility,etc.we made deep data mining using descriptive statistics and association rules.Using a prospective and open cohort approach,we included 172 MHE patients who met the inclusion and exclusion criteria,and they were outpatients or inpatients in Beijing Youan Hospital Affiliated to Capital Medical University from 1 May 2013 to 31 July 2015.The patients were divided into treatment group(integrated Chinese and western medicine group)and control group(western medicine group)with 86 cases in each group according to whether they can accept the treatment of traditional Chinese medicine or not The selected cases should bein accordance with the diagnosis of liver cirrhosis with minimal hepatic encephalopathy by western medicine,they should also be in accordance with the diagnosis of coma in traditional Chinese medicineand theTCM syndrome typeshould be qi deficiency and blood stasis syndromeof liver and spleen.The control group was treated with western medicine(lactulose),the treatment group was treated with Hegankaiqiao Yin,the treatment lasted for 4 weeks and the follow-up lasted for 6 months,and the neuropsychiatric symptoms,TCM syndrome scoring,digital connection test,digital symbol test,liver function,Child-Pugh classification,serum endotoxin level,blood ammoniaof the two groups were compared to evaluatethe efficacy of HegankaiqiaoYin in the treatment of MHE.Results:1.102 cases were included in retrospective study.We inputpatients syndrome differentiation and prescription into MISCR related technology database and analyzed the data.Among them,the first three types of TCM syndromes appeared frequently are qi deficiency and blood stasis syndrome 49 cases(49.01%),water-dampness internal obstruction syndrome 28 cases(27.45%),accumulated dampness-heatsyndrome 17 cases(16.66%).There are 18 kinds of traditional Chinese medicines used more than 20 times,the main function of these herbsare softening the liver with Hexuetherapy and inducing resuscitation.the first three herbs appeared frequently are radices paeoniae alba,radix rehmanniaerecens,peach kernel;Statistics according to four properties and five tastes showed that the medicinal properties of these herbs are mainly warm,cold and mild cold while the five flavors are mainly bitter,acrid and sweet.The channel tropism are mainly liver and heart.The core prescription for MHE is Hegankaiqiao Yin.and there are 50 prescriptions for qi deficiency and blood stasis syndrome.28 prescriptions for water-dampness internal obstruction syndrome,17prescriptionsfor accumulated dampness-heatsyndrome,7 prescriptionsfor deficiency of liver-yin and kidney-yin syndrome.2.The study included 172 MHE patients.86 in the treatment group(integrated Chinese and western medicine group)and 86 in the control group(western medicine group).There was no significant difference in general data including sex,age,course of disease and etiology between the two groups.The control group was treated with lactulose andBifidobacterium viable preparations Bifico,while the treatment group was treated with Hegankaiqiao Yin on the basis of western medicine.Scores of TCM syndromes in two groups before and after treatment showed that the total effective rates of treatment group at 1w,2w and 4w were 68.25%,56.39%and 52.41%respectively,and the total effective rates of control group at 1w,2w and 4w were 37.64%,28.35%and 26.96%respectively,the difference was significant(P<0.05).In neuropsychological testing,the duration of digital connection test in treatment group was shorter than that in control group,the score of digital symbol test in treatment group was higher than that in control group,the difference was statistically significant.The therapeutic effect of the treatment group was better than that of the control group in biochemical indexes such as TBIL,ALB,PTA,Child-Pugh classification,serum endotoxin level and blood ammonia.The number of pathogenic bacteria decreased and the number of probiotics increased in the treatment group,and the therapeutic effect was better than that in the control group.the difference was statistically significant.Conclusion:1.We summarized the general rules of Professor Qian Ying’s treatment of MHE with Hexue therapythrough data mining,including common TCM syndromes,core prescriptions and frequency of common drugs,and the work has certain reference value for clinic.2.For the treatment of liver cirrhosis patients with mild minimal hepatic encephalopathy,Hegankaiqiao Yin can obviously shorten NCT-A time,increase DST score,bring down serum endotoxin level,lower blood ammonia,improve liver function,reduce OHE recurrence,increase the survival rate of patients,which is worth popularizing widely in clinic.