Analysis Of Related Risk Factors And High-risk TCM Syndromes Of Spontaneous Rupture And Hemorrhage In Primary Liver Cancer

ObjectiveTo analysis the independent risk factors and high-risk TCM syndromes of spontaneous ruptured and hemorrhage in primary liver cancer to support early prevention of the disease.MethodsIn this study,42 patients with spontaneous rupture of primary liver cancer who were hospitalized in the Department of Infectious Diseases of Sichuan Hospital of traditional Chinese Medicine from January 2015 to December 2020 were selected as the study group.56 patients with unruptured primary liver cancer who were randomly selected in the same period were retrospectively analyzed as the control group.The age,sex,TCM syndrome type,complicated with hepatitis B,liver cirrhosis,hypertension,diabetes,ascites,Child-Pugh grade,BCLC stage,laboratory test results(Hb,AFP,PLT,TBIL,ALB,ALT,AST,PT,INR,FIB,HBs Ag,Scr),imaging examination results(maximum tumor length diameter,number of tumors,maximum tumor location,presence of static portal hypertension,PVTT,etc.),TACE history and other factors were statistically analyzed.The counting data were tested by Chi-square test or Fisher exact probability method with SPSS 26.0.t test was used for the data in accordance with normal distribution,and rank sum test was used to analyze the data of skewed distribution.Logistic regression model was established to test whether the single factor was an independent risk factor or protective factor.As a result,the independent risk factors or independent protective factors leading to spontaneous rupture of primary liver cancer were obtained,the predictive accuracy was assessed by drawing the receiver operating characteristic curve(ROC curve)and calculating the area under the curve(AUC),and the differences of TCM syndrome types between the two groups were analyzed.Thus,we can judge the high-risk TCM syndromes of patients with spontaneous rupture of primary liver cancer.Results1.Univariate analysis: The differences between the study and control groups in PT,INR,maximum tumor length diameter >5 cm,AFP >400 ng/ml,ascites,Child-Pugh classification,history of TACE treatment,and maximum tumor located in segments II,III,IVb,and VI were statistically significant(P < 0.05)and may be risk factors for spontaneous rupture and hemorrhage in primary liver cancer.2.Multifactorial analysis: The relevant univariate factors that were statistically significant in the above were included in a multi-factor binary logistic regression,yielding the results that the differences in maximum tumor length diameter >5 cm,AFP >400 ng/ml,and maximum tumor located in segments II,III,IVb,and VI were statistically significant,(P < 0.05),and were independent risk factors for the development of spontaneous rupture and hemorrhage in primary liver cancer.3.By calculating the area under the curve of each index with maximum tumor length diameter > 5 cm,AFP > 400 ng/ml,and maximum tumor located in segments II,III,IVb,and VI,the area under the curve was found to be 0.643,0.667,and 0.631,respectively,and the accuracy of predicting spontaneous rupture and hemorrhage in primary liver cancer was relatively high.4.High-risk TCM syndrome: The difference in the composition of liver heat and blood stasis syndrome between the study group and the control group was statistically significant(P < 0.005)by the R × C columnar test of chi-square test with Bonferroni correction,and liver heat and blood stasis syndrome was a high-risk type of spontaneous rupture and hemorrhage in primary liver cancer.Conclusions1.Maximum tumor length diameter >5 cm,AFP >400 ng/ml,and maximum tumor located in segments II,III,IVb,and VI are independent risk factors for causing spontaneous rupture and hemorrhage in primary liver cancer and can be used as predictors of spontaneous rupture and hemorrhage in primary liver cancer.2.The Liver heat and blood stasis syndrome is the high risk syndrome type of spontaneous rupture and hemorrhage in primary liver cancer.