Correlation Between TCM Syndromes And Prognosis Of Hepatitis B Associated Hepatocellular Carcinoma

Objective:This study intends to explore the distribution of TCM syndrome types in patients with hepatitis B-related liver cancer(HBV-HCC),analyze the correlation between TCM syndrome types and clinical data,screen out the factors affecting the prognosis of TCM syndrome types,and evaluate the survival of patients with HBV-HCC under the treatment of integrated traditional Chinese and Western medicine,so as to provide reference for the diagnosis,treatment,prognosis evaluation and prospective study of HBV-HCC.Methods: Patients who were first diagnosed as HBV-HCC by clinical or pathological diagnosis in the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine were selected according to inclusion criteria and exclusion criteria.Collect the basic information of patients,TCM syndromes,TCM prescriptions,laboratory indicators and imaging data,analyze the distribution of TCM syndromes and commonly used TCM prescriptions;SPSS 21.0 statistical software was used for statistical analysis to understand the correlation between TCM syndromes and clinical data.The correlation between TCM syndrome types and prognosis was compared,and the survival curve was plotted by Kaplan-Meier method after classification according to different syndromes.COX regression analysis was used to screen out the factors affecting prognosis in different TCM syndromes.Results:(1)The distribution of TCM syndromes in 391 patients with HBV-HCC was liver depression and spleen deficiency syndrome > liver heat and blood stasis syndrome > liver and gallbladder damp heat syndrome >liver and kidney yin deficiency syndrome > spleen deficiency and dampness stagnation syndrome > other syndromes;the most commonly used prescriptions of TCM syndromes are : damp-heat syndrome of liver and gallbladder : Yinchenhao decoction;liver heat and blood stasis syndrome:modified Xuefu Zhuyu Decoction;liver and kidney yin deficiency syndrome:consistent decoction;liver depression and spleen deficiency syndrome: Modified Chaishao Liujunzi Decoction;spleen wet trapped syndrome: Wuling powder addition and subtraction;other syndromes :Chaihu Guizhi Ganjiang Decoction and Fuzheng Xiaoji Pill.(2)The ratio of male to female was about 6.38 : 1,in which the average age of onset of female(57.58 ± 12.95 years old)was higher than that of male(53.19 ± 12.08 years old).There was no significant difference between TCM syndrome types and gender,age,smoking history,tumor number,PLR,GGT,PT and AFP levels.There were significant differences between TCM syndrome types and drinking history,tumor diameter,BCLC stage,Child-Pugh classification of liver function,NLR,ALT,AST,ALB,TBIL,CHE,ALP,TBA,PVTT,cirrhosis basis.(1)The values of NLR,ALT,AST,TBA,ALP and TBIL in patients with liver-gallbladder damp-heat syndrome and liver-kidney yin deficiency syndrome were higher,while the values of CHE and ALB were lower.The values of ALT,AST,TBA,ALP and TBIL in patients with liver stagnation and spleen deficiency syndrome were lower,and the values of CHE and ALB were higher.(2)Most of the patients with liver and gallbladder damp-heat syndrome and liver and kidney yin deficiency syndrome had drinking history,and few of the patients with spleen deficiency and dampness stagnation syndrome had drinking history.The incidence of PVTT in other syndromes was higher,and the incidence of PVTT in patients with liver depression and spleen deficiency syndrome was lower.Liver heat and blood stasis with decompensated cirrhosis patients are less,spleen deficiency and dampness with decompensated cirrhosis patients are more;the tumor diameter of patients with other syndromes was larger,and the tumor diameter of patients with liver depression and spleen deficiency syndrome was smaller.(3)The patients of BCLC stage 0 and A were mainly liver depression and spleen deficiency syndrome,while the patients of stage C were mainly liver and gallbladder damp heat syndrome,and the patients of stage D were mainly liver and gallbladder damp heat syndrome and liver and kidney yin deficiency syndrome.The liver function reserve of patients with liver depression and spleen deficiency syndrome was better,and the liver and gallbladder damp-heat syndrome and liver and kidney yin deficiency syndrome were poor.(3)The difference between TCM syndrome types and prognosis was statistically significant.Among them,the mortality of patients with livergallbladder damp-heat syndrome,liver-kidney yin deficiency syndrome and other types of syndrome was high,and the prognosis was poor.The mortality of patients with liver depression and spleen deficiency syndrome was low,and the prognosis was good.(4)COX regression analysis showed that the factors affecting the prognosis in different syndromes were different.The factors affecting the prognosis in liver-gallbladder damp-heat syndrome were Child-Pugh classification,tumor diameter,and NLR.The factors affecting the prognosis in liver-heat and blood stasis syndrome were BCLC staging,Child-Pugh classification,AFP level,PVTT,and surgical methods.The factors affecting the prognosis in liver-kidney yin deficiency syndrome were Child-Pugh classification,AFP level,and surgical methods.The factors affecting the prognosis in liver depression and spleen deficiency syndrome were Child-Pugh classification,tumor diameter,and surgical methods.Conclusion:(1)The distribution of TCM syndromes in 391 patients with HBV-HCC was liver depression and spleen deficiency syndrome > liver heat and blood stasis syndrome > liver and gallbladder damp heat syndrome >liver and kidney yin deficiency syndrome > spleen deficiency and dampness stagnation syndrome > other syndromes;the most commonly used prescriptions of TCM syndromes are : damp-heat syndrome of liver and gallbladder : Yinchenhao decoction;liver heat and blood stasis syndrome:modified Xuefu Zhuyu Decoction;liver and kidney yin deficiency syndrome:consistent decoction;liver depression and spleen deficiency syndrome: Modified Chaishao Liujunzi Decoction;spleen wet trapped syndrome: Wuling powder addition and subtraction;other syndromes :Chaihu Guizhi Ganjiang Decoction and Fuzheng Xiaoji Pill.(2)The ratio of male to female patients was 6.38 : 1,and the average age of onset in females was higher than that in males.There was no significant difference between TCM syndrome types and gender,age,smoking history,tumor number,PLR,GGT,PT and AFP levels.There were significant differences between TCM syndrome types and drinking history,tumor diameter,BCLC stage,Child-Pugh classification of liver function,NLR,ALT,AST,ALB,TBIL,CHE,ALP,TBA,PVTT,cirrhosis basis.(3)There was a statistically significant difference between TCM syndrome types and prognosis,among which the mortality rate of patients with liver-gallbladder damp-heat syndrome,liver-kidney yin deficiency syndrome and other types of syndrome was higher and the prognosis was poor.The mortality rate of patients with liver depression and spleen deficiency syndrome was lower and the prognosis was better.(4)The factors influencing the prognosis in different syndromes are different.The factors influencing the prognosis in liver-gallbladder dampheat syndrome are Child-Pugh classification,tumor diameter,and NLR.The factors influencing the prognosis in liver-heat and blood stasis syndrome are BCLC staging,Child-Pugh classification,AFP level,PVTT,and surgical methods.The factors influencing the prognosis in liver-kidney yin deficiency syndrome are Child-Pugh classification,AFP level,and surgical methods.The factors influencing the prognosis in liver depression and spleen deficiency syndrome are Child-Pugh classification,tumor diameter,and surgical methods.