Clinical Significance Of Tongue Features In Patients With Liver Cirrhosi

Purpose:Liver cirrhosis is the terminal stage of chronic liver damage caused by various reasons,which seriously threatens human health.As a part of TCM inspection,tongue diagnosis plays a vital role in the diagnosis and treatment of liver cirrhosis.Purple dark tongue in patients with liver cirrhosis is one of the indications of blood stasis syndrome,which may indicate the hypercoagulable state of patients with liver cirrhosis.There is still a lack of research on the correlation between tongue image and laboratory tests,especially hemostasis laboratory tests.The objectives of our research include: 1.To explore the relationship between the characteristics of tongue images in patients with liver cirrhosis,laboratory indicators and thromboelastography(TEG),and to provide clinical guidance for the diagnosis of the severity of liver cirrhosis patients by TCM tongue diagnosis.Material and method:Part I: We continuously collected patients with liver cirrhosis who were hospitalized in the Department of Gastroenterology,General Hospital of the Northern Theater Command from November 2020 to September 2021.Grouping Reference to Tongue Grouping in Study 1.According to the tongue characteristics of the patients,the patients were divided into pale red tongue group and pale white tongue group,pale red tongue group and red-purple tongue group,pale red tongue group and purple tongue group,white coating group and yellow coating group,teeth-marked tongue and without teeth-marked tongue,fissured tongue and without fissured tongue,spotted tongue and without spotted tongue and thin coating group and thick coating group differences laboratory parameters were compared between the two groups.A two-sided P < 0.05 was considered as statistically significant.Part II: We consecutively collected patients with liver cirrhosis who were hospitalized in the Department of Gastroenterology,Northern Theater General Hospital from November 2020 to September 2021 and underwent TEG testing.According to the characteristics of the tongue images of patients with liver cirrhosis,the patients were divided into weakened body resistance group(pale tongue,light red tongue)and excessive pathogen group(red tongue,purple tongue),white coating group and yellow coating group,thin coating group and thick coating group,fat tongue and thin tongue,and fissured tongue and without fissured tongue.Tongue group,the differences in TEG test between the two groups,including reactive time(R),coagulation time(K),angle(α),and maximum amplitude(MA)were compared.A patient with hypercoagulability would be considered,if at least two of the following criteria are met: shortened R,shortened K,increased α,or increased MA as compared to the reference range.Results:Part 1: Total bilirubin(64.75 ± 66.60 vs.31.74 ± 38.13,P = 0.015),AST(65.55 ± 40.86 vs.47.31 ± 35.34,P = 0.042)in the purple tongue group compared with the light red tongue group levels were significantly higher;international normalized ratio(1.35 ± 0.22 vs.1.27 ±0.26,P = 0.037)and prothrombin time(16.55 ± 2.09 vs.15.88 ± 2.48,P = 0.039)levels were significantly higher in the pale tongue group.Compared with the non-scarred tongue group,the scarred tongue group had a significantly higher proportion of alcoholic liver disease(35.10% vs.21.8%,P = 0.027).Compared with the without fissured tongue group,the fissured tongue group had significantly higher proportions of alcoholic liver disease(43.1%vs.22.7%,P = 0.004)and males(80.4% vs.64.8%,P = 0.035).Compared with the thin coating group,the Child-Pugh score(8.21 ± 2.13 vs.7.45 ± 2.22,P = 0.02)and total bilirubin level(45.71 ± 46.11 vs.36.06 ± 52.37,P = 0.033)were significantly higher in the thick coating group.Part II: Compared with weakened body resistance group,the proportion of MA(hypercoagulability)in the excessive pathogen group was significantly higher(3.10% vs.2.70%,P = 0.044);The proportion of hypercoagulability was not significantly different between two groups(5.50% vs.12.50%,P = 0.212).The prevalence of hypercoagulable states indicated by TEG test was significantly higher in the fissured tongue than in the without fissured tongue(18.2% vs.4.8%,P = 0.036).There was no significant difference in the prevalence of hypercoagulable state suggested by TEG test between white coating group and yellow coating group,thin coating group and thick coating group,fat tongue and thin tongue.Conclusion:Tongue appearance in patients with cirrhosis is associated with increased severity of liver function.When a patient has red-purple tongue,and purple tongue,it indicates a stasis phenomenon accompanied by abnormal liver function.Tongue features in liver cirrhosis may be related to MA,but not to hypercoagulable state suggested by TEG test.