The Clinical Features, Prognosis Of HBV-ACLF, The Relationship Between HBV-ACLF And SIRS And The Research Of TCM Syndrome Differentiation And Treatment

Liver failure is a common clinical syndrome of severe liver disease, refers to the acute or chronic severe liver damage caused by many factors, resulting in severe impairment or decompensation of liver synthesis, detoxification, biotransformation functions and excretion, appears to coagulation disorders, jaundice, hepatic encephalopathy, ascites as the main performance of a group of clinical syndromes. HBV-ACLF is a chronic liver disease based on HBV caused by acute liver function discompensation. SIRS is a variety of pathogenic factors trigger excessive immune generated inflammation, coagulation and clinical course of an impaired fibrinolytic response, in which systemic inflammation caused by infection, also known as sepsis is an important cause of critically ill patients with MODS and death.The infection rate of severe hepatopathy such as cirrhosis and liver failure is high, which can induce serious complications such as hepatic encephalopathy and decrease survival rate.In recent years, we found that SIRS/sepsis involved the disease evolution of ACLF. Make a more detailed description on predisposing factors, clinical features,SIRS of HBV-ACLF patients, and analysis of the outcome, accurately and objectively determine the prognosis of patients early in the disease, and actively explore and seek effective treatment measures become an important research of HBV-ACLF.Objective1.Systematically understanding clinical features, mortality, and valuable clinical indicators of prognosis. To evaluate the value of CLIF-SOFA score and MELD score for the prognosis of patients with HBV-ACLF.2. Discussion SIRS and its impact in HBV-ACLF patients with onset of the disease. To evaluate the prognostic value of CLIF-SOFA score and MELD score in patients with HBV-ACLF combined with SIRS.3, Evaluating efficacy of integrative medicine measure basing on the method of "Yang Huang-Yin-Yang Yin Yang Huang" diagnosis and treatment for HBV-ACLF by randomized controlled clinical study. Explore the mechanism of TCM treatment for HBV-ACLF from SIRS.Method1、Collect clinical data of160patients admitted with HBV-ACLF, make descriptive analysis of the general situation (underlying disease, predisposing factors, disease stage), complications, laboratory, and summarize clinical characteristics of patients with HBV-ACLF; Compare different underlying diseases in general condition of the patient, complications, and compare the laboratory tests; summary analysis of HBV-ACLF different disease characteristics and prognosis of the laboratory tests, summarize and analyze the disease characteristics and laboratory examination of different prognosis in patients with HBV-ACLF. To evaluate the value of CLIF-SOFA score and MELD score for the prognosis of patients with HBV-ACLF.2、Studies in patients with HBV-ACLF overall incidence of SIRS; according to the diagnostic criteria of SIRS HBV-ACLF patients were divided into SIRS group and non SIRS group, analyzed two groups of patients in general (age, sex, stage of disease, underlying diseases, incentives), complications occurrence, laboratory tests (liver function, kidney function, blood coagulation, electrolytes, and fasting blood glucose), serum cytokines as well as differences in disease outcome. To evaluate the prognostic value of CLIF-SOFA score and MELD score in patients with HBV-ACLF combined with SIRS.3、Adopting multicenter randomized controlled trial,160patients of HBV-ACLF were randomly divided into trial group and control group, each group of80cases. The trial group was given western medicine comprehensive treatment, and on the basis of western medicine comprehensive treatment, the control group was given "Yanghuang-Yiyang huang-Yinhuang" syndrome differentiation, treated8weeks and followed up4weeks, assess the clinical efficacy. Two groups were compared mortality, laboratory tests, symptom scores, CLIF-SOFA score, MELD score SIRS circumstances change and consolidation. Results1、Patients with peasants as the main occupation; Inducing factors of HBV-ACLF with unknown causes and related factors of the main antiviral therapy;158cases of HBV-ACLF patients, Basic diseases for chronic hepatitis B, accounted for the most patients with compensated liver cirrhosis of hepatitis B for the second; no significant difference between the Patients with cirrhosis in ACLF are more in middle and advanced stage, patients without cirrhosis are more in early stage; probability of complications in patients with liver cirrhosis basis is significantly greater than the patients without cirrhosis basis; the baseline of PTA in patients with cirrhosis was significantly lower than those without cirrhosis based foundation of patients; the baseline of INR was significantly higher than that of patients without cirrhosis basis.2, In158HBV-ACLF patients12weeks a total of38cases of death; there are many factors influencing the prognosis of patients with HBV-ACLF, including ACLF staging, underlying diseases, complications etc; by observing the change trend, can make preliminary judgment of the prognosis of patients with HBV-ACLF. CLIF-SOFA score and MELD scores were important for the prognosis of patients with HBV-ACLF. For underlying diseases in patients with chronic hepatitis B MELD score to predict prognosis is better, for the underlying disease to liver cirrhosis patients, CLIF-SOFA score for predicting the prognosis is better.3、Among the158HBV-ACLF patients,72cases had SIRS, the incidence rate was45.6%; patients in the SIRS group and non SIRS group patients had no significant difference in gender, age; decompensated hepatitiscirrhosis and decompensated hepatictis B cirrhosis incidence rate of SIRS was higher than that in chronic hepatitis B; ACLF mid and late SIRS patients was significantly higher than that of patients with early stage; The main reason for HBV-ACLF complicated with SIRS was infection, the main infection sites was abdominal cavity, followed by gastrointestinal bleeding, other causes; The probability of complications in patients with SIRS group was significantly greater than that of non SIRS group, according to the frequency of the disorder of electrolyte, followed by the emergence of hepatorenal syndrome, hepatic encephalopathy; SIRS group of TBIL, Cr, INR higher than those in non SIRS group, and TBIL, Cr, INR increased with theincreasing of SIRS integral; SIRS group of PTA was lower than that in non SIRS group,and PTA increased with the decreased SIRS integral; Group SIRS electrolyte disorder incidence was higher than that in non SIRS group, one of the most common was hyponatremia, SIRS group Na was significantly lower than that in non SIRS group; There were no significant difference between the two groups of patients with ALT, K, CL, BG; HBV-ACLF patients with SIRS group, TNF-a, IL-6, IL-10, IL-17was significantly higher than non-SIRS group; two of IFN-y, IL-4was no significant difference; SIRS group cumulative death were significantly higher than non-SIRS groups. SIRS group CLIF-SOFA score, MELD score was significantly higher than the non-SIRS group, and SIRS points higher, CLIF-SOFA score, MELD score higher. CLIF-SOFA score, MELD score of HBV-ACLF merger SIRS prognosis of patients are of great significance, and CLIF-SOFA score of HBV-ACLF merger SIRS prognosis of patients with higher MELD score.4、Based on the "Yang Huang-Yin and Yang Huang-Yin Huang," Chinese medicine diagnosis and treatment patterns intervention to reduce TBIL HBV-ACLF patients obvious; can significantly improved symptoms in patients with HBV-ACLF; can significantly reduce the incidence of HBV-ACLF hepatorenal syndrome and primary peritonitis. It can significantly improve the patient’s CLIF-SOFA score, MELD score, which reduces the HBV-ACLF of mortality may be related to reducing the incidence of SIRS related.Conclusion1、The main occupation was farmers; the main inducement were unknown causes and related factors of antiviral treatment.The basis of disease in patients with HBV-ACLF in chronic hepatitis B patients accounted for the most, compensated hepatitis B cirrhosis accounted for the second,; HBV-ACLF patients with cirrhosis were more at middle-late stage, had greater probability of complications, and the coagulation was significantly poorer than in patients without cirrhosis.2、There are many factors influencing the prognosis of patients with HBV-ACLF, including ACLF staging, complications, underlying diseases. CLIF-SOFA score and MELD scores were important for the prognosis of patients with HBV-ACLF. For underlying diseases in patients with chronic hepatitis B MELD score to predict prognosis is better, for the underlying disease to liver cirrhosis patients, CLIF-SOFA score for predicting the prognosis is better.3、The main reason for HBV-ACLF complicated with SIRS was infection, the main infection sites was abdominal cavity; patients with cirrhosis or at middle-late stage had a greater incidence of SIRS; once the patients with HBV-ACLF complicated with SIRS, could make liver injury aggravated, the incidence and mortality of patients with complications, CLIF-SOFA score, MELD score and mortality rate increased sharply; Cytokines TNF-a,IL-6,IL-10, IL-17may merge plays a role in the pathogenesis of SIRS in HBV-ACLF. CLIF-SOFA score, MELD score of HBV-ACLF merger SIRS prognosis of patients are of great significance, and CLIF-SOFA score of HBV-ACLF merger SIRS prognosis of patients with higher MELD score.4、Based on the "Yang Huang-Yin and Yang Huang-Yin Huang," Chinese medicine diagnosis and treatment patterns intervention to reduce TBIL HBV-ACLF patients obvious; can significantly improved symptoms in patients with HBV-ACLF; can significantly reduce the incidence of HBV-ACLF hepatorenal syndrome and primary peritonitis; can significantly improve the patient’s CLIF-SOFA score, MELD score, which reduces the HBV-ACLF of mortality may be related to reducing the incidence of SIRS related.