Research On The Correlation Between Hepatocirrhosis And Tongue Change

Background: Hepatitis is a common disease in China, each year a large number of hepatitis patients get hepatocirrhosis. Hepatocirrhosis is one of the main diseases that cause people death, and is seriously endangering the health of our nationals. Currently hepatocirrhosis has become a serious social and medical problems. As laparoscopy technology has been becoming more and more mature, using it to the morphology of early diagnosis of hepatocirrhosis has great advantages, especially in the diagnosis of cirrhosis that the clinical diagnostic criteria can not be confirmed yet, but the morphology of the clinical diagnosed as hepatocirrhosis of the liver pre-Sclerosis. In Chinese medicine' s opinion , in the various stages of development of hepatocirrhosis, blood stasis is an important element of Chinese medicine syndrome. Congestive tongue Shezhi changes, such as Shezhi dark purple or tongue of Yuban and stasis, as the objective of blood stasis tongue Attendance targets, can be observed easily, and can reflect the degree of blood stasis. Close relation has been found between hepatocirrhosis and congestive tongue Shezhi change in former research. So the research of the TCM Syndrome distribution and congestive tongue Shezhi changes of the tongue in different stages of hepatocirrhosis and bleeding Shezhi change on the diagnosis of hepatocirrhosis is of great significance.Objective: In order to discover the correlation between Chinese tongue inspection indicators (bleeding tongue Shezhi changes) and hepatocirrhosis, research is done mainly in three aspects as bellow: (1) the distribution of hepatocirrhosis 3 including pre-clinical, compensated and decompensated period of TCM Type of Syndrome and the distribution of elements of TCM pattern; (2) the distribution of Shezhi and congestive tongue Shezhi changes including Shezhi dark purple or tongue of Yuban, stasis and liver palm, Spider-burst in healthy people, patients with chronic hepatitis and hepatocirrhosis as well as the differences between them; (3) the value of bleeding tongue Shezhi change indicators and liver palm, Spider-burst indicators in the diagnosis of hepatocirrhosis.Method: The research adopt the methods of epidemiology investigation and diagnostic test. 139 cases were studied, which were divided into hepatocirrhosis group(pre-clinical group, compensated hepatocirrhosis group, decompensated hepatocirrhosis group) and non-hepatocirrhosis group (healthy control group, chronic hepatitis group).The survey questionary was filled by diplomats. Chinese Shezhi whose photos were taken and saved by digital camera under the same condition were diagnosed and recorded by more than three physicians-in-charge. Observed measures including She Zhi (Danhong, Danbai, red, Hongjiang, short dark, Anhong, purplish red, pallida, cyanosis), congestive tongue Shezhi change indicators (Shezhi dark purple or tongue of Yuban, stasis Points), liver-palms and Spider-burst. Data were input into computers, databases were established to manage the data, statistical data were analysed by SPSS13. 0. Count data rate figured as ratios were compared by X~2 test. Measurement data figured as mean±standard deviation were compared by t-test, a = 0. 05. Sensitivity , specificity, accuracy, positive likelihood ratio and negative likelihood ratio are used to evaluate the diagnostic value. Results: (1) In Traditional Chinese Medicine Type of Syndrome aspect, Blood stasis, Shuishi internal resistance, Hot and humid Yunjie are common types in hepatocirrhosis group, which is 96.6 percent of the survey. TCM patterns in pre-clinical hepatocirrhosis group are mainly depression of liver-QI and hot and humid Yunjie. Patterns in compensated hepatocirrhosis group are mainly depression of liver-QI and obstruction of collaterals by blood stasis. Patterns in decompensated hepatocirrhosis group are mainly to Shuishi and obstruction of collaterals by blood stasis. There is difference in the distribution of the three groups (P <0.01), which has a statistically significant meaning. In TCM Syndrome elements aspect, "Yu", "stasis" and "spleen deficiency" is main in all three groups of hepatocirrhosis, followed by the "wet" and "hot" and "Yu", "stasis, " "spleen deficiency" in no difference between the three stages of hepatocirrhosis (P> 0. 05); the proportions of "Wet" in all three groups of hepatocirrhosis have an upward trend (P <0. 01), "Hot" is more in decompensated hepatocirrhosis group than compensated hepatocirrhosis group(P <0. 05). (2) Types in non-hepatocirrhosis group and cirrhotic group are mainly tongue of Yanhong. Types in early hepatocirrhosis group are mainly tongue of Yanhong and Short dark. Types in compensated hepatocirrhosis group are mainly tongue of Anhong. Types in decompensated hepatocirrhosis group are mainly tongue of short dark. There are significant differences between the distribution of non-hepatocirrhosis group and the distribution of cirrhotic group in Tongue (P<0.01). And there are also significant differences between the distribution of chronic hepatitis group and hepatocirrhosis group in She Zhi changes (P<0. 01). There are significant differences between the distribution of chronic hepatitis group and hepatocirrhosis group in She Zhi changes (P <0. 01). There are significant differences in the distribution between the various groups of Congestive Tongue (P<0.01).There are significant differences between hepatocirrhosis group and the healthy control group in the distribution of congestive tongue Shezhi changes (P<0.01). There are significant differences between the distribution of hepatocirrhosis group and chronic hepatitis group in congestive tongue Shezhi changes (P <0.01). (3) Through analyzing the difference among Shezhi change of conestive tongue, liver-palms, Spider-burst and Joint detection indicators in the three hepatocirrhosis groups, it is found that the specificity of liver-palms and Spider-burst is the highest (98.04%), the congestive tongue Shezhi changes (tongue Of purple or dark tongue of Yuban, stasis) has the highest sensitivity (89. 8%), the lowest negative likelihood ratio (0.1491) and the highest accuracy (82 %), which are better than liver-palms and Spider-burst.Conclusions: (1) As elements of Chinese medicine syndrome, Yu, stasis and spleen deficiency always company with hepatocirrhosis. With the aggravation of hepatocirrhosis, stasis gradually play a leading role. Wet, hot and stasis may be important factors aggravating hepatocirrhosis. Deficiency Syndrome may be the factor deferring hepatocirrhosis .which makes hepatocirrhosis can not be cured in a short term. The syndrome indicators like these reflect pathology features of TCM pattern well. (2) Shezhi of cases in pre-clinical hepatocirrhosis group are mainly tongue of Yanhong and Short dark. Those in compensated hepatocirrhosis group are mainly Anhong tongue. Those in decompensated hepatocirrhosis group are mainly short dark tongue. Dark tongue exists in all groups. (3) From indicators' perspective, such as comprehensive sensitivity, specificity and accuracy, bleeding tongue Shezhi change (Shezhi dark purple or tongue of Yuban, stasis) is superior to the liver-palm or Spider-burst indicators. In conclusion, Congestive tongue Shezhi change (Shezhi dark purple or tongue of Yuban, stasis) is of high value in the diagnosis of hepatocirrhosis, as well as liver-palms and Spider-burst. It can be considered as an important objective indicator in the diagnosis of hepatocirrhosis.