A Review And Retrospective Study Of Hepatocirrhosis: Disease Reason, Mechanism, Diagnosis And Treatment

ObjectiveThe study concluded and summarized the diagnosis and treatment routine of hepatocirrhosis after reviewing correlative literature. At the same, through the retrospective study of the epidemiology and routine for diagnosis and treatment, we discussed the pathogeny laws, clinical characters and treatment routine of hepatocirrhosis, which was hoped to be of help to the development in the period ahead.MethodsThe study consulted the literature in CNKI and Wanfang database with the prefabricated search type, and aggregated and summarized the literature. At the same, the case history information of hepatocirrhosis inpatients treated in the 1st affiliated hospital of Guangzhou University of Traditional Chinese Medicine from 1st January 2005 to 1st January 2010 was collected for retrospective study. The information included:sociology information, diagnoses, therapy, drugs and curative effect ect, which was used to have statistical analysis according to the exploratory study of the diagnosis and treatment of hepatocirrhosis. Then tried to make an initial summarization of the measures of diagnosis and treatment.Result1 Literature studyThere was significant difference according to the gender. Most hepatocirrhosis patients were male. The ratio between male and female was (3.6-8):1.The main pathogeny of cirrhosis was alcoholic hepatitis in Europe and America, when it was viral hepatitis in Asia and Africa. Recently, the proportionment of alcoholic cirrhosis raised. There is no effective therapy for cirrhosis currently. Forepart diagnosis was very important.Once diagnosised the patient should start anti-fibrosis treatment as soon as possible. Giving corresponding processing according to the pathogeny could prevent cirrhosis further development.At later stage, preventing and curing complications should be treated actively. At the terminal stage, we depended on liver transplantation only.2 Retrospective survey2.1 Epidemiology information:Hepatitis B virus infected was the main pathogeny. The proportionment of alcoholic cirrhosis raised and was the second pathogeny. The age of this group was 55.6±13.44 yesrs old. The youngest was 16 years old, when the oldest was 90 years old. The ratio between male and female was 4.56:1. Blood type most was type 0 Rh posibive. These patient mainly came from Guangzhou, radiating to the whole province. Some came from Guangxi province, Henan province, Hainan province, Jiangxi province, Sichuan province, Heilongjiang province, Yunnan province and so on. There were 5 foreign patients.2.2 Diagnosis:Most patient were decompensated cirrhosis. There were 69 patint(accounting for 28.87%) who were firstly diagnosed cirrhosis during hospitalization in these group. During these patients, there were 23 patients with varicose(accounting for 33.33% of patients firstly diagnosised).Hypersplenism (148 hyperthyroidism patients, accounted for 61.9%) was the most frequent complication, and followed by infection (58 cases, accounting for innovation) and upper gastrointestinal bleeding (51 cases, accounting for 21.3%). When hepatorenal syndrome happened, the mortality raised. During the patients who took electronic gastroscope, there were 87.76% patient with varicose veins and there were 62.79% patients with red-color sign. Varicosity classification:11.6% were mild,11.6% were moderate and 76.7% were severe. According to the standard of Child-pugh score,9.2% patients were grade A,37.2% patients were grade B,53.1% patients were grade C.2.3 Therapeutic2.3.1 Western medicine:General treatment included sickbed, eating high calorific value and high fibrin and easily digested food. At the same time, give treatment to protect liver and nutritional support. The treatment of liver cirrhosis aimed at pathoge -ny was insufficient, which eflected in the the antiviral treatment and temperance. In tems of upper gastrointe- stinal bleeding, more patients use medical drug treatment, when emergency endoscopic examination and treatment was rare. There was much side-effect when patient used the Sengstaken-Blakemore tube, such as distress, suffo- cation, rupture of esophagus and aspiration pneumonia ect, so just 7patients used it. For the patients with hyperthy roidism, the treatment of they was not positive enough, which should cause the attention of clinician- s. Those who with spontaneous peritonitis, fluoroquinolone were used more common, followed by cephalosporins and penicillins. Early identification and removal of incentives is very important for the patient with hepatic encephalopathy. At the same time, taking active measures to reduce the creation and absorption of intestinal nitrogen toxic substances and using drugs to promote ammonia metabolism was important. For the patients with hepatorenal syndrome, positively controlling the predisposing factor was important. The main predisposing factor was infection, upper gastrointestinal bleeding, fluid and electrolyte disorders ect. This hospital had no terlipressin, a2-receptor antagonist midodrine and no TIPS technology, so the treatment for they was enough. There was no effective medical treatment for the patients with hepatopulmonary syndrome. In this group, oxygen cure was the only treatment. Liver transplantation was the only way for them. There was no condition to carry out this treatment, so mortality rate of hepatopulmonary syndrome was very high.2.3.2 Therapy on TCM:The TCM Syndrome after modified syndrome included liver pent-up, spleen and kidney yang deficiency, liver-yin and kidne-yin deficiency, intrinsic heat and damp, moisture resistance and blood stasis. 91.63% of the patient took Chinese medicine.92.89% of the patient choosed intravenous injection and (or) eat Chinese medicine preparation.224 Chinese medicine were involved. They could be divide to 20 categories. Diuresis Shenshi drugs, antipyretic drugs, remove blood stasis drugs, drugs for regulating QI flow, yin tonics drugs, anastaltic drugs were the top 7 categories. Besides of oral administration, many ways such as intravenous drip, coloclysis, acupuncture and moxibustion ect were also used to enlarge the therapeutic mens of TCM in hepatocirrhosis.ConclusionThere were much more male patient than female. The main pathogeny was still virus hepatitis(Hepatitis B and Hepatitis C), followed by alcoholic hepatitis. The proportion of alcoholic cirrhosis was significantly higher than reported in recent years, which should cause our attention. For patients, good habits was an important means to avoid and prevent cirrhosis. When doctors in admissions, chronic viral hepatitis, long-term heavy drinkers should be long-term close follow-up; the doctors should pay attention to the function of liver and spleen and its changes. When we found that liver stiffness increase, splenomegaly, abnormal liver function, B-ultrasonic examination showed changes in liver parenchyma echo inequality and so on, we should pay attention to early cirrhosis. When it was necessary took liver bispsy;it could diagnose cirrhosis. In recent years, as a variety of new drugs, traditional Chinese medicine and other therapy and technology developed and applicated, the efficacy and patient's quality had a great change. However, liver cirrhosis complicated by hepatorenal syndrome, hepatopulmonary syndrome and other serious complications, the treatment is limited, and the prognosis is still far from satisfactory. In terms of traditional Chinese medicine diagnosis and treatment, the "liver, spleen and kidney" dysfunction was the main performance. Qi stagnation, blood stasis, water retention was the pathological product. Intrinsic heat and damp was the most common TCM syndrome, followed by moisture resistance and liver Qi Stagnation. Diuresis Shenshi drugs, antipyretic drugs, remove blood stasis drugs, drugs for regulating QI flow, yin tonics drugs, anastaltic drugs were the top 7 categories, which was consistent with the therapeutic guideline that attacked and reinforced at the same time. It was consistent with pathologic features that was "Qi stagnation, blood stasis, water retention". Besides of coloclysis, acupuncture, local application and moxibustion used in this group, there was various methods, were also used to enlarge the therapeutic mens of TCM in hepatocirrhosis. There was much room for the therapy on TCM to development.