Analysis Of TCM Constitution Of Autoimmune Hepatitis And The Diagnostic Value Of APRI And FIB-4 In Hepatic Fibrosis

Research purposes1.The TCM Constitution survey of 247 cases of patients with autoimmune hepatitis, and studying the constitution distribution characteristics, in addition, exploring correlation between gender, age and cirrhosis of the liver and the physical distribution of traditional Chinese medicine, in order to guide the disease of traditional Chinese medicine treatment and nursing.2.The clinical data of 71 patients with AIH were analyzed retrospectively, and the diagnostic value of APRI value and FIB-4 value of non invasive diagnosis model of hepatic fibrosis was studied in AIH liver fibrosis.Research methods1. Analysis of TCM constitution AIH1.1 According to the inclusion and exclusion criteria,247 patients with AIH who were admitted to theBeijing Ditan Hospital Affiliated to Capital Medical University from September2013 to December 2015 were included, and collected general information on all patients, and according to the 2009 China Association of Chinese medicine to develop "the TCM constitution classification and judgment of self-test table "conducted a questionnaire survey to take patient self-administered or question and answer form to complete "the autoimmune hepatitis TCM Constitution determine all the problems of the form".1.2 The data was entered into the database and sorted, and data were analyzed by using statistical software,and observing the characteristics of the physical distribution of AIH, in addition,observing the effect of the distribution of TCM Constitution of AIH according to gender, age, liver cirrhosis group.2. Value of APRI and FIB-4 in the diagnosis of liver fibrosis in AIH2.1 Data and clinical data of 71 patients with AIH who were admitted to the Beijing Ditan Hospital affiliated to Capital Medical University from January 2010 to December 2015 were retrospectively analyzed.2.2 The clinical data of the patients into the database into the database, according to the calculation formula APRI and FIB-4 value.2.3 According to the liver biopsy results values from the three aspects of Apri and FIB-4 diagnostic value of liver fibrosis (≥S1), significant fibrosis (≥S2) and severe liver fibrosis (≥S3).Research results1.Analysis on TCM Constitution of AIH1.1 Distribution of TCM Constitution in AIH:Included a total of 247 patients, including the TCM Constitution with Yin deficiency (25.1%) and Qi Stagnation (21.1%),and the percentage distribution of the remaining 7 kinds of TCM Constitution from big to small is as follows:Qi deficiency (15.0%), flat and quality (13.0%), damp heat constitution (10.5%), phlegm (8.1%), blood stasis (3.2%), deficiency of Yang (3.2%), special intrinsic quality (0.8%). In addition,various types of traditional Chinese medicine constitution is different(x 2=85.858,p=0.000).1.2 Gender did not influence the distribution of traditional Chinese Medicine Constitution:41 cases of male patients with AIH (16.6%),206 cases of female patients (83.4%), male to female ratio is about 1:5. Among them the physique of male patients with AIH with Qi deficiency, qi stagnation and dampness heat is given priority to, still mainly to yin deficiency and qi stagnation constitution of female patients, but between different gender, physique type of TCM distribution had no significant difference (x2=11.830, P=0.159) that gender does not affect overall constitution of AIH patients with TCM Constitution.1.3 Age can affect the distribution of TCM Constitution:In AIH patients, there were 46 young patients (44 years old),102 cases in middle age group (45-59 years old), and 99 cases in the elderly group (60 years old).Comparison, it is found that in the young group is mainly Yin deficiency, qi stagnation, flat and quality, in the middle-aged group is mainly Yin deficiency, qi stagnation and flat and quality, the elderly patients with qi stagnation, yin deficiency and Qi deficiency, and the age constitution group overall constitution exists difference (x2=27.311, P=0.038). Age can affect the distribution of TCM Constitution types.1.4 Cirrhosis can affect the distribution of TCM Constitution Type:In this study, there were 96 cases of cirrhosis and 151 cases without cirrhosis of the liver in patients with AIH. Comparison of AIH patients with cirrhosis with stagnation of Qi and yin deficiency, non cirrhotic patients with Yin deficiency, Qi deficiency and qi stagnation and cirrhosis of the liver and non liver cirrhosis in the distribution of constitution type has significant difference (x2=26.145,P=.001).2.Value of APRI and FIB-4 in the diagnosis of liver fibrosis in AIH2.1 A total of 71 patients with AIH were enrolled, and the stage of liver fibrosis was:SO has 6 cases (8.5%), S1 has 34 cases (47.9%), S2 has 22 cases (31%), S3 has 8 cases (11.3%), S4 has 1 cases (1.4%). By rank sum test, age, ALT, AST, PLT and APRI value had no significant difference in different stages of liver fibrosis, but FIB-4 value had significant difference in different stages of liver fibrosis (P=0.038<0.05).2.2 In the study of the relationship between the degree of liver fibrosis, the age, ALT and AST are not related to the degree of hepatic fibrosis, but Apri values and FIB-4 values were correlated positively with the degree of liver fibrosis, with the increase of the degree of liver fibrosis,on the contrary, PLT and the degree of liver fibrosis was negatively correlated, the PLT value was smaller, the degree of liver fibrosis was higher.2.3 APRI value and FIB-4 value on the diagnosis of hepatic fibrosis in AIH:APRI value and FIB-4 value under the ROC curve area were 0.459 (P=0.741> 0.05),0.603 (P=0.408> 0.05), there was no significant difference.2.4 APRI value and FIB-4 value in the diagnosis of severe hepatic fibrosis in AIH:the value of APRI ROC curve in diagnosis of AIH severe hepatic fibrosis was 0.658 (P=0.128> 0.05), and there was no significant difference. FIB-4 in diagnosis of the area under the ROC curve of severe hepatic fibrosis was 0.704 (P=0.049) and FIB-4 optimal cut-off value is 261.5, sensitivity of 88.9%, specificity was 53.2%, the positive predictive value was 21.8%, the negative predictive value was 97.0%.2.5 APRI value and FIB-4 value on the diagnosis of AIH significant liver fibrosis:Apri values in the diagnosis of significant fibrosis under the ROC curve area of 0.666 (P=0.017), Apri optimal cutoff value is 0.6725, sensitivity of 87.1%, specificity was 40%, the positive predictive value was 53.0%, the negative predictive value was 80.0%; FIB-4 in diagnosis of the area under ROC curve of significant liver fibrosis was 0.698 (P=0.004) and FIB-4 optimal truncation value was 2.135 and sensitivity was 77.4%, the specificity was 57.5%, the positive predictive value was 58.6% and the negative predictive value was 76.6%.2.6 Diagnostic value of APRI combined with FIB-4 in the diagnosis of AIH significant liver fibrosis:Apri values combined with FIB-4valuesin diagnosis of the area under ROC curve of significant liver fibrosis was 0.707 (P=0.003), and sensitivity was 48.4%, the specificity was 87.5%, the positive predictive value was 75.0%, the negative predictive value was 68.6%.Conclusion and significance1. Analysis on TCM Constitution of AIH1.1 AIH is mainly manifested as biased constitution, and the biased constitution type is mainly due to yin deficiency, qi stagnation and Qi deficiency.1.2 Gender does not affect the distribution of TCM constitution type of AIH, and age and liver cirrhosis influence the distribution of TCM constitution type. With the increase of age, the Normal constitution gradually decrease, and the deficiency of Yang and blood stasis are gradually increasing,and as the disease progresses, qi stagnation, blood stasis, yin deficiency, Yang deficiency constitution gradually increased, and Normal constitution, Qi deficiency, phlegm dampness, damp heat constitution gradually reduced.1.3 The above results suggest that in cirrhosis stage, we need to strengthen the liver qi stagnation, promoting blood circulation and removing blood stasis and nourishing yin and tonifying yang.2. Value of APRI and FIB-4 in the diagnosis of liver fibrosis in AIH2.1 The value of APRI and FIB-4 in the diagnosis of liver fibrosis was low.2.2 The value of APRI and FIB-4 in the diagnosis of significant liver fibrosis and severe hepatic fibrosis was higher,and the level of APRI value and FIB-4 value in the diagnosis of significant liver fibrosis was lower than that of the diagnosis, and the diagnostic value of the combined diagnosis was moderate, which had clinical application value.2.3 APRI value and FIB-4 value for the diagnosis of severe hepatic fibrosis, FIB-4 value is higher, reaching a moderate level of diagnosis, and APRI value does not have the ability to diagnose severe hepatic fibrosis.2.4 APRI value and FIB-4 value as closely related with the liver fibrosis index, has some clinical reference value, especially for those who refuse to liver biopsy or unable to liver biopsy of patients can effectively judging the degree of liver fibrosis, in clinical diagnosis and treatment.