| ObjectiveHepatitis B virus related primary hepatocellular carcinoma is insidious, and develops rapidly. Most of the patients have been diagnosed at middle or late stage or even distant metastasis. But the disease treatment method is limited, and the recurrence rate and the mortality rate is very high, which brings the heavy medical burden and the huge psychological harm to the patient. Traditional Chinese medicine has a long history of diagnosis and treatment of hepatocellular carcinoma. In the prevention and treatment of tumor recurrence, improving clinical symptoms and improving the quality of life and other aspects of the patients, it has a great advantage and has become one of the important clinical means of prevention and treatment of hepatocellular carcinoma. Of 140 cases of hepatitis B virus associated primary hepatocellular carcinoma patients were studied through the subject, exploration of hepatitis B virus associated primary hepatocellular carcinoma characteristics of TCM syndrome, induction its etiology and pathogenesis, and the patient’s anxiety and depression status were investigated and analyzed, preliminary study on hepatitis B virus associated primary hepatocellular carcinoma patients with mental health status, in order to clinical treatment has a guiding role.MethodsBy referring to the relevant literature, summarizing the common symptoms of hepatitis B virus related primary hepatocellular carcinoma, and consulting the relevant experts, the questionnaire was made completely. A total of 146 cases were collected in Dongzhimen Hospital of Beijing University of Chinese Medicine,302 Military Hospital of China, and Peking University Frist Hospital, and 140 cases were qualified. Syndrome differentiation and factor analysis method was used to study the regularity of syndrome, and to explore the pathogenesis of the disease. The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were assessed on patients with mental health status.ResultsIn this study, the ratio of male to female was 6.37:1. The average age of the patients was 54.16, male age of onset is 5.367 ± 7.803, female age at onset was 57.26 ±7.978, female incidence age later than male (P< 0.05). The survey found that government personnel and education in secondary school, college or higher education of people with a higher incidence of hepatocellular carcinoma.50.7% of 140 cases of patients with weight is overweight, the average body mass index was 24.02 ± 3.648. There were 29 cases (20.7%) patients with a family history of hepatocellular carcinoma,32.1% patients with HBV infection of Mother to child transmission. The survey of 68.6% patients with smoking or drinking, both smoking and drinkers reached 45.7%.140 hepatitis B virus associated primary hepatocellular carcinoma in HBeAg positive patients with 36 cases (25.7%),61 cases of HBV-DNA positive patients (43.5%), HBeAg positive and HBV-DNA positive patients in 23 cases (16.4%), HBeAg negative and HBV-DNA positive patients 38 cases (27.1%). Patients with AFP greater than 400ug/L accounted for 30%.The proportion of abnormal liver function was more than 30%, of which GGT (57.9%), AST (45%), TBIL (45%) abnormal ratio was higher. The blood routine index in PLT (45%), WBC (34.29%) abnormal high proportion. Tumor portal vein invasion in 46 cases (32.9%).According to BCLC stage, in 140 cases of hepatitis B virus associated primary hepatocellular carcinoma patients,1 case (0.71%) is BCLC-0,19 cases (13.57%) are of BCLC-A,52 cases (37.14%) are of BCLC-B,59 cases (42.14%) are of BCLC-C,9 cases (6.43%) are of BCLC-D. Different staging of liver function of the patients with TBIL, ALT, AST, GGT, ALP, blood RBC, HGB, NE%, blood coagulation in Pt, Pt%, APTT and FIB, tumor marker in AFP and CA199 there are differences (P< 0.05).140 cases of hepatitis B virus associated primary hepatocellular carcinoma patients with TCM syndrome types of frequency from high to low as follows:liver stagnation and spleen deficiency syndrome (35.71%), qi stagnation and blood stasis syndrome (30.71%), damp heat toxin accumulation syndrome (25.71%), yin deficiency of liver and kidney syndrome (5.71%), stagnation of liver Qi syndrome (2.14%). The physical and chemical indicators of different syndromes were compared and found that TBIL and ALB were different in different syndrome types (P<0.05). Table ALB levels in the stagnation of liver Qi syndrome, yin deficiency of liver and kidney syndrome, damp heat toxin accumulation syndrome, liver stagnation and spleen deficiency syndrome, qi stagnation and blood stasis syndrome are in sequence from high to low. TBIL is the highest in damp heat toxin accumulation syndrome, liver stagnation and spleen deficiency syndrome lowest.Through factor analysis to summarize 140 hepatitis B virus associated primary hepatocellular carcinoma patients with the syndrome, two of the most common type of qi stagnation and blood stasis and spleen deficiency (27.14%); blood stasis and dampness (23.57%), the remaining type is sequentially as liver fire and deficiency of spleen and blood stasis (12.86%); spleen deficiency and dampness heat and stagnation of liver Qi (9.29%); damp heat and blood stasis and liver stagnation and spleen deficiency (9.29%); liver blood stasis and spleen deficiency and dampness (7.14%); blood stasis and dampness and spleen deficiency (5.17%); liver fire and damp heat (4.28%); liver fire disturbance (0.71%). By analysising of syndrome elements, it concludes that blood stasis (85.71%), spleen deficiency (71.43%), Qi Stagnation (62.86%) and wet (59.29%), heat (36.43%).140 cases of hepatitis B virus associated primary hepatocellular carcinoma patients with anxiety index was20.06±5.97,86.4% of the patients with anxiety, including moderate anxiety accounted for 39.9%, severe anxiety accounted for 40.7%, serious anxiety 6.4%.140 cases of hepatitis B virus associated primary hepatocellular carcinoma patients with depression index was 22.37±8.47,61.4% patients were detected depression, severe depression accounted for 55%, severe depression 6.4%. Of 37 patients (26.4%) with simple anxiety,2 patients (1.4%) with depression,84 patients with anxiety and depression (60%). The HAM A score and HAMD score of the patients with type A were higher than other blood groups. There were significant differences in anxiety score (P< 0.05) in patients with different course of hepatocellular carcinoma. The anxiety score (21.44 ± 5.45) in the patients with the course of 0.5 years was significantly higher than that in other groups. Different BCLC stages of hepatocellular carcinoma, HAMD score index differences (P< 0.05).Patients with different TCM syndromes anxiety scores and depression scores in the qi stagnation and blood stasis type was the highest, followed by liver stagnation and spleen deficiency type, damp heat toxin accumulation type in the lowest.Conclusions1 Hepatitis B virus associated primary hepatocellular carcinoma pathogenesis is complex and the core is"deficiency of vial QI and toxin and blood stasis". Pathological factors are mainly about spleen deficiency,qi stagnation, blood stasis,dampness and heat.Lesion site is mainly in the liver and spleen. Through factor analysis inductive type of syndrome of TCM. This disease is mainly based on the compound of syndrome,a small number of patients for a simple type of syndrome. The innate character of this disease is a mixture of deficiency and excess.2 ALB with Yin deficiency, spleen deficiency and blood stasis aggravated a downward trend; TBIL in patients with damp heat toxin accumulation syndrome is the highest, and the other syndrome with similarity level.3 Hepatitis B virus associated primary liver carcinoma patients showed different levels of anxiety and depression. |
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