| [Objective]:To comprehend the clinical characteristics of cholestatic hepatitis, and look for the earlier predictable index for this disease, to measure prognosis. To discuss the effect of a combination of western medicine and TCM for this disease. [Method]:This article summarizes the clinical characteristics of 261 patients hospitalized in Beijing Ditan hospital due to cholestatic hepatitis during the recent 10 years, include general conditions, course of disease, pathogeny, clinical presentation, diagnoses in TCM, laboratory examination and prognosis. We also contrast western medicine and a combination of western medicine and TCM for this disease. [Result]:Among these patients,82.76% were of acute cholestatic hepatitis and 17.24% chronic cholestatic hepatitis. Further analysis shows:46.74% were due to viral hepatitis type E or a combination of viral hepatitis type E and Alcoholic Hepatitis; 18.39% were due to type B hepatitis; 11.11% were due to non-branched type hepatitis; 5.75% were due to drug-induced Hepatitis. About 50.75% of these patients had decolorized stool or skin itchiness, which was proportionate to the severity of their Jaundice (P<0.05). In diagnoses of TCM,87.5% patients have red or dark-red tongue; 85.42% patients have yellow coating, and 14.58% patients have white coating of the tongue; 88.54% patients have wiry pulse; 90.63% patients are Congested Blood Blocking Meridian,86.46% patients are Hepatochlic Hygropyrexia,48.96% patients are Liver Depression and Spleen Deficiency. The peak of blood TBiL is 395.96±155.87 umol/L,and the highest level is 1095.9 umol/L;The peak of blood TBiL usually happens in around 20.47±16.38 days, and continued for about 16.98±10.54 days.The peak of blood GGT and ALP usually happens in around 23.8±22.37 days and 45.18±22.10 days during the course respectively, and the peak of blood TBA happens in around 18.52±17.32 days. The peak of the blood CHO and TG happens in 39.59±18.66 days and 27.05±16.48 days. The abdominal ultrasonic examination usually shows wide-spread enhanced liver echo and less translucent and contracted Gall Bladder, The hepatic pathology of Cholestatic hepatitis shows the inflammation of the hepatic cells and in the portal areas, the cholestasis of hepatic cells andthe bile capillaries. 93.87% patients (245 cases) got recovery or better,1.15% patients (3 cases) died,4.98% patients (13 cases) against-advice discharged. In treatment, the score of symptom in TCM decline 26.99±2.02 points at A group (western medicine group), but decline 28.13±2.37 points at B group(a combination of western medicine and TCM group)at the begging 8th weeks; The peak of blood TBiL lasted 17.38±11.41days at A group, but lasted 12.73±8.15 days at B group; The patients average in hospital is 67.2±11.24 days at A group, but is 58.65±12.38 days at B group. The average Hospital expense is 26142.07 yuan per capita at A group, but is 22247.28 yuan per capita at B group.The effective rate is 80% at A group, but is 95% at B group. (P<0.05). [Conclusion]:Cholestatic hepatitis are usually acute, and due to viral hepatitis type E or a combination of viral hepatitis type E and Alcoholic Hepatitis. Not all patients have decolorized stool or skin itchiness. But it is real that decolorized stool or skin itchiness has more possibility as more deep jaundice. In TCM, the diagnoses are mainly Congested Blood Blocking Meridian, Liver Depression and Hepatochlic Hygropyrexia. The patients have a higher peek of blood TBiL and it can last a long time. The peak of blood GGT and ALP is later then the peak of blood TBiL. The peak of blood TBA happens in around 18.52±17.32 days, which is earlier then the peak of blood TBiL. This result indicates that the elevation of blood TBA at an early stage and hence can be regarded as a sensitive index to suggest cholestasis. Liver puncture can act as an effective way to diagnose cholestatic hepatitis but it can be risky due to its damage. So it is not regarded as an mandatory examination. The abdominal ultrasonic examination usually shows wide-spread enhanced liver echo and less translucent and contracted Gall Bladder, but these are not very evident for early diagnosis. Fortunately, though cholestatic hepatitis usually takes a long course, most patients have good prognosis. We compared the methods of western medicine only with a combination of western medicine and TCM (western medicine plus Yu Dan Soup), in regards to the alleviation of clinical symptoms, the length of the persisting peak Jaundice and the outcome, as well as the length and cost of hospitalization and the result shows that the combination of western medicine and TCM is better then the treatment of Western medicine only, in all respects. So it is worthwhile to promote this combinational treatment method. |
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