Cirrhotic Patients With Intestinal Dysfunction In Integrative Medicine Clinical Research And TCM Syndrome

Objectives:1According to the core pathogenesis of the cirrhosis with intestinal dysfunction, to analyze the clinical features, using the method of prospective, randomized controlled study to observe the short-term efficacy in patients suffered from cirrhosis with intestinal dysfunction who were treated with oral decoction that tonifying spleen for eliminating dampness and detoxification prescription and external using regulating qi and dispersing distention prescription sticking umbilicus dynamically.2To analyze and summarize the syndrome type distribution discipline and the syndrome differentiation. Besides, investing the correlation between different syndromes and laboratory examination indictors.Methods:160patients who were diagnosed cirrhosis with intestinal dysfunction and were hospitalized at DiTan Hospital integrative medicine center from May2013-February2014were involved in the study that was using prospective, randomized controlled method. Taking the random number table,60patients were randomly divided into two groups,30cases were experiment group (integrative medicine therapy group), and the other30cases were control group (western medicine group). Control group used western medicine treatment (treatment for the cause, protecting liver treatment, nutrition and supportive treatment, maintaining intestinal microflora environment treatment, complications of cirrhosis treatment), the experimental group used integrative medicine (western medicine treatment and oral decoction that tonifying spleen for eliminating dampness and detoxification prescription and external using regulating qi and dispersing distention prescription). Dynamically observed the liver and kidney function, blood routine examination, blood clotting mechanism, ammonia and other laboratory examination indicators, and traditional Chinese medicine symptoms score (total symptoms score, the main symptoms score, the individual symptom score), intestinal dysfunction score, incidence of adverse events at baseline,1w after treatment,2w after treatment,2w of follow-up. Applying of SPSS17.0statistical software for statistical analysis.2Collected and recorded clinical TCM symptoms, tongue, pulse of the60patients who were enrolled, and summarized the distribution of syndromes and syndrome differentiation. Besides, preliminarily explored the relationship between the different syndrome and laboratory examination indicators (the width of the portal vein, portal vein blood flow velocity, length of spleen, thickness of spleen and T cell subsets). Results:1At baseline, comparing the liver function (ALT, AST, TBIL, DBIL, ALB), blood routine examination (WBC, NE, LY), and TCM symptoms score (total symptoms score, the main symptoms score, individual symptom such as abdominal distension and inappetence score), intestinal dysfunction score (total score, decreased bowel sounds severity score) of two groups, the difference was not statistically significant (P>0.05). At1w after treatment, comparing the TCM symptoms total score, the main symptoms score, abdominal distension score and inappetence score, intestinal dysfunction score of two groups, the differences were statistically significant (P<0.05). AT2w after treatment, comparing the abdominal distension score, the differences were statistically significant (P<0.05). And, comparing the serum TBIL, DBIL, NE, LY of two groups, the differences were also statistically significant (P<0.05). At2w after follow-up, comparing serum ALB of two groups, the difference was statistically significant (P<0.05). Besides, at1w,2w after treatment and2w after follow-up, the treatment group had more efficiency on the aspects of improvement of symptoms and intestinal dysfunction score than control group. Also, the treatment group had lower complications of the cirrhosis with intestinal dysfunction and lower mortality than control group.2The highest frequency clinical manifestations are abdominal distension, fatigue, loss of appetite, sallow complexion, heavy cumbersome limbs, yellow urine. The basic syndromes of cirrhosis with intestinal dysfunction are summarized as the syndrome of qi stagnation and blood stasis, the syndrome of dampness and heat stagnation, the syndrome of deficiency of both qi and yin, the syndrome of yang deficiency of spleen and kidney and the syndrome of stagnation of liver qi and spleen deficiency. According to regard Qi deficiency as the main syndrome whether or not, compare the T cell subsets CD3of Qi deficiency as the main syndrome and the other group, the difference was statistically significant (P<0.05).Conclusions:1The core pathogenesis of cirrhosis with intestinal dysfunction is "spleen deficiency and qi stagnation, dampness and toxic blocking". The treatment of cirrhosis with intestinal dysfunction with oral decoction that tonifying spleen for eliminating dampness and detoxification prescription and external using regulating qi and dispersing distention prescription sticking umbilicus has ability to tonify the spleen, regulate qi and activate blood, clear heat and detoxicate, remove dampness, free the bowels and discharge detoxification. And, it can promote jaundice decrease so as to reduce liver cell damage; Besides, it can promote blood albumin synthesis and improve liver reserves synthesis; Further more, it also can reduce the white blood cell count within the normal range, which helps to reduce and control abdominal infection. Besides, it can reduce symptoms score and intestinal dysfunction severity score, relieve the abdominal distension, inappetence and other common symptoms, and reduce the serious complications and mortality.2Cirrhosis with intestinal dysfunction being deficiency symptom as the main symptom has relation with of the immune regulation ability.