| ObjectiveTo probe the differences among the TCM syndrome types of Autoimmune hepatitis by observing the relationship of syndromes and objective detective sign and pathology. After that, we can open out the essential of syndrome and the rule of syndrome and objective detective sign, so to make a scientific base for drawing up a canonical, standard and special advantage of TCM diagnosis and treatment for AIH.MethodsAdopt the method of clinical epidemiology and DME. The 86 cases were diagnosed of AIH in Department of hepatology or outpatient in Guangdong Provincial Hospital of Chinese medicine from January 2010 to November 2015. Write down the detail information including the medical record, symptoms, syndrome types, differentiation of symptoms and the laboratory results (such as ALT、AST、GGT、ALP、TBil、DBil、TBA、IgG、autoantibody and pathology) etc. Summarize the data, set up a database and then use SPSS 20.0 to analyze the relationship between the TCM syndrome types of syndrome and objective detective sign.Results(1)General information of the patients of Autoimmune HepatitisOf the 86 patients of AIH, there are 14 cases of male and 72 cases of female, the sex radio is 1∶5. The maximum age of onset among the case group is 71, the minimum is 23, with an average of 48.59±13.62 years.55 of the 86 patients are in the age group from 40 to 59(63.95%); 39.53% of the 86 objects combine with extra-hepatic autoimmune diseases, with 12 of them combine with autoimmune thyroid disease and 9 with rheumatoid arthritis.(2) The correlation of the TCM syndrome types and symptoms, syndrome types of Autoimmune HepatitisThe TCM syndrome types are in following orders:the stagnation of liver-energy and spleen deficiency type (31/86 cases,36.05%), the retention of evil wetness-heat type (15/86 cases,17.44%), the blood stasis type(18/86 cases,20.93%) and the liver and the kidney yin-deficiency type (22/86 cases,25.58%). Patients of the retention of evil wetness-heat type and the stagnation of liver-energy and spleen deficiency type seem to have higher ratio of the occurrence of syndromes such as weak, poor appetite, naupathia, uncomfortable of hepatic region and be yellow of skin and mucous than the ones of the blood stasis type or the liver and the kidney yin-def iciency type. We find that the difference is statistically significant when contrast with the patients of the blood stasis type. While the ratio of the occurrence of signs of chronic liver disease such as liver palms or spider nevus in the patients of the blood stasis type or the liver and the kidney yin-deficiency type is evidently higher than the other two groups. When contrast with the cases of the retention of evil wetness-heat type, the difference is statistically significant.(3) The correlation of the TCM syndrome types and objective detective sign of Autoimmune Hepatitis① The correlation of the TCM syndrome types and biochemical Indicators of Autoimmune HepatitisThe sequence of ALT and AST is the retention of evil wetness-heat type, the stagnation of liver-energy and spleen deficiency type, the blood stasis type and the liver and the kidney yin-deficiency type. ALT and AST rise obviously in the patients of the retention of evil wetness-heat type, the difference is statistically significant; the value of ALT and AST is also higher in the patients of the stagnation of liver-energy and spleen deficiency type, when compares with the ones of the blood stasis type and the liver and the kidney yin-deficiency type, the difference is also statistically significant. GGT and ALP evidently rise in the patients of the retention of evil wetness-heat type and the stagnation of liver-energy and spleen deficiency type, the difference is no statistically significant in these two groups while is statistically significant when compare with the group of the blood stasis type. TBil, DBil and TBA rise evidently in the ones of the retention of evil wetness-heat type, when contrast with the other three groups, the difference is statistically significant. IgG also rises evidently in the patients of the retention of evil wetness-heat type, when contrast with the other three groups, the difference is statistically significant. The value of ALB reduces obviously in group of the blood stasis type and the liver and the kidney yin-def iciency type, when contrast with the ones of the retention of evil wetness-heat type, we find the difference is statistically significan.②The correlation of the TCM syndrome types and autoantibody of Autoimmune HepatitisOf the 86 cases, only one of them is with negative autoantibody, such diagnosing with IV type AIH. The other 85 cases are with positive ANA and/or SMA who are diagnosed with Ⅰ type AIH. There are no Ⅱ type and Ⅲ type AIH. By analyzing the distribution of the autoantibody among the four groups, there is no statistically significant of the difference.③The correlation of the TCM syndrome types and pathology of Autoimmune Hepatitis60 of the 86 cases were undergone liver-biopsy. The pathology of patients of and the stagnation of liver-energy and spleen deficiency type the retention of evil wetness-heat type has the characteristic of moderate or a lot of lymphoplasmacytoid in portal area and moderate interface inflammation, while the pathology of patients of the blood stasis type and the liver and the kidney yin-deficiency type can see a little or moderate of lymphoplasmacytoid in portal area and mild interface inflammation. Only one of the pathology of the retention of evil wetness-heat type and one of the the liver and the kidney yin-deficiency type can be seen the lesion of roses and non of the pathology can be seen the phenomenon of cells through.Conclusion(1) AIH appears mostly in female, especially in middle-aged women.(2) The patients of the stagnation of liver-energy and spleen deficiency type and the retention of evil wetness-heat type have obvious syndromes, high level of liver function and immunoglobulin, the pathology of patients can be seen obvious inflammatory response. It seems to be struggling between the vital energy and the pathogenic factor of these patients, with obvious inflammatory response and active immune. The patients of the blood stasis type and the liver and the kidney yin-deficiency type have evident signs of chronic liver disease and lower level of albumin, prompting that we should be vigilant whether those patients are in the stage of liver cirrhosis. The distribution of autoantibody, the significance of AIH, are found no dependency when contrasted with syndromes of TCM.(3)The above objective detective signs are close to the TCM type of syndrome, which can help to externalize and normalize the TCM type of syndrome. While treating, we should zealously detect the objective detective signs, so to adopt timely intervention and slow the progression of the disease. |
PDF Full Text Request