Study On The Correlation Between Liver Cirrhosis And Condition And TCM Syndrome In Patients With Chronic Hepatitis B In Southern Sichuan

Objective:To investigate the relationship between liver stiffness measurement(LSM)in patients with chronic hepatitis B(CHB)in southern Sichuan and its condition and TCM syndrome type,and to verify its biopsy histopathological examination as a gold standard.Compliance was established by establishing a reference standard for determining the condition and TCM classification of patients with chronic hepatitis B in Southern Sichuan based on LSM,in order to guide the diagnosis,follow-up and evaluation of curative effects in patients with chronic hepatitis B in this area.Methods:A retrospective study method was used to include 126 cases of chronic hepatitis B patients who underwent Fibroscan liver stiffness examination from September2014 to September 2016 at the Department of Hepatobiliary Outpatient Clinic and Inpatient Department of the Chinese Medicine Hospital Affiliated to Southwestern Medical University.To assess the association of LSM with hepatitis B virus deoxyribonucleic acid(HBV DNA),Hepatitis B virus antigen(HBeAg),disease course,and TCM syndrome type,etc.LSM reflects the accuracy of the disease;87 patients with chronic hepatitis B who underwent liver biopsy were selected.Liver biopsy was used as a gold standard,and liver fibrosis staging(S2-S4)was marked as significant hepatic fibrosis,(S3-S4)marked as severe liver fibrosis,S4 marked as early cirrhosis,by analyzing the LSM of this group of people,draw the receiver operating characteristic curve(ROC),calculate the area under the curve(Area under the Receiver operating characteristic curve(AUROC),which draws the LSM cutoffs for significant hepatic fibrosis,severe hepatic fibrosis,and early hepatic cirrhosis,estimates the LSM interval for hepatic fibrosis in chronic hepatitis B patients in the region,and simultaneously estimates The LSM interval corresponding to the degree of inflammatory activity was compared with the diagnostic threshold recommended in the Expert Consultation on Diagnosis of Liver Fibrosis by Transient Elastography.In order to assess liver fibrosis in chronic hepatitis B patients in the region and the degree of inflammation.Finally,a reference standard for determining the condition and TCM classification of patients with chronic hepatitis B in southern Sichuan was established based on LSM to guide the diagnosis,follow-up,and evaluation of curative effects in patients with chronic hepatitis B in this area.The results obtained in this study were analyzed using SPSS 17.0 statistical software.P<0.05 was considered statistically significant.Results:1.Basic data of patients with chronic hepatitis B in southern Sichuan.126 patients with chronic hepatitis B included in the study in Southern Sichuan,90 male patients,accounting for 71.4%of the total number,36 female patients,accounting for 28.6%of the total number of patients,age At the age of(43±10)years,the body mass index(BMI)was 22(19-26)kg/m2,and the LSM was(13.5±8.6)kPa.2.Relationship between HBV DNA,HBeAg,duration of disease,TCM syndrome type and LSM126patients with chronic hepatitis B in southern Sichuan,90 male patients and 36female patients.First,according to HBV DNA load levels group,and observed the LSM of each group.Tests and analysis of LSM in each group showed no significant differences(H=2.614,P>0.05).Second,according to the HBV DNA qualitative group,after statistical analysis,the difference between HBV DNA positive and HBV DNA negative LSM(t=-2.031,P<0.05)was statistically significant.Third,according to HBeAg qualitative group,the statistical analysis showed that there was no significant difference in LSM(t=0.482,P>0.05)between HBe Ag positive and HBeAg negative.Fourth,according to the course of the disease group,the LSM of each time period was compared.After statistical analysis,there was a statistically significant difference between the groups(F=3.354,P<0.05).The LSM with a course of?5 years(group 1)and a disease course of>20 years(group 4)(t=-4.788,P<0.05)was statistically significant;10 years<course of disease?20 years(group 3)and course of disease>20 The LSM of the year(4 groups)(t=-6.190,P<0.01)was statistically different.Fifth,according to the TCM syndrome type group,statistical analysis showed that there was a statistically significant difference between the LSM groups(F=21.303,P<0.05).There was a statistically significant difference in liver stiffness between the damp-heat syndrome(1 group)and the liver depression and spleen deficiency syndrome(2 groups)(t=6.379,P<0.05);damp-heat syndrome(1 group)and stasis-resistance syndrome.(4 groups)(t=-16.055,P<0.05)had statistically significant differences in liver stiffness values;liver depression and spleen deficiency syndrome(2 groups)and stasis and blood stasis syndrome(4 groups)(t=-22.433,P<0.05 There was a statistically significant difference in the hepatic hardness value of the liver;kidney and liver yin deficiency syndrome(group 3)and blood stasis syndrome(group 4)(t=-18.567,P<0.01)had significant differences in liver hardness values.3.Liver biopsy histopathological examination and LSM.In chronic hepatitis B patients with 87 cases of liver biopsy in South Sichuan,there were24 G1 patients,42 G2 patients,13 G3 patients,and 8 G4 patients.There were 3patients with S0 phase,29 patients with S1 phase,29 patients with S2 phase,15patients with S3 phase,and 11 patients with S4 phase.Therefore,there were 55patients with hepatic fibrosis(S2-S4 phase)with severe liver fibrosis.A total of26 patients(S3-S4)were included in the study,and 11 patients with early cirrhosis(S4)were included.The LSM of different inflammatory activity groups were G1(8.00±2.33)kPa,G2(13.00±8.87)kPa,G3(20.97±7.40)kPa,and G4(26.38±6.32)kPa,respectively,after statistical analysis The difference between the groups was statistically significant(F=17.819,P<0.05),and there was a significant correlation between LSM and inflammatory activity(G)(r=0.729,P<0.05).The LSM of different hepatic fibrosis stages were S0 stage(7.30±1.31)k Pa,S1 stage(9.22±3.02)kPa,S2 stage(12.77±8.07)kPa,S3 stage(16.49±7.66)kPa,S4 stage(28.63±8.09)kPa,after statistical analysis,the difference between groups was statistically significant(F=17.926,P<0.05),and there was a significant correlation between LSM and liver fibrosis(S)(r=0.645,P<0.05).The cut-off value of LSM in the diagnosis of hepatic fibrosis(S2-S4)was 12.20 kPa,the cut-off value in diagnosis of severe hepatic fibrosis(S3-S4)was 14.35 k Pa,and the cut-off value in diagnosis of early cirrhosis(S4)was17.55kPa,the LSM cut-off corresponding to the degree of inflammation(G2-G4),(G3-G4),and G4 were 9.20,14.05,and 17.10 kPa.The LSM interval value below S2 in patients with chronic hepatitis B in Southern Sichuan is<12.20kPa,the LSM interval in S2 is 12.20-14.35kPa,the LSM interval in S3 is14.35-17.55kPa,and the LSM interval in S4 is It is>17.55kPa.The LSM interval value below G2 for inflammation activity was<9.20 k Pa,the LSM interval value for G2 was 9.20-14.05 kPa,the LSM interval for G3 was14.05-17.10 kPa,and the LSM interval for G4 was>17.10 kPa.Conclusions:1.LSM is related to the course of disease,HBV DNA qualitative,TCM syndrome type,liver fibrosis,and inflammatory activity in patients with chronic hepatitis B in southern Sichuan.It can reflect the severity of the disease to a certain extent,but with HBV DNA load.There was no correlation between HBeAg and positivity.2.LSM can be used as a reference for the diagnosis of chronic hepatitis B TCM syndrome type.3.The mean value of LSM in patients with chronic hepatitis B in southern Sichuan is higher than the normal value recommended in the expert opinion of transient elastography in diagnosing hepatic fibrosis.4.Hepatitis B virus treatment should be considered when HBV DNA is positive in chronic hepatitis B patients in southern Sichuan(ie viral load>10~3copies/mL)and LSM?9.20 kPa.5.LSM>12.20kPa in patients with chronic hepatitis B in southern Sichuan can be diagnosed as significant hepatic fibrosis,LSM>14.35kPa can be diagnosed as severe hepatic fibrosis,LSM>17.55kPa can be diagnosed as early hepatic cirrhosis,for significant hepatic fibrosis Patients should be given antiviral therapy in a timely manner,while patients with severe liver fibrosis and early liver cirrhosis should also be treated with antifibrosis while antiviral.