Research On TCM Syndrome Differentiation Of Chronic Diarrhea Related To AIDS

OBJECTIVEThe paper analyze the link between AIDS associated diarrhea and the syndrome of Chinese Medicine through the study of theory in order to discuss discuss the causes and pathogenesis of AIDS associated diarrhea.It shows the current research of AIDS associated diarrhea and questions home and abroad.through the clinical studying and analysis the clinical epidemiologic investigation, we get the message of the TCM syndrome rule of AIDS associated chronic diarrhea by sum up the symptoms,signs,syndromes and their correlations with factors.Through the lincical research,to investigate the TCM methods of treatment of AIDS associated chronic diarrhea.METHOD1Theory ResearchBased on a large number of documents and papers about diarrhea,relational information about AIDS associated diarrhea home and abroad, and investigation of clinical manifestation of AIDS associated diarrhea, we discuss the causes and pathogenesis, the common TCM syndromes of this disease,and offer help for normalization of TCM syndromes,formulating investigation forms of syndrome and clinical intervention.2Clinical Research(1)311cases come from Beijing,Henan,Guangxi,Guangzhou,and Xinjiang met inclusion criteria.by statistical analysis of symptoms,signs,syndromes and their correlations with clinical epidemiologic investigation, we get the message of the TCM syndrome rule of AIDS associated chronic diarrhea.(2) Through a multicenter,randomly,comparative experiment. Method153cases of AIDS associated chronic diarrhea were randomly divided into the treatment group and control group,treatment course2weeks,and then To evaluate the effectiveness of prescription of serengthening the spleen and antidiarrhea to relive AIDS associated chronic diarrhea.RESULTS1Results of Theory ResearchAIDS associated diarrhea belong to the category of diarrhea of TCM.majority scholars of TCM think the main pathogenesis of AIDS associated diarrhea is spleen deficiency.the main viscerae involved are spleen and kidney.2Results of Clinical Research(1)Study of clinical epidemiologic investigation and TCM syndromeOf the311cases of AIDS associated chronic diarrhea.the age range from20to69years old.most of cases are at the age of30-60(83.0%),the male to female ratio is1.37:1.The main possible infection routes include blood (52.1%).sexual contact (28.6%),and intravenous drug injection(11.9%).Majority of them have moderate diarrhea(66.6%),without abodominal pain or with mild abodominal pain(89.1%).the main stool consistency is loose and liquid(90.1%).Of all cases,there are17cases with CD4+cell count over500/ul,104cases with CD4+cell count between200-499/ul,and190cases with CD4+cell count less than200/ul.The causative of AIDS associated chronic diarrhea involve fungus(64.31%), Cryptosporidiosis(4.82%),cytomegalovirus(3.22%),tubercle bacillus(2.25%), clostridium septicum(1.29%),campylobacter Jejuni(0.64%),Salmonella(0.32%), Cyclospora caye-tanensis(0.32%).Of the311cases,224cases have had colonoscopy,42are normal,182are abnormal,cases with abnormal colonoscopy accounted for81.3%of all cases who have colonoscopy.In addition to one case who have not fill up the inventory of Traditional Chinese medicine symptom, in the remainder of310cases,135are syndrome of spleen deficiency with dampness encumbrance(43.5%),78are syndrome of dampness-heat obstructing(25.2%),66are spleen-kidney yang deficiency syndrome(21.3%),24are syndrome of spleen deficiency(7.7%),13are cold-heat complex syndrome(4.2%),2are syndrome of liver depression and spleen deficiency,1is yin deficinecy syndrome.10cases have2syndrome simultaneously.The common follow-up synptoms of AIDS associated chronic diarrhea are weary(74.2%),bowel sounds(68.7%),loose stools(63.2%), abdomen distends(60.3%), bodily fatigued(59.4%),abdominal pain(55.5%),inappetence(51.6%).When we study on the main5TCM syndromes of AIDS associated diarrhea,we find that,in addition to CD4, cases with different sex,ages, infection routes,degree of diarrhea,degree of abdominal pain, and results of colonoscopy have different distribution of type of syndrome(p<0.05). female, cases beyond50years old have higher propotion in yndrome of spleen deficiency.patients infected by blood mostly syndrome of dampness-heat obstructing,infected by sexual contact and intravenous drug injection mostly spleen-kidney yang deficiency syndrome.most cases with mild diarrhea are syndrome of spleen deficiency with dampness encumbrance, with moderate diarrhea mostly syndrome of spleen deficiency, with severe diarrhea mostly spleen-kidney yang deficiency syndrome.100%have abnormal colonoscopy results in cases of syndrome of dampness-heat obstructing and syndrome of spleen deficiency.In addition to CD4, cases with different sex.ages.degree of diarrhea,degree of abdominal pain, and results of colonoscopy have different distribution of infection routes(p<0.05). male have higher propotion in cases infected by intravenous drug injection and sexual contact.while while female have higher propotion in cases infected by blood, most cases before40years old are infected by intravenous drug injection, a large portion of cases beyond 40years old are infected by blood, most cases with mild diarrhea are infected by sexual contact, with moderate diarrhea mostly infected by blood, with severe diarrhea mostly infected by intravenous drug injection, cases with unpainful diarrhea mostly infected by blood, with mild,moderate,and severe painful diarrhea mostly infected by intravenous drug injection.cases infected by blood have the highest abnormal results of colonoscopy.Cases with different sex,ages,degree of diarrhea,somatotype,CD4, and results of colonoscopy have different distribution of degree of diarrhea(p<0.05).Most cases with mild diarrhea have CD4+cell count over than200/ul,while cases with severe diarrhea mostly have CD4+cell count less200/ul.there are increasing degree of abdominal pain, decreasing body mass index,increasing positive results of colonoscopy as the diarrhea get worse.Cases with different sex,treatments and TCM syndromes have no significant difference in Scores of quality of life,Clinic symptoms and diarrhea scaling(p>0.05).cases with different years have no significant difference in Scores of Clinic symptoms and diarrhea scaling(p>0.05),but have significant difference in Scores of quality of life(p<0.05),cases over50years old have the highest Scores of quality of life,followed by cases between40-49years old and cases before40years old.cases with different infection routes have no significant difference in Scores of diarrhea scaling(p>0.05),but have significant difference in Scores of quality of life and Clinic symptoms (p<0.05).the scores of quality of life are(from high to low), cases infected by sexual contact,cases by blood,and cases by intravenous drug injection, the scores of quality of Clinic symptoms are(from high to low), cases infected by intravenous drug injection, cases infected by sexual contact and cases by blood. cases with different degree of diarrhea and abdominal pain have significant difference in Scores of quality of life,Clinic symptoms and diarrhea scaling(p<0.05).there are decreasing scores of quality of life.icreasing Scores of Clinic symptoms and diarrhea scaling as diarrhea or abdominal pain get worse.When study on the body mass index,Scores of quality of life,Clinic symptoms,diarrhea scaling,and the relationships with them,we find that,there are decreasing body mass index and Scores of quality of life when the Scores of Clinic symptoms or diarrhea scaling increased.The positive rate for pathogen in cases of AIDS associated chronic diarrhea have relationship with sex,ages, infection routes, TCM syndromes and CD4,female,cases before40years old, cases infected by sexual contact, cases have syndrome of spleen deficiency and cases with CD4+cell count less200/ul have higher propotion in positive rate for pathogen.(2)Study on clinical treatmentMethod153cases of AIDS associated chronic diarrhea were randomly divided into the Chinese herbal medicine group and loperamide group,treatment course2weeks,and then To observe the CD4,HIV viral load, Scores of quality of life.Clinic symptoms,diarrhea scaling.and so on.we find that.the Chinese herbal medicine is effective for AIDS associated chronic diarrhea,not only can obviously alleviate the diarrhea,but also can improve the clinical symptoms and increase the Scores of quality of life,and is safe.CONCLUSIONS1Majority cases of AIDS associated chronic diarrhea are young male.The main infection routes include blood,sexual contact, and intravenous drug injection. Majority of them have moderate diarrhea,without abodominal pain or with mild abodominal pain.the main stool consistency is loose and liquid.the positive rate of colonoscopy is higher(81.3%). The main causative of AIDS associated chronic diarrhea is fungus.2The main5TCM syndromes of AIDS associated diarrhea are yndrome of spleen deficiency with dampness encumbrance, syndrome of dampness-heat obstructing, spleen-kidney yang deficiency syndrome,syndrome of spleen deficiency and cold-heat complex syndrome.there are different distribution of TCM syndrome among different populations.3Compared with cases have CD4+cell count over than200/ul, cases with CD4+cell count less200/ul have worse diarrhea,higher positive rate for pathogen,lower Scores of quality of life,higher Scores of Clinic symptoms.suggest that AIDS associated diarrhea related with immunization effectiveness.4There are relationships between body mass index,Scores of quality of life,Scores of Clinic symptoms, and Scores of diarrhea scaling.5The Chinese herbal medicine is effective for AIDS associated chronic diarrhea,not only can obviously alleviate the diarrhea,but also can improve the clinical symptoms and increase the Scores of quality of life,and is safe.