Study On The Distribution Pattern Of TCM Syndromes And Related Indexes Of Chronic Hepatitis B Complicated With Hepatic Steatosis

Objective: To observe the differences of TCM syndromes distribution in chronic hepatitis B(CHB)patients with or without hepatic steatosis,to provide a reference basis for TCM syndromes differentiation and treatment.At the same time,to observe the differences of the relevant indicators in CHB patients with or without hepatic steatosis,and to discuss the influence of hepatic steatosis on CHB patients,so as to provide reference indicators for the evaluation of hepatic steatosis in CHB patients.Methods: The clinical case of patients with CHB who were hospitalized at the Department of Infectious Diseases,Xiamen hospital of traditional Chinese medicine,Fujian,China,from September 2017 to December 2018 were collected.The patients were divided into fatty liver group(140 cases)and non-fatty liver group(140 cases)depending on the presence or absence of fatty liver,and the differences in clinical indicators between the two groups were compared.The statistical analysis was used SPSS24.0 statistical software,measurement data of two groups was done with independent sample T-test,Mann-Whitney U rank sum test was used for non-normal distribution,categorical data were tested by chi-square test,and Wilcoxon Mann-Whitney U rank sum test or Kruskal-Wallis H test were selected base on the number of groups in the R C table data of unidirectional ordered ulticlassification variables,logistic regression analysis was used to test the related factors of hepatic steatosis.Results:1.Distribution of TCM syndromes in the two groups: The distribution frequency of TCM syndromes in fatty liver group was syndrome of accumulated damp-heat(50%),syndrome of liver depression and spleen deficiency(37.9%),blood stasis obstructing collaterals syndrome(5%),liver-kidney yin deficiency(4.3%),yang deficiency of Kidney and Spleen(2.8%).Whereas,the non-fatty liver group was liver depression and spleen deficiency syndrome(54.3%),syndrome of accumulated damp-heat(32.9%),blood stasis obstructing collaterals syndrome(5%),liver-kidney yin deficiency(5%),yang deficiency of Kidney and Spleen(2.8%).This shows that the syndrome of accumulated damp-heat was more likely to occur in CHB patients with hepatic steatosis than without hepatic steatosis and the difference was statistically significant(?2=10.284,P<0.05).And moderate to severe hepatic steatosis is high in accumulated damp-heat syndrome(?2=10.875,P<0.05).2.Comparison of gender,age and BMI between the two groups: CHB with fatty liver was more likely to occur in men,the difference was statistically significant(?2= 11.499,P<0.05),and the incidence of fatty liver increased with age(Z=-2.272,P<0.05).The BMI of CHB group with hepatic steatosis was higher than another group(t =9.802,P<0.001).3.Comparison of liver function,blood lipid,FPG,UA,HBVM between the two groups: Levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),direct bilirubin(DB),albumin(ALB),triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL),fasting plasma glucose(FPG),uric acid(UA),high-density lipoprotein(HDL),HBV DNA titer and HBsAg quantitative levels were significantly different between the two groups(P<0.05).Whereas,the difference in total bilirubin(TB),serum globulin(GLO)and HBeAg distribution between the two groups was not statistically significant(P>0.05).4.Comparison of the value of CAP and LSM between the two groups: The value of liver controlled attenuation parameter(CAP)in fatty liver group was significantly different higher than non-fatty liver group(Z=-9.647,P<0.001).Whereas,the liver stiffness measurement(LSM)value between the two groups was not statistically significant(P>0.05).5.Comparison of characteristics of liver biopsy lesions between the two groups: Hepatic inflammatory activity grade G was not statistically significant between the two groups(P>0.05),but the degree of hepatic fibrosis was more severe in the fatty liver group,the difference between the two groups was statistically significant(?2= 6.171,P<0.05).6.CAP and BMI were risk factors for hepatic steatosis in CHB patients.Conclusion: 1.Fatty liver was more likely to occur in men and the incidence of fatty liver increased with age.2.ALT and AST levels in fatty liver group were lower than those the non-fatty liver group,while GGT?DB and ALB levels were higher.3.Fatty liver patients are more likely to present with glucose and lipid metabolism disorder.4.HBV DNA titer and HBsAg quantitative levels in fatty liver group were lower,while hepatic fibrosis was more severe,thus,further studies are needed to establish their connections.5.CAP and BMI are the independent risk factors of hepatic steatosis,the unusual results must be vigilant.6.The syndrome of accumulated damp-heat is more likely to happen hepatocyte steatosis and the proportion of moderate to severe hepatic steatosis is high,so it hope to improve by clearing heat and promoting diuresis.