Clinical Study Of Jiedu Huayu Granules In Treatment Of Chronic Acute Liver Failure And Screening Of Prognostic Risk Factors

Objective: Observe the clinical efficacy of Jiedu Huayu Granules in treating patients with chronic and acute liver failure(ACLF),and screen for risk factors that affect the prognosis of ACLF,and provide evidence-based medical evidence for the treatment of ACLF.Method:1.Clinical research part: 48 ACLF patients were divided into treatment group24 cases and control group 24 cases according to random number table method.The control group was treated with western medicine comprehensive treatment,and the treatment group was treated with Jiedu Huayu granules on the basis of the western medicine comprehensive treatment of the control group.The observation end point was 8 weeks.Observe the liver function(TBIL,ALB,AST,ALB),coagulation function(PTA),mortality,MELD score,and TCM syndrome scores of the two groups of patients before and after treatment to evaluate the clinical efficacy of Jiedu Huayu Granule on ACLF.2.Screening of risk factors: The 48 ACLF patients included were divided into survival group and death group according to prognosis after 8 weeks.Logistic regression was used to analyze the age,sex,course of disease,antiviral history,TBIL,AST,Cr,MELD score,hepatic encephalopathy,and infection of the two groups of patients.Screen and analyze the risk factors affecting the prognosis of ACLF.(ROC)and area under the curve(AUC)to evaluate the predictive value of various indicators for the prognosis of ACLF patients.Result:1.Clinical research part:(1)In terms of efficiency and mortality: after treatment,the total effective rate of the treatment group(70.8%)was better than that of the control group(37.5%)(P < 0.05);The cumulative mortality rate of the treatment group(20.9%)was lower than that of the control group(54.2%)(P<0.05);(2)At the level of liver function: Compared with week 0,the levels of TBIL,ALT,and AST of the two groups of patients at week 4 and week 8 after treatment were significantly lower than before(P<0.05);the treatment group and control group were treated The ALB levels in the 4th and 8th week after the increase were higher than before(P<0.05);compared with the control group at the same period,the levels of TBIL,ALT,and AST in the treatment group decreased significantly at 4th and 8th week after treatment(P<0.05),the ALB level increased significantly at 4 weeks after treatment,the difference was statistically significant(P<0.05);but the ALB level increased at 8 weeks after treatment was not significant,and the difference was not statistically significant(P>0.05);(3)In terms of coagulation function: Compared with week 0,the PTA levels of the two groups of patients at week 4 and week 8 after treatment were significantly higher than before(P<0.05);compared with the control group,the treatment group PTA levels increased significantly at 4 and 8 weeks after treatment(P<0.05);(4)On the MELD score: Compared with week 0,the MELD scores of the two groups of patients at week 4 and week 8 after treatment were significantly lower than before(P<0.05);compared with the control group,the treatment group The MELD score level at week 4 and week 8 after treatment was significantly reduced(P<0.05);(5)In terms of TCM syndrome scores: Compared with week 0,the levels of TCM syndrome scores in the two groups of patients at 4 and 8 weeks after treatment were significantly lower than before(P<0.05);compared with the control group at the same period,In the treatment group,the TCM symptom score level decreased significantly at 4 and 8 weeks after treatment(P<0.05).2.Screening of risk factors: The results of single factor analysis showed that age,course of disease,TBIL,AST,MELD score and infection were statistically significant(P < 0.05),suggesting that the prognosis of ACLF patients is related to the above factors.After multivariate logistic regression analysis,the MELD score was finally screened as an independent risk factor affecting ACLF prognosis.Through ROC analysis,age,course,TBIL,AST,MELD score,and area under the curve of infection were 0.664,0.556,0.853,0.893,0.949,0.644,respectively,and concluded that MELD score,TBIL,AST have higher predictive value,age,The course of disease and the predicted value of infection are low.Conclusion:1.On the basis of comprehensive treatment of Western medicine,the combined application of Jiedu Huayu Granules in the treatment of patients with chronic and acute liver failure can effectively improve the liver function and coagulation function of patients,improve clinical efficacy,improve prognosis,and reduce mortality.2.The prognostic risk factors for chronic acute liver failure include age,course of disease,TBIL,AST,MELD score,and infection;MELD score is an independent risk factor that affects ACLF prognosis.