Study On The Incidence And Symptoms Of Mild Hepatic Encephalopathy In Patients With Hepatitis B Liver Cirrhosis

Objective:To investigate the prevalence rate,risk factors and TCM syndromes of minimal hepatic encephalopathy(MHE)in patients with hepatitis B virus-related cirrhosis.Methods:Collected the clinical information of 173 cases of healthy people and completed NCT-A,DST,MMSE detections.Found out the related influencing factors of NCT-A,DST,MMSE test results through the statistical analysis.On this basis,determined the normal range of NCT-A,DST,MMSE for different levels.Collected the data of general situation(including gender,age,professional type,blood type,level of education),medical history(including mother-to-child transmission,family history,history of hepatitis B and cirrhosis,portal hypertension and cirrhosis of the liver stages,the Child-Pugh grade),physical and chemical indicators(including HBeAg,HBV-DNA,ALT,AST,GGT,AKP,ALB,A/G,WBC,RBC,HGB,PLT,the ratio of neutrophils and lymphocytes absolute value,prothrombin activity,blood ammonia,AFP,inside diameter of the portal vein,splenomegaly,liver nodules)and syndrome data of 130 cases of hepatitis B virus-related cirrhosis patients.Tested on the patients with NCT-A、DST、MMSE,if anyone of the test results was abnomal,the diagnose of MHE can be made.Figured out the morbidity of MHE in hepatitis B virus-related cirrhosis patients.Compared the MHE with non-MHE groups,explored the risk factors of MHE and if there was any correlation between MHE with the physical and chemical indicators.Classified the patients into different TCM syndromes by using the consensus for diagnosis and treatment of cirrhosis of the liver made by combination of Chinese traditional and Western medicine.Studied MHE syndrome characteristics of different liver stages and found out the risk factors of different liver stages.Then used clustering analysis method to investigate the main syndromes of MHE in different liver cirrhosis stages.Results:(1)In total,173 healthy volunteers completed the tests.Age and education had a significant impact on NCT-A,DST,MMSE(P<0.05).No significant differences were found in different gender and blood type.(2)MHE morbidity was 56.2%.Compared with compensated cirrhotic patients,decompensated cirrhotic patients had a higher proportion of MHE(39.0%vs.64.0%).Compared with Child A,Child B and C had a higher proportion of MHE(45.7%vs.86.7%vs.62.5%).Both cirrhosis stages and Child-Pugh grade had a significant impact on MHE morbidity(P<0.05).(3)Age,professional type,cirrhosis stages,Child-Pugh grade as well as splenomegaly had a significant impact on MHE(P<0.05).GGT,AKP and blood ammonia were significantly increased,while ALB,A/G and prothrombin activity were significantly decreased(P<0.05).(4)Professional type and education level had a significant impact on MHE of compensated cirrhotic(P<0.05).AKP was significantly decreased,while splenomegaly was significantly different(P<0.05).(5)MHE of decompensated cirrhotic had a correlation with age and Child-Pugh grade(P<0.05).There was significant differences in HBeAg,ALB,A/G,RBC(P<0.05).(6)By traditional syndrome differentiation,the top three syndromes of compensated period and decompensated period in patients with hepatitis B virus-related cirrhosis MHE were both diseases with ease,hot and humid embodiment,liver and kidney Yin deficiency.No significant differences were found in different cirrhosis of the liver stages(P>0.05).(7)Compared different TCM syndromes of decompensated cirrhosis MHE,there was no significant difference in gender,age,professional type,blood type,education level,cirrhotic periods,Child-Pugh grade,history of hepatitis B,history of cirrhosis,HBeAg,HBV-DNA,liver function(like ALT,AST,GGT,AKP,ALB),routine blood test(WBC,RBC,HGB,PLT,the ratio of neutrophils and lymphocytes absolute value),prothrombin activity,blood ammonia and AFP,inside diameter of the portal vein and splenomegaly(P>0.05).(8)Clustering analysis indicates that the main TCM syndromes of decompensated period MHE were qi deficiency syndrome types for wet resistance and qi stagnation syndrome,and hot and humid embodiment and blood stasis syndrome,liver fire,phlegm heat intrinsic and blood stasis,liver and kidney Yin deficiency and dampness trapped spleen deficiency.Conclusion:(1)There is a high morbidity of MHE in Hepatitis B virus-related cirrhosis patients.And it had a correlationship with cirrhosis of the liver stages,Child-Pugh grade,patients’ age,professional type,some physical and chemical indicators(GGT,AKP,blood ammonia,A/G,prothrombin activity,splenomegaly).Different liver stages of hepatitis B virus-related cirrhosis patients with MHE also have different clinical characteristics respectively.(2)The influencing factors of compensated period and decompensated period of hepatitis B virus-related cirrhosis with MHE are different.(3)The main TCM syndromes of both compensated period and decompensated period in hepatitis B virus-related cirrhosis patients with MHE are diseases with ease,hot and humid embodiment,liver and kidney Yin deficiency.(4)There is no difference among different TCM syndromes of decompensated cirrhosis with MHE.(5)Clustering analysis can help to classify the syndromes of MHE,determine the preliminary points syndromes and provide the theory basis for TCM diagnosis and treatment.