Study On Syndrome And Pathogenesis Of Hepatitis B Cirrhosis By Epidemiological Investigation

Hepatitis B virus (HBV) infection is a important of global public problem hepatic cirrhosis is its important of one of the development stage.In recent years, it becomes the hot pot to improve the diagnosis and treatment level of hepatitis B cirrhosis. To date, the therapy with satisfying therapeutic effect is absent, but traditional Chinese Medicine (TCM) exerts a promising future for clinical treatment, with combination of disease and syndrome differentiation, entirely regulation from multiple pathway and mufti-strata.On support of National Natural Science Foundation of China, this research explores the etiological factors, discipline of the syndrome and pathogenesis of the hepatitis B cirrhosis, employing epidemiological method, by means of statistical methods,on the basis of past researches. The paper can be divided into two parts: theory and clinical research.Part I:Theory study:the exploration of the hepatitis B cirrhosis s etiology and pathogenesis of TCM.For many years, after long-time clinical practice and researches, my advisor and researching group postulate that the etiology of hepatitis B cirrhosis is "epidemic toxin" and "endogenous toxicity", the location of disease is "liver meridian", "the discord of the spleen and the liver" is basic pathological changes of the hepatitis B cirrhosis.This research proposes and expounds basic pathogenesis of "toxin damaging the liver meridian and the discord of the spleen and the liver", analyzes the characteristics of the occurrence and development of hepatitis B cirrhosis.liver meridian is the important part of the whole collateral and meridian system, which distributes in liver, and constitutes the basic structural and functional unit. It processes not only the characteristics of meridian but also its special physiological and pathological features. Pathologically, liver meridian is the pathway of evil invasion, transmission and stagnating location. Liver can regulate the physiological function of related organs through its collateral and meridian system, in which the relationship of the liver and the spleen is most osculating,they are key points of ascending-descending。Vise visa, the diseases of the liver can affect other organs by the collaterals and meridians. So that, damp-heat epidemic toxin" and "endogenous toxicity" easily invade into the liver-blood, liver meridian, offenseing liver and tired spleen, transmission along and change, then inducing a series of diseases.In terms of the literature study, combined with advisor's clinical practice and experimental studies, we concluded the etiological factors and major pathogenesis as following①Inhiding epidemic toxin is the promoter and the key of the hepatitis B cirrhosis.②They which are "the discord of the spleen and the liver,the deficiency of vital qi" effect the disease development, which is basic pathological changes of the hepatitis B cirrhosis.③Blocking stasis,wet,sputum and water are clinic pathological changes of the hepatitis B cirrhosis.④"toxin damaging the liver meridian and the discord of the spleen and the liver" are hepatitis B cirrhosis's basic pathogenesis. The therapeutic principle suggested to be resolveing toxin and dredging merdian, harmonizing liver and spleen.PartⅡ:clinical research:Clinical research on the pathogenesis and the syndrome characteristics of hepatitis B cirrhosis.This research analyzes of 650 eligible case of illness from 2007 to 2009, which come from several infectious diseases hospital of Guang'anmen Hospital,302 Military Hospital of China,Beijing YouAn Hospital,Beijing DiTan Hospita,The fifth Anyang People's hospital,The fifth People's hospital of WuHu,The People's hospital of GongZuLing,HeNan Provincial hospital of TCM.1.Research on the baseline material.The occurrence and activation of the hepatitis B cirrhosis is caused by multiple factors. Our research suggests that sex, age, duration, season and emotional factors participated in the pathogenesis, especially the season. The research has discovered that seasons have a certain influences on the development and(or) activation of the hepatitis B cirrhosis(202/650,31.1%), accounting for 52.0%(105/202) in the spring; accounting for 33.7%(68/202)in the winter.especially the spring.It is worth to further study that whether the development and/or activation of the hepatitis B cirrhosis are related to the enhanced 2 The study on the syndrome distributing laws of hepatitis B cirrhosis.We applied frequency analysis, studied the syndrome distributing laws difference of hepatitis B cirrhosis different stages. It is suggested that liver and gallbladder dampness-heat, spleen-stomach dampness heat, dampness obstructing middle-jiao, Yin deficiency of liver and kidney appeared in Cirrhosis of the Liver, they are not different in the hepatitis B cirrhosis different stages; the discord of the spleen and the liver, liver depression and spleen deficiency, liver qi stagnation syndromemainly reflects in compensatory phase cirrhosis; qi stagnation and blood stasis, spleen-kidney yang deficiency, internal retention of cold wetness, mainly reflects in loss compensatory phase cirrhosis,which are syndrome characteristic or principal contradiction of loss compensatory phase cirrhosis.This indicates that syndrome characteristics of hepatitis B cirrhosis involves in dampness-heat, qi stagnation, blood stasis, phlegm-dampness, liver, spleen, kidney, yang deficiency,yin deficiency. With the disease development, damp-heat epidemic toxin and endogenous of toxicity lead to the discord of the spleen and the liver, qi stagnation and blood stasis aggravated gradually, disease of zang and fu is from liver-spleen to kidney, then gradually from yin deficiency to yang deficiency.3. The study on pathogenesis and Clinical Characteristics of the hepatitis B cirrhosis.We study on the "information from the TCM four diagnostic methods" by factor analysis and cluster analysis, combining with traditional chinese medicine theory,we analyze the results.(1) Factor analysis shows that the pathogenesis of the hepatitis B cirrhosis involves in dampness-heat, weakness of spleen-stomach, liver qi stagnation, disharmony of liver-spleen, phlegm-dampness, water retention, blood stasis, kidney deficiency ect, which reflects in the pathogenesis evolution process of the hepatitis B cirrhosis, its character is group insufficiency and excess.It reveals as damp-heat epidemic toxin HBV latending in liver, which damages the liver meridian, results in the discord of the spleen and the liver and vital qi deficiency, qi blood and body fluid disorder, producing blood stasis and phlegm-dampness ect, that finally causes damp-heat brewing internally, discord of the spleen and the liver, stagnation of damp turbidity and static blood,that blocks merdian, forms of disease of hepatic cirrhosis.(2) Cluster analysis shows that syndrome category which is "toxin damaging the liver meridian and the discord of the spleen and the liver"of the hepatitis B cirrhosis is stagnation of dampness due to splenic asthenia classified syndrome, liver depression and spleen deficiency classified syndrome, damp-heat brewing internally and liver-spleen-kideny deficiency classified syndrome, liver and gallbladder dampness-heat classified syndrome.(3) We calculate weight of related indexes that have obtained by using cluster analysis and preliminary study on diagnostic criteria of related syndrome category,which are related with "toxin damaging the liver meridian and the discord of the spleen and the liver"of the hepatitis B cirrhosis's basic pathogenesis.Stagnation of dampness due to splenic asthenia classified syndrome:burnout and hypodynamia, poor appetite, abdominal distension, liver palms,yellowish eyes, spider telangiectasia, bloating great, weiwan expansion, reluctant to speak, short of breath, low extremity edema, body huang, heaviness sensation of body, stool pond, xielei expansion, mouth pale dull, pale tongue, thick white greasy fur, deep and fine pulse.Liver depression and spleen deficiency classified syndrome:burnout and hypodynamia, liver palms, Looking chlorosis, abdominal distension, poor appetite, xielei expansion, dark purple veins under the tongue, yellow red of Urine, mental or emotional abnormalities, pale dark red tongue, thick white greasy fur, mouth pale dull, weiwan expansion, thirsty, deep fine string pulse.Damp-heat brewing internally and liver-spleen-kideny deficiency classified syndrome:burnout and hypodynamia, yellow red of Urine, heaviness sensation of body, abdominal distension, body huang, weiwan expansion, liver palms, yellowish eyes, mental or emotional abnormalities, reluctant to speak, short of breath, thirsty,sour and feeble of the lion and knees, poor appetite, Poor sleep,more dream,easy to sign, low extremity edema, complexion dark and gloomy, xielei expansion, Dry eyes, abdominal distension, mouth pain, having a bad memory, abnormal bleeding, irritable, dark red tongue, thick yellow greasy moss, string pulse.Liver and gallbladder dampness-heat classified syndrome:yellowish eyes, body huang, liver palms, thirsty, yellow of Urine, mouth pain, burnout weak, abdominal distension, complexion dark and gloomy, poor stool, dark red tongue, thick yellow greasy moss, dark purple veins under the tongue, tortuous sublingual veins, string slip su pulse.4. Exploring the relation of the "toxin damaging the liver meridian and the discord of the spleen and the liver" related syndrome and the clinical investigating indexes.After clustering analysis, this research compared the common clinical indexes related to various syndromes of hepatitis B cirrhosis of the liver, we consider that disordered bilirubin and bile acid (BA) metabolism may be the pathogenesis and Syndromes of the hot and humid Immunotoxin; ALP, PT reflects the hepatocellular lesions and synthesis dysfunction may be the physical and chemical basis of the evolution of the basic pathogenesis; The decline of plasma protein in the Immunotoxin with the liver and spleen are not transferred under the action of pairs of heavy development as the gradual emergence of the disease; ALT, AST and y-GT embodies the basic pathogenesis of the biochemical appearances of the hepatitis B cirrhosis of the liver, that is " toxin damaging the liver meridian and the discord of the spleen and the liver". in this aspect we made a preliminary exploration and found some tendency, which still need to be verified by more intensive and extensive researches, we try to find the relation between the syndrome and the micro-index by collecting clinical material, provide references for the clinical practice.'...