Study On The Correlation Between Risk Factors Of Hepatitis B Cirrhosis Complicated With Upper Gastrointestinal Bleeding And TCM Syndromes

Objective: Through systematic retrospective analysis of hepatitis B cirrhosis(HBV-RC)complicated by upper gastrointestinal bleeding(UGIB)related risk factors,and from the perspective of TCM syndrome differentiation,summedup the analysis of HBV-RC complicated by UGIB risk factors and TCM syndrome correlation.To provide technical support for the prevention,detection and treatment of HBV-RC complicated with UGIB in clinical practice.Methods: Patients with hepatitis B cirrhosis who were hospitalized in the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine between January 2019 and December 2021 were collected according to the inclusion and exclusion criteria by retrospective study.According to the history of upper gastrointestinal bleeding/upper gastrointestinal bleeding,they were summarized as bleeding group and non-bleeding group.Collect the basic information,TCM syndrome types,laboratory indicators and imaging data of the two groups.Choose SPSS 21.0 to compare the differences clinical data between the two groups,then use logistic analysis to explore the risk factors of UGIB in HBV-RC,and the differences in the distribution of TCM syndrome types in the risk factors of HBV-RC complicated with UGIB were compared to understand the correlation between TCM syndrome types and each risk factor.Results:1.Brought into 516 patients with HBV-RC,including 406 males(79%)and 110 females(21%).According to the history of upper gastrointestinal bleeding/upper gastrointestinal bleeding,they were divided into bleeding group(117 cases)and non-bleeding group(399 cases).2.There were significant differences in age,hospitalization time,antiviral therapy,drinking history,PLT,TBi L,ALB,TBA,INR,PT,PTA,NLR,esophagogastric varices,red sign,Child-Pugh classification,and MELD score between the two groups.There was no significant difference in gender,ethnicity,smoking history,WBC,ALT,AST,SCr,AFP and HBV-DNA between the two groups.3.Logistic regression analysis: Binary logistic regression analysis was performed for the indicators with statistical significance in theclinical data study,and the results were: age,in-hospital course,antiviral therapy,ALB,PTA,NLR,esophagogastric varices,red sign,Child-Pugh classification as the influencing factors of HBV-RC complicated with UGIB(P<0.05),of which antiviral therapy,ALB,PTA were the protective factors of HBV-RC complicated with UGIB(P<0.05,OR<1),and age,in-hospital course,NLR,esophagogastric varices,positive red sign,CTP classification grade B,and CTP classification grade C were the risk factors of UGIB in HBV-RC(P<0.05,OR>1).4.Distribution of TCM syndrome types:(1)The distribution of TCM syndrome types of hepatitis B cirrhosis with upper gastrointestinal bleeding is:liver and spleen blood stasis syndrome>spleen and kidney yang deficiency syndrome>liver and kidney yin deficiency syndrome>damp-heat accumulation syndrome>liver qi stagnation syndrome>other types of syndrome>water dampness internal resistance syndrome;(2)The distribution of TCM syndrome types of hepatitis B cirrhosis without upper gastrointestinal bleeding is: liver qi stagnation syndrome>damp-heat accumulation syndrome>liver and spleen blood stasis syndrome>water dampness internal resistance syndrome>spleen and kidney yang deficiency syndrome>other types of syndrome>liver and kidney yin deficiency syndrome.5.Risk factors associated with TCM syndrome types of hepatitis B cirrhosis complicated with upper gastrointestinal hemorrhage:(1)Age: There were no significant differences in the mean age of each TCM syndrome type between the bleeding group and non-bleeding group.(2)Hospitalization time:There were significant differences in the hospitalization time between the bleeding group and non-bleeding group(P<0.05),and the hospitalization time was longer in the two groups for liver and spleen blood stasis syndrome,liver and kidney yin deficiency syndrome and spleen and kidney yang deficiency syndrome than in other syndromes.(3)NLR: The NLR levels of each TCM syndrome type in the bleeding group cases were higher than those in the nonbleeding group.In the comparison of the distribution of NLR between the two groups,the NLR of liver and spleen blood stasis syndrome,liver and kidney yin deficiency syndrome and spleen and kidney yang deficiency syndrome was higher than other syndromes(P<0.05).(4)Esophagogastric varices: The positive rate of esophagogastric varices was higher in the bleeding group with liver-kidney yin deficiency syndrome,other types of syndromes,spleen-kidney yang deficiency syndrome,and liver-spleen blood stasis syndrome(P<0.05),and the probability of esophagogastric varices was higher in the non-bleeding group with spleen-kidney yang deficiency syndrome and liver-kidney yin deficiency syndrome than in the other groups(P<0.05)(5)Red sign: The difference was not statistically significant of TCM syndromes in the positive red sign of esophagogastric varices.(6)CTP classification : In the bleeding group and non-bleeding group,the syndrome of stagnation of liver-qi was mostly distributed in Child-Pugh classification A,the syndrome of water dampness internal resistance was more distributed in class A and class B,the syndrome of damp-heat accumulation was distributed in classes A,B,and C.The syndrome of liver-spleen blood stasis,liver-kidney yin deficiency,and spleen-kidney yang deficiency was mainly distributed in classes B and C(P<0.05).Conclusion(s):1.Antiviral therapy,ALB and PTA are protective factors for UGIB in HBV-RC;age,course of treatment in hospital,NLR,esophagogastric varices,positive red sign,CTP grade B and C are the risk factors of HBV-RC complicated with UGIB.2.HBV-RC complicated with UGIB group TCM syndrome distribution is liver and spleen blood stasis syndrome>spleen and kidney yang deficiency syndrome>liver and kidney yin deficiency syndrome>damp-heat accumulation syndrome>liver qi stagnation syndrome>other types of syndrome>water dampness internal resistance syndrome.3.Liver and spleen blood stasis syndrome,liver and kidney yin deficiency syndrome,spleen and kidney yang deficiency syndrome,damp-heat accumulation syndrome are high-risk syndromes of HBV-RC patients complicated with UGIB.Each TCM syndrome type is associated with the risk factors of HBV-RC complicated by UGIB.