Distribution Characteristics Of TCM Syndromes In Mild Hepatic Encephalopathy And Diagnostic Value Of Combined Stroop Test

Objective:This study aims to explore the distribution of minimal hepatic encephalopathy(MHE)in traditional Chinese medicine(TCM)types of liver cirrhosis,and seek the early diagnosis of MHE from the perspective of TCM.To explore the clinical application value of Stroop color and word test,and combine it with TCM syndromes to improve the detection rate of MHE,and provide a new diagnosis and treatment direction for simple,fast and accurate screening of MHE,so as to achieve early prevention,slow down or even reverse the progression of the disease.Method:A total of 151 patients diagnosed with cirrhosis in the First People’s Hospital of Yunnan Province from November 2021 to November 2022 were included.The same investigator guided the patients to perform the Stroup test and traditional neuropsychological tests(number connection test-a,NCT-A,digit symbol test(DST),and animal naming test;Record the basic information of patients,the time required to complete the test,and collect relevant clinical data;According to the test results,MHE was divided into two groups.At the same time,the medical history was collected and the syndrome differentiation was carried out by means of the four diagnoses of traditional Chinese medicine.SPSS 26.0 was used to organize and analyze the data to explore the distribution of TCM syndrome types of MHE,and the area under ROC curve was taken to discuss the clinical application value of Stroop test.Binary logistic regression and disordered multiple logistic regression were used to analyze the correlation between TCM syndrome types and the risk factors of MHE diagnosed by Stroop test.Results:1.Syndrome type distribution: 151 patients were divided into two groups according to the abnormal results of NCT-A,DST and animal naming tests as diagnostic criteria.87patients(57.6%)were in the group without mild hepatic encephalopathy and 64 patients(42.4%)were in the group with cirrhosis and mild hepatic encephalopathy.(1)The proportion of TCM syndrome types in cirrhosis with MHE group from high to low was:damp-heat accumulation syndrome 22 cases(14.6%),blood stasis obstruction syndrome 16cases(10.6%),liver and kidney Yin deficiency syndrome 9 cases(6.0%),liver qi stagnation syndrome 7 cases(4.6%),water and humidity internal obstruction syndrome 6cases(4.0%),spleen and kidney Yang deficiency syndrome 4 cases(2.6%);(2)In the non-MHE group,the proportions of TCM syndrome types were as follows: dampness-heat accumulation syndrome in 29 cases(19.2%),water-dampness-internal obstruction syndrome in 20 cases(13.2%),liver-qi stagnation syndrome in 15 cases(9.9%),liver-kidney Yin deficiency syndrome in 14 cases(9.3%),blood stasis obstruction syndrome in 5 cases(3.4%),spleen-kidney Yang deficiency syndrome in 4 cases(2.6%).(3)The main syndromes in MHE group were damp-heat accumulation syndrome(14.6%)and blood stasis obstruction syndrome(10.6%),while the main syndromes in MHE group were damp-heat accumulation syndrome(19.2%)and water-dampness-internal obstruction syndrome(13.2%).There were significant differences in the distribution of syndrome of blood stasis and internal blockage of water and humidity between the two groups(P <0.05),but no significant differences in the distribution of syndrome of damp-heat accumulation(P > 0.05).(4)Statistical analysis of TCM syndrome types and laboratory indicators showed that there was no statistical significance in the syndrome of damp-heat accumulation among the indicators(P > 0.05);2.Application value of Stroop test: Among the 151 patients with cirrhosis enrolled,5patients were excluded because they could not distinguish red and green,which affected the test results,and 146 patients actually completed Stroop test.(1)The Stroop test took less time than the traditional test,and the difference was statistically significant(P < 0.05);There were no significant differences in gender and years of education between the two tests(P > 0.05).(2)According to the feedback of subjects and researchers,Stroop test was better than traditional test in terms of strong operability,good acceptability and good data collection integrity,and the difference was statistically significant(P < 0.05);(3)When Stroop test was Off Time+On Time > 215.2435 seconds,the AUC value for the diagnosis of MHE was 0.754,the sensitivity and specificity were 78.1% and 64.6%,respectively,and the positive predictive value and negative predictive value were 0.7 and 0.6,respectively.Among 146 patients with cirrhosis,67(45.9%)were without MHE and 79(54.1%)were with MHE.3.Correlation between syndrome type and Stroop test results:(1)The risk factors of MHE in patients with cirrhosis were analyzed by binary Logstic regression.The results showed that TCM syndrome type,years of education and pct were the risk factors of MHE(OR=3.2,P < 0.05).(2)Analysis of TCM syndrome types and risk factors of MHE by binary Logstic regression showed that the syndrome of damp-heat accumulation and syndrome of blood stasis were risk factors of MHE(OR=0.750,OR=0.195,P < 0.05),and the other syndrome types had no correlation with the incidence of MHE(P > 0.05).(3)Taking the water-dampness-internal obstruction syndrome as the reference object,the disordered multiple Logstic regression analysis of whether MHE was the risk factor of TCM syndrome showed that cirrhosis patients with OR without MHE was the risk factor of damp-heat accumulation syndrome(OR=0.586,P < 0.05).There was no significant correlation between cirrhosis patients with or without MHE and other syndrome types(P >0.05).Conclusion:1.The TCM syndromes of cirrhosis complicated with MHE are mainly syndromes of dampness-heat accumulation and blood stasis blocking collages,and the syndromes of the non-MHE group are mainly syndromes of dampness-heat accumulation and water-dampness-internal obstruction.Patients with cirrhosis characterized by two syndromes,namely,dampness-heat accumulation and blood stasis blocking collages,should be alert to the high possibility of their combination with MHE,and should be diagnosed and treated as soon as possible to prevent disease progression.2.Compared with the traditional test,Stroup test is simple,easy to operate,short in time,acceptable,complete in information collection,and highly sensitive.It can be considered as an examination means for early clinical screening of MHE and be widely used,but its specificity is not ideal.3.In summary,the combination of TCM syndrome type and Stroup test can be used as a simple,quick and accurate examination method for screening MHE in an early stage,so as to prevent MHE in an early stage,reduce the social and economic burden,and increase the survival and quality of life of patients.