Analysis Of The Therapeutic Effect Of Intervention On HBV-ACLF Based On The Syndrome Differentiation And Treatment Model Of "Yang Jaundice-Yin Yang Jaundice-Yin Jaundice

Objective:To analyze the short-term efficacy and long-term survival rate of hepatitis B related chronic Liver failure patients based on the "Yang Jaundice-Yin-Yang Jaundices-Yin Jaundice" syndrome differentiation and treatment model,explore the appropriate criteria of ACLF,and provide some basis for clinical decision-making.Methods:Retrospective collection of clinical data of 100 HBV-ACLF patients enrolled in the National Clinical Research Base of Traditional Chinese Medicine project of "the intervention effect of the treatment model of Yang Jaundice-Yin-Yang Jaundices-Yin Jaundice syndrome differentiation on Hepatitis B virus related acute-on-chronic liver failure and its impact on prognosis" from January 2012 to January 2015 in the First Affiliated Hospital of Hunan University of Chinese Medicine,follow-up of patients’ survival until November 30,2022 or the occurrence of endpoint events,analysis of baseline data to obtain clinical characteristics,Patients were grouped according to different diagnostic criteria for ACLF,and the 28 day mortality rate,90 day mortality rate,and endpoint mortality rate were calculated for each group.The 28 day and 90 day mortality rates of HBV-ACLF patients in the COSSH-ACLF group were compared with those in the 2018 COSSH study cohort;According to the endpoint outcome,patients were divided into survival group and death group,and clinical characteristics and long-term prognosis were explored through survival analysis and clinical data comparison.Results:1.A total of 93 patients were included in this study,with 76 patients completing full follow-up or reaching the study endpoint.In this cohort,the 28 day mortality rate of patients in the COSSH-ACLF group was 14.08%,and the 90 day mortality rate was 33.80%.Compared with the short-term mortality rate of the COSSH cohort in 2018,the short-term mortality rate of patients decreased;After grading patients according to diagnostic criteria,compared with the short-term mortality rate of the 2018 COSSH study cohort,the mortality rate of all three grading patients in this study cohort was reduced,and the 28 day mortality rate of ACLF-1 grade was reduced by more than 10%.2.According to the follow-up endpoint,patients were divided into a death group(31 cases)and a survival group(45 cases).The survival analysis results showed a significant reduction in the risk of death after11 weeks.The long-term(7-10 years)survival rate of 52 patients who passed the 90 day risk period reached 77.4%,especially for patients in the early stage of the disease,with a long-term survival rate of over 87%.3.In this study cohort,the 28 day and 90 day mortality rates of early patients who met the 2018 Chinese Liver failure guidelines were 7.31% and 14.63% respectively,and the 28 day and 90 day mortality rates of patients in the middle stage were 17.85% and 42.85% respectively;There were 71 patients in the COSSH-ACLF standard group,with a 28 day mortality rate of 14.08% and a 90 day mortality rate of 33.80%.There were 5 patients who did not meet the COSSH standard,with a mortality rate of 0%;More than 75% of patients in the queue did not meet the European and American diagnostic standards,but the 90 day mortality rate reached 20%,and the long-term mortality rate exceeded30%.However,the 28 day mortality rate,90 day mortality rate,and overall mortality rate of patients who met the standards were 26.32%,63.16%,and 73.68%,respectively.Conclusion:1.The traditional Chinese and Western medicine treatment plan based on the "Yang Huang Yin Yang Huang Yin Huang" syndrome differentiation and treatment mode is superior to the simple Western medicine treatment plan in reducing the short-term mortality rate of HBV-ACLF.Moreover,traditional Chinese medicine intervention can reverse the condition of most early patients,while for mid to late stage patients,traditional Chinese medicine intervention can delay the progression of the disease and strive for the opportunity for patients to wait for liver transplantation.2.The traditional Chinese and Western medicine treatment plan based on the "Yang Huang Yin Yang Huang Yin Huang" syndrome differentiation and treatment model intervenes in HBV-ACLF patients,and the long-term survival rate is longer.Patients who survive for more than 11 weeks have a significantly reduced risk of death,especially in early disease patients,the long-term survival rate can reach over 87%,and there is no patient death after 384 weeks of survival.3.COSSH standard,Chinese Liver failure guideline standard and AARC standard are more suitable for the diagnosis of HBV-ACLF.Early identification and early medical intervention can reduce the risk of death;The condition progresses to the middle to late stage or meets the diagnostic criteria of EASL and NACSELD.Internal medical treatment has a high mortality rate,and it is recommended to perform liver transplantation as early as possible to achieve better outcomes.