Study On The Law Of The Syndrome Types Development Of TCM In Patients With Primary Hepatic Carcinoma During The Stage Of The Treatment By Transcatheter Arterial Intervention And The Expression Of VEGF And BFGF Before And After The Treatment

Objective①To make retrospective analysis on the medical literature about primary hepatic carcinoma(PHC) including some advancement about the etiopathogenisis and pathogenesis and syndrome types of TCM and the method of transcatheter arterial intervention(TAI) and the method combined treatment TCM and western medicine.②To investigate initially the distributing and development regularity of the syndrome types of TCM and the correlation between disease and syndrome types of TCM about PHC, then analysis the character of the etiopathogenisis and pathogenesis and the therapy method of TCM during the stage of the treatment of TAI.③To investigate initially the status of tumor angiogenesis and search the evidence to combine the treatment by antagonizing angiogenesis after the treatment of TAI, then investigate the correlation between the plasma levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) and clinical stage or carcinoma epistom or the common syndrome types of TCM in patients with PHC, which will provide initial thinking method of antagonizing angiogenesis.Methods①The patients with PHC by the treatment by TAI were investigated by clinical epidemiology. And the retrospective sample survey was made on inpatients from Guangdong provincial hospital of TOM in the past 5 years, which is the main method. And the prospective survey is the secondary one. The method of data-information exploration from four diagnostic methods of TCM was used.②Plasma VEGF and bFGF levels were measured by quantitative sandwich enzyme-linked immunosorbent assay (ELISA R&D system) 1 week before or after the treatment by TAI.ResultsPart One①There was an evident change from 4 main syndromes and signs before TAI to 7 main ones after the treatment. And the 4 main syndromes and signs were pain in hepatic region, listlessness and lassitude, abdominal distention, anorexia and etc, the frequency of which were 109 (65.27%), 87 (52.10%), 77 (46.11%) and 67 (40.12%), respectively. And the 7 main syndromes and signs were fever, anorexia, abdominal distention, pain in hepatic region, nausea and vomitting, listlessness and lassitude, jaundice and etc, the frequency of which were 71 (45.51%), 66 (42.31%), 50 (32.05%), 47 (30.13%), 44 (28.21%), 43 (27.56%) and 40 (25.64%), respectively.②The 5 common kinds of syndrome types of TCM were obtained from data-information exploration on four diagnostic methods of TCM in 323 cases of PHC such as qi-stagnancy and blood stasis, splenasthenic hygrosis and blood stasis, endoretention of damp heat, tagnation of liver-QI with deficiency of the spleen, hepatic and renal yin deficiency and so on, the frequencies of which were 142 (44.0%), 48(14.9%), 48(14.9%), 43(13.2%) and 42(13.0%), respectively.③The 5 common kinds of syndrome types of TCM were distributed in 167 cases of patients with PHC before TAI such as qi-stagnancy and blood stasis, tagnation of liver-QI with deficiency of the spleen, splenasthenic hygrosis and blood stasis, hepatic and renal yin deficiency, endoretention of damp heat and so on, the frequencies of which were 75 (44.9%), 35(21.0%), 22(13.1%), 19(11.4%) and 16(9.6%), respectively. And the 5 common ones after TAI were qi-stagnancy and blood stasis, endoretention of damp heat, splenasthenic hygrosis and blood stasis, hepatic and renal yin deficiency, tagnation of liver-QI with deficiency of the spleen and so on, the frequencies of which were 67 (42.9%), 32 (20.6%), 26 (16.7%), 23 (14.7%) and 8 (5.1%), respectively.④The distributional difference was significant between before and after TAI (P=0.000). And the syndrome types named endoretention of damp heat increased significantly after TAI (P=0.006). However the syndrome type named tagnation of liver-QI with deficiency of the spleen decreased significantly after TAI (P=0.000). And the distributional difference was significant between before and after transcatheter arterial chemoembolization(TACE) (P=0.017). On the contrary the distributional difference was not significant between before and after TACE combined Chinese medicinal materials.⑤Results of the correlation between disease and syndrome types of TCM about PHC such as:Ⅰ. The distributional difference about the 5 common kinds of syndrome types of TCM was not significant between the main clinical classification of PHC such as makro-lump type, other lump type, tubercle type and so on (P=0.402).Ⅱ. The syndrome type named hepatic and renal yin deficiency was significantly more in patients in stageⅡb of PHC than others in stageⅡa～Ⅲa (P=0.011). And the syndrome type named splenasthenic hygrosis and blood stasis appeared positive correlation with clinical stage of PHC (P=0.007).Ⅲ. The distributional difference about the 5 common kinds of syndrome types of TCM was not significant between the rankings of gross tumor volume in PHC (P=0.709). And the 5 common kinds of syndrome types of TCM appeared quiet correlation with the rankings of gross tumor volume.Ⅳ. The syndrome type named hepatic and renal yin deficiency was significantly less in patients with carcinoma epistom in the bole of portal vein or in inferior vena than others (P=0.037). And the syndrome type named splenasthenic hygrosis and blood stasis appeared positive correlation with the range of carcinoma epistom (P=0.049).Ⅴ. The 5 common kinds of syndrome types of TCM were distributed in 34 cases of patients with metastasis in the liver such as qi-stagnancy and blood stasis, tagnation of liver-QI with deficiency of the spleen, splenasthenic hygrosis and blood stasis, endoretention of damp heat, hepatic and renal yin deficiency and so on. And the syndrome type named splenasthenic hygrosis and blood stasis appeared positive correlation with the metastasis in the liver (P=0.023). But the syndrome type named hepatic and renal yin deficiency appeared negative correlation with the metastasis in the liver (P=0. 010). However, all the common syndrome types appeared quiet correlation with the metastasis in the lung.Ⅵ. Except that the syndrome type named tagnation of liver-QI with deficiency of the spleen appeared little, other syndrome types appeared in patients with symptom complex after embolization frequently such as qi-stagnancy and blood stasis, endoretention of damp heat, splenasthenic hygrosis and blood stasis, hepatic and renal yin deficiency and so on. And the syndrome type named qi-stagnancy and blood stasis decreased significantly in patients with fever after embolization (P=0.001) but the syndrome type named hepatic and renal yin deficiency increased significantly (P=0.000). And the 2 kinds of syndrome types including qi-stagnancy and blood stasis and tagnation of liver-QI with deficiency of the spleen appeared negative correlation with fever after embolization (P=0.003, P=0.027). But the other 2 kinds of syndrome types including endoretention of damp heat and hepatic and renal yin deficiency appeared positive correlation with it (P=0.039, P=0.000).Ⅶ. Except that the syndrome type named tagnation of liver-QI with deficiency of the spleen appeared little, other 4 kinds of syndrome types appeared frequently in patients with damage in Liver function after embolization. And the syndrome types named splenasthenic hygrosis and blood stasis appeared positive correlation with damage in Liver function (P=0.043). But the syndrome types named qi-stagnancy and blood stasis appeared negative correlation with damage in Liver function (P=0.013).Part Two①Serum VEGF and bFGF levels were significantly higher in 11 patients with PHC after TACE than those before TACE (P=0.002, P=0.032).②Serum VEGF levels were positively correlated with Serum bFGF levels in 19 patients with PHC without partial therapy (P=0.012).③Serum VEGF and bFGF levels were positively correlated with clinical stage (P=0.001, P=0.026).④Serum VEGF levels were positively correlated with the range of carcinoma epistom (P=0.031), but Serum bFGF levels were little correlated with it (P=0.052).⑤Serum VEGF and bFGF levels were positively correlated with the syndrome types named splenasthenic hygrosis and blood stasis(P=0.000, P=0.031), but Serum bFGF levels were negatively correlated with the syndrome type named tagnation of liver-QI with deficiency of the spleen (P=0.039). Initial ConclusionPart OneThe feature of etiopathogenisis and pathogenesis of TCM in patients with PHC was recapitulated. For example,①The carcinogenesis of PHC can be caused by multiple exterior and interior factors including exogenous evil, hepatopathy protraction, food and drin, affection disharmony, congenital innate deficiency and etc.②The pathogenic precondition is that multiple factors are coincided and that the endogeny is carcinoma toxin. And the multiple factors include many kinds of etiopathogenisis of TCM such as stagnation of liver-QI, stagnation of QI, stagnation of blood, phlegm, pathogenic damp, humid heat, fire stagnation and toxic heat and so on.③The basic pathology are both the disharmony in entrails and deficiency of vial QI. And the key point is that the competence of anticancer is descending by degrees.④Carcinoma toxin of PHC belongs to a species of yin pathogen generated ab intra, which can form solid tumor in some regions. And carcinoma toxin can possess some characteristics such as complexity, delitescence, ponderosus nature, recurrence, diffusibility, depletion and so on.⑤The position of PHC is located in the liver and relates to the spleen and stomach, gallbladder and kidney. And PHC is a kind of disease considered as state of evil domination and asthenia of healthy energy, deficiency in origin and adequacy on surface, pathopoiesis of deficiency, which is that the pathogenetic condition is complicated and that the transmission of a disease is quick and that the prognosis is bad.Nowadays the types of syndrome of TCM about PHC are not unified. According to literature investigation, the common types of syndrome of TCM can be induced as qi-stagnancy and blood stasis, splenasthenic hygrosis, endoretention of damp heat, tagnation of liver-QI, hepatic and renal yin deficiency and so on.According to the contemporary literature investigation, the cause impacting therapeutic effect is the recurrence of residual focus of infection and metastasis in exterior and interior of liver after TACE. And the cause of the recurrence and metastasis and prognosis mala is the establishment of some bypass circuits in the tumor of liver, the main molecular biology mechanism of which may be that angiogenesis levels have increased significantly. So it is predominant to combine TACE and anti-angiogenesis therapy.The therapy of TCM can possess some characteristic such as little adverse reaction while long-term taking medicine, survival with tumor, opposition to the recurrence and metastasis and so on. Especially the complex prescription of TCM can possess some characteristic such as multitude links and targets, integrated accommodation and etc. So it is desirable to search a multitude links and targets anti-angiogenesis therapy from traditional Chinese medicine, the study about which begins just recently.Part Two①There was an evident change from 4 main syndromes and signs before TAI to 7 main ones after the treatment. And the 4 main syndromes and signs were pain in hepatic region, listlessness and lassitude, abdominal distention, anorexia and etc. And the 7 main syndromes and signs were fever, anorexia, abdominal distention, pain in hepatic region, nausea and vomitting, listlessness and lassitude, jaundice and etc. So these main adverse reactions are symptom complex and damage in liver function after embolization.②The 5 common kinds of syndrome types of TCM during the stage of the treatment by TAI were obtained such as qi-stagnancy and blood stasis, splenasthenic hygrosis and blood stasis, endoretention of damp heat, tagnation of liver-QI with deficiency of the spleen, hepatic and renal yin deficiency and so on.③The characteristic of the pathogenesis of TCM in patients with PHC before TAI can be mostly summarized as stagnation of liver-QI, stagnation of blood, weakness of the spleen and stomach and so on. But the characteristic after TAI can be mostly summarized as the state of evil domination including stagnation of QI, stagnation of blood, humid heat and pathogenic damp. Meanwhile it can be mostly summarized as the asthenia of healthy energy including weakness of the spleen and stomach and hepatic and renal yin deficiency, too. It is outstanding to appear endoretention of damp heat in the feature of the pathogenesis of TCM after TAI, which is significant after TACE except after TACE combined with Chinese medicinal materials. ④While the development of clinical stage, the pathogenesis of TCM can change more and more complicated, the characteristic of which can be summarized as the combination of toxin and blood stasis and deficiency. And carcinoma epistom belongs to the category of stagnation of blood, So the characteristic in patients with carcinoma epistom can be summarized as the combination of blood stasis and toxin and deficiency. And it can be summarized as the combination of toxin and blood stasis and deficiency in patients with metastasis in the liver or with damage in Liver function. And it can be mostly summarized as the combination of humid heat and yin asthenia in patients with fever after TAI.⑤The characteristic of the pathogenesis of TCM in patients with recurrence and metastasis can be summarized as that the key point of the pathopoiesis is some residual carcinoma toxin of PHC. And the foundation of transmission of PHC is both insufficiency of qi and degression of the anticancer ability. And the main mode of transmission of PHC is the empty of carcinoma toxin. And the characteristic of the pathogenesis of TCM in patients with recurrence and metastasis can be summarized as the combination of toxin and blood stasis and deficiency, which belongs to the pathology process considered as both state of evil domination and asthenia of healthy energy.Part Three①Serum VEGF and bFGF levels increased significantly after TACE.②The expression of serum VEGF and bFGF levels can reflect the condition of angiogenesis induced by tumor after TACE to some extent, which is considered as a kind of sensitive serum index correlated with the prognosis and the range of carcinoma epistom.③The expression of serum VEGF and bFGF levels were positively correlated with the characteristic of the pathogenesis of TCM named splenasthenic fluid-retention and stagnated blood.