| Objective:We aimed to explore the traditional Chinese medicine(TCM)syndromes distribution of cirrhotic patients with minimal hepatic encephalopathy(MHE),and to investigate the prevalence and associated factors of among cirrhotic patients based on a rectified norm of number connection test A(NCT-A)and digital symbol test(DST)in China.Methods:Healthy subjects and cirrhotic patients included in our study were required to complete NCT-A and DST,and to fill out the clinical information.(1)Factors related to results of NCT-A and DST were found out through multiple linear regression analysis,based on which rectified norms were established.(2)Referring to the established norms,cirrhotic patients with MHE were diagnosed if a result of either NCT-A or DST was abnormal.The prevalence and associated factors of MHE were further investigated using logistic regression analysis.(3)Factor analysis,cluster analysis and comlex network technology were performed to find the regularities of TCM syndromes and syndrome elements distribution of cirrhotic patients with MHE.(4)Based on factor analysis,the distribution of TCM syndromes and syndrome elements of cirrhotic patients with MHE with those without MHE were compared.Results:(1)651 healthy subjects were included,and age(P=0.000,P=0.000),education(P=0.029,P=0.000)and gender(P=0.019,P=0.001)were found to be influencing factors for their performance of NCT-A and DST.A rectified norm was developed based on mean ± 2 times standard deviation.(2)1311 cirrhotic patients were included,among whom 219 MHE patients were diagnosed,with a proportion of 16.70%.127MHE patients belonged to compensated cirrhosis,while 92 belonged to decompensated cirrhosis.The proportion of MHE was 13.50%(98 cases),19.02%(58 cases)and 25.33%(19 cases)among cirrhotic patients with Child-Pugh classification A,B and C,respectively,and the difference was statistically significant(P=0.006).Logistic regression analysis showed that the length of cirrhosis history(P=0.016,B=0.090),blood ammonia(P=0.031,B=-0.020)and ascites(P=0.042,B=1.012)were associated factors of cirrhotic patients with MHE.(3)The most common TCM symptoms of MHE patients were fatigue(79.00%),gloomy complexion(63.01%),poor appetite(50.23%),yellow urine(47.49%),bitter taste(46.12%),sallow complexion(43.84%),abdominal distension after eating(43.38%),lazy words(42.47%),liver palm(41.55%),shortness of breath(40.18%),indented tongue(29.68%),thin tongue(27.40%),red tongue(36.53%),pale red tongue(29.22%),dark tongue(25.11%),white tongue fur(60.73%),thin tongue fur(49.32%),yellow tongue fur(36.53%),greasy tongue fur(31.96%),sublingual vein circuity(55.71%),string pulse(74.43%)?fine pulse(33.33%)and slip pulse(27.85%).According to the factor analysis,the common TCM patterns were syndrome of accumulated dampness-heat(20.09%),syndrome of yin deficiency in liver and kidneys,and liver fire due to qi stagnation(20.09%),syndrome of blood stasis(12.33%),syndrome of blood stasis and water retention(12.33%),syndrome of spleen deficiency and qi stagnation(10.05%),syndrome of liver qi and stomach qi stagnation and dampness retention(8.22%),syndrome of qi stagnation and retention(7.76%),syndrome of liver qi stagnation and spleen deficiency and accumulated dampness-heat(7.31%),syndrome of spleen qi deficiency(6.39%).While the common TCM syndrome elements were water,dampness and phlegm(55.71%),qi stagnation(53.42%)and heat(40.18%),the disease location includes spleen(67.58%)and liver(55.71%),affecting kidney(32.42%),stomach(18.26%),heart(7.31%)and head(7.31%).Cluster analysis showed that TCM symptoms should be divided into 7 or 11 clusters.Taking 7 clusters as an example,the common TCM patterns were syndrome of spleen qi deficiency,syndrome of liver fire due to qi stagnation,syndrome of blood stasis and accumulated dampness-heat,syndrome of liver qi and stomach qi stagnation,syndrome of liver fire due to qi stagnation and accumulated dampness-heat,syndrome of spleen deficiency and dampness retention.While the common TCM syndrome elements were water,dampness and phlegm,heat,blood stasis and qi deficiency,the disease location includes spleen and liver,affecting heart,head and stomach.(4)Factor analysis was further performed to investigate the distribution of TCM patterns of compensated and decompensated cirrhotic patients both with and without MHE.The proportions of symptoms indicating spleen deficiency(lazy words,shortness of breath,poor appetite,sallow complexion and spontaneous perspiration)and red tongue,greasy tongue fur and deep pulse were higher in compensated cirrhotic patients with MHE than those without,while the proportions of symptoms indicating spleen and kidney deficiency,and water retention(abdominal distention,edema and heavy head and body),old tongue,red tongue and little tongue fur were higher in decompensated cirrhotic patients with MHE than those without.Also,the proportions of syndromes of qi deficiency and dampness-heat were higher in compensated cirrhotic patients with MHE than those without,while the proportions of syndromes of blood stasis,dampness-heat and water retention were higher in decompensated cirrhotic patients with MHE than those without.Furthermore,the proportion of syndrome elements of qi deficiency and yin deficiency were higher in compensated cirrhotic patients with MHE than those without,while the proportions of syndrome elements of blood stasis,water,dampness and phlegm,yin deficiency and disease location on spleen and kidneys were higher in decompensated cirrhotic patients with MHE than those without.Conclusion:(1)Cirrhotic patients have a relatively high prevalence of MHE,which will go higher with the deterioration of liver function.The length of cirrhosis history,blood ammonia and ascites were main associated factors of cirrhotic patients with MHE.(2)Common TCM symptoms of cirrhotic patients with MHE mostly belonged to spleen deficiency,blood stasis and dampness-heat,while common TCM patterns were syndrome of liver qi stagnation and spleen deficiency,syndrome of dampness retention,syndrome of accumulated dampness-heat,syndrome of blood stasis,syndrome of spleen qi deficiency,syndrome of liver qi and stomach qi stagnation,syndrome of liver fire due to qi stagnation,syndrome of blood stasis and water retention and syndrome of yin deficiency in liver and kidneys.The main syndrome elements were water,dampness and phlegm,blood stasis,heat and qi deficiency,while the disease location includes spleen and liver.The pathogenesis of MHE may be that on the basis of weakened body due to cirrhosis,dampness-heat,blood stasis,phlegm and dampness and heat go head and confuse the orifices.Also,the pathogenesis may be that the orifices fail to be moistened due to spleen deficiency and lucid yang failing to rise.(3)The comparison of TCM syndrome distribution of compensated cirrhotic patients with and without MHE showed that,while dampness-heat,blood stasis and phlegm and dampness exist,deterioration of the spleen deficiency and dampness-heat may finally lead to the strike of MHE.For decompensated cirrhotic patients,liver qi stagnation for a long time during compensated cirrhosis period may lead to aggravated blood stasis,and spleen deficiency may cause kidney deficiency in decompensated cirrhosis,which further leads to water retention.As a result,water,dampness and blood stasis go head and confuse the orifices,or yin deficiency caused by dampness-heat and kidney deficiency may further give rise to heat which disturb patients'mind. |
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