Different Stages Morphological Changes Of Liver Cirrhosis And Their Relationships With TCM Syndrome Distribution

Backgrounds:In China,there are many patients with hepatitis,each year a large number of hepatitis patients develope to liver cirrhosis.Presently,liver cirrhosis has become a common and major cause of death in China,and seriously endangeres the health of our Chinese people,which is a serious social and medical problem. Laparoscopic morphological diagnosis is "gold standard" that can diagnose compensatory period of pre-clinical(CPP) cirrhosis cases which the clinical diagnostic criteria cannot be made.Our previous clinical investigations indicated that certain cases in CPPG(the main morphologic changes are incomplete septal and micronodular type) are reversed through Chinese medicine treatment,but the decomensated cases are irreversible.Based on this,we hold that exploring the distribution of TCM syndrome(TCMS) in different groups of periods of cirrhosis ((CPPG),compensated period of clinical group(CPCG) and decompensated period group(DPG)) and in different groups of morphological changes(incomplete septal cirrhosis group(ISCG),micronodular cirrhosis group(MicroNCG),mixed macronodular and micronodular cirrhosis group(MixedNCG),macronodular cirrhosis group (MacroNCG)) has great guiding significance for the exploratioin of TCMS.Objective:Exploring the characteristics in different groups cirrhosis(CPPG,CPCG, DPG) and in different groups of morphological change(ISC,MicroNC,MixedNC, MacroNC).Methods:Based on clinical epidemiological survey research methods,researching subjects were divided into two groups:68 cases in liver cirrhosis group(27 cases of CPP6,28 cases of CPCG,13 cases of DPG) and 83 cases in non-cirrhotic control group(60 cases of non-liver disease group(NLDG),23 cases of chronic hepatitis group(CHG)),151 cases in total.Major symptoms and clinical diagnosis data are recorded on Case Record Form(CRF),liver morphological change data are collected through laparotomy or laparoscope examination.Statistical packages SPSS13.0 are used for Data analysis,aχ~2 test is used for evaluating ratio or constituent ratio data;a t-test is used for measurement data with mean±standard deviation;test level isα=0.05.Results:(1)General information:Characteristic of cirrhosis morphological change changes on different stages:In NLDG and CHG,the liver surface is smooth and no abnormal morphology observed;27 cases of the CPPG,ISC cases accounted for 70.37%, MicroNC cases accounted for 25.93%,one case of MacroNC in CPPG,accounting for 3.70%of all;28 cases of the CPCG,the main morphological changes are MicroNC, MixedNC and MacroNC which accounted for 53.57%,25.00%,21.43%,respectively; 13 cases in the DPG,the mian morphological changes are MixedNC and MacroNC, accounted for 76.92%and 23.08%,respectively.By theχ~2 test,P=0.000＜0.05, prompted the morphological changes in the distribution of each group were significantly different,and there is statistical significance.Characteristics of liver cirrhosis morphological changes in etiopathogenisis:In this study,the morphological changes of alcoholic liver cirrhosis are MacroNC and MixedNC; hepatitis B cirrhosis morphological changes in various morphological types have all distributions;hepatitis C cirrhosis,cirrhosis of Schistosoma,cholestatic liver cirrhosis,Budd-Chiari syndrome cirrhosis,cryptogenic cirrhosis, "Alcoholic+hepatitis B" cirrhosis are mainly MacroNC changes.(2)TCM syndrome distribution:①From the different stages of liver cirrhosis(division) point of view:In cirrhosis group,the distribution of TCMS of "depression of liver-QI(DOL-QI)" occupied a large part of the group,accounting for 39.71%,TCMS of "obstruction of collaterals by blood stasis(OCBS)",the second,accounting for 38.24%,the distribution of "endoretention of damp heat(ERDH)","non-syndrome(NS)","asdthenic splenonephro-yang"(ASN-yang), "damp abundance due to splenic asthenia(DASA)",followed by the proportion of times,are 13.24%,5.88%,1.47%,1.47%,respectively;In CHG,distribution of "ERDH" has the largest share for 52.17%,accounted for 30.43%, "DASA" and "OCBS" accounted for 8.70%,respectively;In NLDG,"ERDH" has the largest share of 48.33%,followed by "DOL-QI",accounting for 40.00%,"OCBS", "hepatic and renal yin deficiency"(HRYD),"DASA" has the proportion of 13.33%, 10.00%,1.67%,respectively.By theχ~2 test,P=0.000＜0.05,statistically significant,suggesting that the distribution of TCMS in liver cirrhosis groups and control groups are different.In the cirrhosis group,"DOL-QI" in CPPG has the largest share of 70.37%,for the "ERDH" times,accounting for 14.81%,"OCBS", "DASA" by the proportion accounted for 11.11%,3.70%respectively;the distribution of TCMS of "OCBS" in CPCG has the largest share,accounting for 35.71%,"DOL-QI" was 28.57%,"ERDH" and "NS" is also a large proportion of 17.86%,14.29%,respectively,"ASN-yang" the proportion of the smallest is 3.57%; 13 cases collected in DPG,the "OCBS" has the percentage of 100.00.By theχ~2 test, P=0.001＜0.05,statistically significant,suggesting that TCMS between the groups of cirrhosis are different in distribution.②From the view of morphological changes of cirrhosis:In all cases of ISCG,"DOL-QI" has the largest share of 68.42%, for the "ERDH","OCBS","DASA" accounted for 15.79%,10.53%,5.26%, respectively;in all cases of MicroNCG,"DOL-QI" has the largest share of 50.00%, for the "ERDH","OCBS","NS","ASN-yang",proportion followed by 18.19%, 18.19%,9.09%,4.55%,respectively;in all cases of MixedNCG,"OCBS" has the largest share of 70.00%,for the "ERDH","DOL-QI","NS" each has the proportion of 10.00%;in all cases of MacroNCG,"OCBS " has the largest share of 76.47%, for the"DOL-QI","ERDH","NS" has the proportion of 11.76%,5.88%,5.88%, 5.88%,respectively.Distribution of TCMS in different morphological groups(other than ASN-yang) by theχ~2 test,a P = 0.000＜0.05 is got,statistically significant, suggesting different TCMS distributions in all morphological groups.(3)Rate of missed diagnosis of cirrhosis without using "gold standard":The present study,27 cases in CPPG through clinical diagnostic criteria are not confirmed,but the morphological diagnosis of all cases are diagnosed as liver cirrhosis,accounting for the total number of cases of liver cirrhosis(68 cases)of 39.71%,thus the rate of missed diagnosis of cirrhosis of 39.71%is drawn.Conclusions:(1)From the general information point of view,correlation between the morphological change group and clinical stages(sub-) group is seen,the progress of the disease from CPPG→CPCG→DPG,characteristics of Morphological changes of liver cirrhosis showed obvious regularity from IS→MicroN→MixedN→MacroN there is a positive correlation;different etiology of liver cirrhosis may have the diversity of morphological changes or complexity.(2)From the research,"DOL-Q" and "OCBS" occupied a large proportion in liver cirrhosis TCMS group,and there was a increasing trend from NLDG→CHG→LCG; "ERDH" in liver cirrhosis group only occupied a small proportion;and there was a decreasing trend from CHG→NLDG→LCG.From the cirrhosis group point of view, "DOL-QI" occupied a large proportion in CPPG;distributions of TCMS in CPCG have clear evidence of diversity;"OCBS" is the main TCMS in DPG;with the progress of the disease,there was a decreasing trend from CPPG→CPCG→DPG characterized by the distribution of TCMS of "DOL-QI",and a increasing trend from CPPG→CPCG→DPG characterized by the distribution of "OCBS" is detected either.In ISCG, of TCMS of "DOL-QI" occupied a large proportion;Distribution of TCMS possess diversity In MicroNCG;the main distributions of TCMS in MixedNCG and MacroNCG is "OCBS".