A Correlative Study On TCM Syndrome Differentiation Types In Different Periods Of Cirrhosis And Histological Scoring Of Knodell Scoring System

BackgroundThere are a large number of people infected with hepatitis in China, and each year many patients with hepatitis develop to liver cirrhosis. At present, liver cirrhosis has become one of the common diseases and major cause of deat h which seriously endangers the health of people, moreover, it has gradually b ecome a serious social and medical problem. Previous studies indicated that TC M syndrome differentiation types in chronic liver fibrosis may have certain pa thological basis, for example, the pathological basis of the developments and changes of "liver stagnation", "retention of dampness", "Yin-deficiency", "yan g-deficiency" and "blood stasis" reflects a continuous increasing degree of in flammation and fibrosis of the hepatic tissue. Knodell scoring system has been widely recognized and applied at home and abroad, and now it is still conside red to be the most classic and extensively used grading and staging system. La paroscopic morphological examination is regarded as a "gold standard " in dia gnosing liver cirrhosis. Only by further studies in research objects and inclu ding compensatory period of pre-clinical cirrhosis into the research objects b ased on the " gold standard " for the diagnosis of liver cirrhosis can we get true and reliable conclusion. For this reason, we divided cirrhosis group int o three groups, that is, compensatory period of pre-clinical group (CPPG), com pensated period of clinical group (CPCG) and decompensated period group (DPG) to explore the correlation between TCM syndrome differentiation types in diffe rent groups and histological scoring of Knodell scoring system, as well as acc urately grasp the pathological changes of liver disease, and this can be most instructive.ObjectiveThe study was to explore the correlation between TCM syndrome differentia tion types in different groups of periods of cirrhosis (CPPG, CPCG, DPG) and h istological scoring of Knodell scoring system.MethodsBased on clinical epidemiological survey research methods, researching sub jects were divided into three groups:63 cases in liver cirrhosis group (20 ca ses in CPPG,27 cases in CPCG,16 cases in DPG) and 3 cases in non-liver disea se group (NLDG),6 cases in chronic hepatitis group (CHG),72 cases in total.Both clinical and diagnostic data for clinical diagnosis were recorded o n Case Record Form(CRF), liver tissues were got through laparotomy or laparosc ope, fixed with 10% formalin, embedded with paraffin, sliced serially, staine d with HE and AgNOR., and then scored with Knodell scoring system by Jinyu med ical test centre(recognized by international CAP).Statistical packages SPSS13.0 were used for Data analysis, as there were cases of relatively large differences between cases in different groups, we us e descriptive statistics method, a x2 test were used for evaluating ratio or constituent ratio data, a t-test is used for measurement data with mean±stan dard deviation; Rank sum test were used to deal with the data of non-normal di stribution, the test levelαis= 0.05.ResultWith regard to general information, sex and age factors of patients inclu ded in this study have been tested to have no influence over the results.With regard to the fibrosis score value of Knodell scoring system from ea ch team, the score value contained in the new CPPG is 4, conforming to histolo gical diagnosis standard of liver cirrhosis, while the fibrosis score value i n the control group is (1.67±1.16)With regard to the inflammatory and necrosis score value of Knodell scori ng system from each team, the overall score value in DPG (14.56±3.16) was th e greatest, while in CPPG(13.8±3.17), CPCG(13.48±3.79) and CHG(9.00±4.34) decreased gradually and slightly and in NLDG(8.36±4.18) decreased obviously; The score value of the interface and bridging inflammation got the highest va lue in DPG(8.81±2.17), while in CPCG(8.07±2.46), CPPG(6.85±2.85) and NLDG (4.73±3.17) decreased gradually and slightly and in CHG(4.50±3.39) decrea sed obviously; The score value of the lobular inflammation in CPCG(3.15±1.04) was the greatest, while in DPG(2.50±1.27), CPCG(2.30±1.41) and CHG(1.67±1.03) decreased gradually and slightly and in NLDG(1.36±0.81) decreased obv iously; The score value of the portal inflammation in CPPG(3.80±0.41) got t he highest value, While in DPG(3.25±0.76), CPCG(3.11±1.12) and CHG(2.83±0.9 8) decreased gradually and slightly and in NLDG(2.27±1.27) decreased obvious ly.With regard to Knodell score value of TCM syndrome differentiation types in liver cirrhosis group, the overall score value of liver inflammation got t he highest value in the distribution of TCMS of "hepatic and renal yin defici ency(HRYD)" (15±4.36), While in the distribution of TCMS of " stagnation of fluid-dampness (SFD) " (14.86±2.48), "obstruction of collaterals by blood st asis(OCBS)" (13.33±3.97), "depression of liver-QI(DOL-QI) " (12.72±4.03)and "endoretention of damp heat(ERDH)" (10.81±4.76) decreased gradually and slig htly and in the distribution of TCMS of "asdthenic splenonephro-yang(ASN-yan g) "下载MP3 (8.00±0.00) decreased obviously; The score value of Interface a nd bridging inflammation got the highest value in the distribution of TCMS of "endoretention of damp heat(ERDH)" (9.33±1.63), While in the distribution o f TCMS of "hepatic and renal yin deficiency (HRYD) " (8.33±2.89), "obstructio n of collaterals by blood stasis (OCBS) " (7.96±2.48), " stagnation of fluid-d ampness(SFD)" (7.71±2.93)and "depression of liver-QI(DOL-QI) " (7.57±2.79) decreased gradually and slightly and in the distribution of TCMS of "asdtheni c splenonephro-yang(ASN-yang) " (4.00±0.00) decreased obviously; The score val ue of the lobular inflammation in the distribution of TCMS of " stagnation of fluid-dampness (SFD) " (3.57±0.53) got the highest value, while in the distri bution of TCMS of "hepatic and renal yin deficiency (HRYD) " (2.67±1.53), "de pression of liver-QI(DOL-QI) " (2.61±1.21), "endoretention of damp heat(ERDH) " (2.17±1.33)and "obstruction of collaterals by blood stasis(OCBS) " (2.52 ±1.41) decreased gradually and slightly and in the distribution of TCMS of " asdthenic spl enonephro-yang (ASN-yang) " (1.00±0.00) decreased obviously; The score value of portal inflammation in the distribution of TCMS "hepatic and re nal yin deficiency (HRYD) " (4.00±0.00) got the highest value, while in the di stribution of TCMS " stagnation of fluid-dampness(SFD) " (3.57±0.53), "depre ssion of liver-QI(DOL-QI) " (3.52±0.89), "obstruction of collaterals by bloo d stasis(OCBS) " (3.10±1.04) and "asdthenic splenonephro-yang (ASN-yang) " (3. 00±0.00) decreased gradually and slightly and "endoretention of damp heat(ER DH) " (2.83±0.98) decreased obviously; The overall score value of liver infl ammation, Interface and bridging inflammation, lobular inflammation as well as portal inflammation distributed closely similar to the above results in TCM syndrome differentiation types in liver cirrhosis group.Conclusion1,The fibrosis scores in each group that contains the new CPPG of liver cirrhosis conform to fibrosis histological diagnostic criteria which proves th e accuracy of the group method.2,The results in the study indicate that in DPG, the Interface inflammati on and bridging necrosis tends to be severer; In CPPG, the lobular inflammatio n and portal inflammation tends to be severer; In CPCG and CHG, the inflammat ion still exists.3,The results in the study also indicate that if patients in liver cirrho sis group present clinical_symptoms of ERDH, it reflects the more obvious of I nterface inflammation and bridging necrosis and indicates the obvious inflamma tory activity in these patients. If patients present clinical symptoms of HRYD,it reflects they may be in an advanced stage and if they present clinical sy mptoms of SFD, DOL-QI, there may be a various degree of inflammation.