A Study On The Correlation Between Elements Of TCM Pattern In Different Periods Of Cirrhosis And Histological Scoring Of Ishak Scoring System

BackgroundCirrhosis is the basis of extensive necrosis in the liver cells to generate diffuse fibrous tissue hyperplasia, and lobular formation of regenerative nodules and false, causing the normal structure of hepatic lobules and vascular supply disruption, chronic liver disease. Cirrhosis is a Chinese medicine "hypochondriac pain, " "bloating, " "single abdominal distension," "disease positive" and other disease areas. Lesions gradually progress, advanced stage liver failure, portal hypertension and a variety of complications, mortality high, Therefore, cirrhosis of the liver has become a serious social and medical issues, and focus of medical workers in a national. With the laparoscopic technology is increasingly mature, using it to carry out morphological examination of the liver in the early diagnosis of liver cirrhosis have a distinct advantage (In particular, the morphology can be found out but the clinical diagnostic criteria can not yet confirmed the clinical diagnosis of early cirrhosis of the liver cirrhosis).Therefore it is necessary to apply morphology, the liver's "gold standard" diagnostic tool to study the liver cirrhosis. TCM has its unique characteristics of liver cirrhosis, previous experiences show that many traditional Chinese medicine diagnosis and treatment of cirrhosis of the liver are good harvest of treatment, but Chinese medicine diagnosis and treatment are lack of sufficient evidence to support modern evidence-based medicine.Objective The study is to explore the correlation between elements of TCM pattern in different groups of periods of cirrhosis (compensatory period of pre-clinical group (CPPG), compensated period of clinical group (CPCG) and decompensated period group (DPG)) and histological scoring of Ishak system.MethodsBased on clinical epidemiological survey research methods, researching subjects were divided into three groups:80 cases in liver cirrhosis group (23 cases in CPPG,39 cases in CPCG,18 cases in DPG) and 11 cases in non-liver disease group (NLDG),10 cases in chronic hepatitis group (CHG),101 cases in total.Both clinical and diagnostic data for clinical diagnosis were recorded on Case Record Form(CRF), liver tissues were got through laparotomy or laparoscope, fixed with 10% formalin, embedded with paraffin, sliced serially, stained with HE and AgNOR., and then scored with Knodell scoring system by Jinyu medical 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 use descriptive statistics method, aχ2 test were used for evaluating ratio or constituent ratio data, a t-test is used for measurement data with mean±standard deviation; Rank sum test were used to deal with the data of non-normal distribution, the test level a is=0.05.ResultsWith regard to general information, sex and age factors of patients included in this study have been tested to have no influence over the results.With regard to histological scoring of Ishak system in each group, grade A score in DPG (3.17±0.71) is the largest and CPCG (3.00±0.69) followed by, CHG(2.60±1.27) significantly lower;Grade B score in DPG (1.89±1.08) is the highest,CPCG (1.79±0.93) followed by,CHG (1.50±0.53) significantly lower; Grade C score in DPG (1.89±0.68) is the largest and CPPG (1.87±0.63) followed by, NLDG(1.55±0.52) significantly lower; Grade D score in DPG (1.89±0.76) is the largest and CPPG (1.87±0.82) followed by, CHG (1.40±0.52) significantly lower;Grading score in DPG (8.83±2.01) is the largest, CPPG (8.17±2.29) and CPCG (8.13±2.25) slightly reduced gradually, NLDG (7.64 ±1.03) and CHG (7.30±1.77) is significantly lower;The stage score in CPCG (5.95±0.22) is the largest, DPG (5.72±0.83) and CPPG (5.52±1.00) slightly reduced gradually, NLDG (4.00±0.78) and CHG (4.00±1.94) is significantly reduced.With regard to Ishak score of the elements of TCM pattern in CPPG, grade A score in the " Spleen Deficiency " (2.79±0.70) is the largest, followed by the " DAMP " (2.78±1.09); Grade B score in the " Heatness " (2.00±1.27) is the largest, followed by the " DAMP " (1.78±1.09);Grade C score in the " DAMP " (2.11±0.60) is the largest, followed by the the " Heatness " (2.00±0.89);Grade D score in the " Heatness " (2.50±1.05) is the largest, followed by the " DAMP " (2.11±1.05); Grading score in the " Heatness " (9.17±3.82) is the largest, followed by the " DAMP " (8.78±3.11);The staging score in the " Blood-stasis " (5.53±1.02) is the largest, in the "Depression " (5.47±1.13), " DAMP " (5.44±0.88), " Spleen Deficiency " (5.43±1.16), " Heatness " (5.33±1.03) gradually reduced.With regard to Ishak score of the elements of TCM pattern in CPCG, grade A score in the " Heatness " (3.13±0.64) is the largest, followed by the " Blood-stasis " (3.07±0.74); Grade B score in the " Heatness " (2.00±1.31) is the largest, followed by the " DAMP " (1.80±0.91)=" Blood-stasis " (1.80±1.10); Grade C score in the " Heatness " (2.00±0.54) is the most obvious;Grade D score in the " Heatness " (1.88±0.99) is the most obvious; Grading score in the " Heatness " (9.00±2.93) is the largest, followed by the " Blood-stasis " (8.27±2.52); The staging score in the " Spleen Deficiency "= " Depression " (6.00±0.00) is the largest, followed by the " Blood-stasis " (5.93±0.25), " DAMP " (5.92±0.28), " Heatness " (5.75±0.46) gradually reduced.With regard to Ishak score of the elements of TCM pattern in DPG, grade A score in the " Depression " (3.50±0.54) is the largest, followed by the " Spleen Deficiency " (3.25±0.75) and " Blood-stasis " (3.21±0.70); Grade B score in the " Spleen Deficiency " (2.08±1.17) is the largest, followed by the " DAMP " (2.00±1.10) and " Depression " (2.00±1.07); Grade C score in the " Blood-stasis " (2.00±0.68)=" Depression " (2.00±0.76) is the largest, followed by the " DAMP " (1.91±0.70);Grade D score in the " Spleen Deficiency " (2.17±0.58) is the largest, followed by the " Depression " (2.13±0.84) and " Yin-deficiency " (2.00±0.00);Grading score in the " Depression " (9.63±2.39) is the largest, followed by the " Spleen Deficiency " (9.25±2.14) and " DAMP " (8.91±2.07); The staging score in the " Yin-deficiency "= " DAMP "= " Heatness " (6.00±0.00) is the largest, in the " Spleen Deficiency " (5.83±0.58), " Blood-stasis" (5.79±0.80) and " Depression " (5.63±1.06) gradually reduced.ConclusionWith the Comparison of other groups, the liver damage in DPG is the most obvious, mainly to the inflammation and necrosis heavier; In CPPG and CPCG, the "Heatness " or " DAMP " of the elements of TCM pattern appear to reflect the most significant degree of liver damage, inflammation, severe necrosis, active inflammation in the liver, These two factors may be associated with Deterioration of liver cirrhosis and may be precipitated by factors of one of cirrhosis of the liver;In DPG, actual situation mixed, The appearance of the" Depression ", " Spleen Deficiency " and " Blood-stasis " can also obviously reflect the degree of liver inflammation and necrosis.The Stage score of liver cirrhosis group was significantly higher than scores of CHG and NLDG, consistent with cirrhosis score standards; Prolonged course in patients with cirrhosis, mixed with the actual situation, the emergence of elements of the syndrome may be prompted to heavy fibrosis.