| Hepatitis B liver cirrhosis is a chronic, progressive, and diffuse liver disease caused by chronic hepatitis B virus damage to the liver. Clinically Cirrhosis were divided into compensatory and decompensated period according to the severity of the disease in clinical. Child-Pugh classification is an international classification standard for the status of liver function. According to the inflammatory activity of the liver, the liver cirrhosis can be divided into active phase and stationary phase.Hepatitis B cirrhosis generally belongs to the category of disease. Chinese medicine "hypochondriac pain", "accumulation", "swelling" and its pathogenesis is complex, syndrome is more than the actual mixture.According to the prophase research, hepatitis B cirrhosis of disease of syndrome elements to sum up mainly blood stasis, yin deficiency, damp heat, qi stagnation, qi deficiency, Yang deficiency, water stop. Therefore, it will be a simple function to study the liver cirrhosis of hepatitis B from the syndrome elements of the disease.Hypothalamic pituitary adrenal axis (HPA or HTPA axis) is the main neuroendocrine system of stress response. The main regulating substance of the HPA axis is the GC, ACTH, and hypothalamic secretion of CRH, which is secreted by the adrenal cortex.There is a very close relationship between the liver and the endocrine system. Liver cirrhosis can lead to changes in endocrine hormones, this study mainly discusses the correlation between hormone levels of HPA axis and the common symptoms of disease in patients with hepatitis cirrhosis and the effect of traditional Chinese medicine intervention on the.Objective:1 To investigate the correlation between serum ACTH and GC with common TCM syndrome elements of patients with hepatitis B cirrhosis2 Observe the effect of traditional Chinese medicine intervention on the serum CRH, ACTH and GC levels of the patients with compensated hepatitis B cirrhosisMethod:This study was based on the 973 project "the mechanism of action of liver cirrhosis and the rule of syndrome and treatment". Topic is divided into two parts. The first part is a national multi center cross-sectional epidemiological survey; the second part is clinical intervention study and research group based on blood stored in the liver controlling dispersion theory, set up to "replenishing qi to invigorate the spleen, soothing the liver and regulating the circulation of Qi, Ruan jian Tong luo rule, principle of a group of drugs, to" replenishing qi to invigorate the spleen, soothing the liver and regulating the circulation of Qi, Ruanjian Tongluo, nourishing yin Rou Gan rule, principle of group B of drugs and simulation group B drug simulation agent C, respectively were randomly divided into 3 groups of decompensated hepatitis B cirrhosis patients were for a period of 6 months of intervention.1 The research is divided into two parts. The first part is a cross-sectional epidemiological survey method of prospective multi center. We take the hepatitis B cirrhosis patients as the research object who comply with strict diagnosis, inclusion and exclusion standard.Collecting the patient’s general condition information, symptoms, characteristics and detection of serum ACTH and GC index and the patients were grouped according to the severity of liver cirrhosis clinical classification system and the actual needs; We determined the patient’s TCM syndrome elements based on the research expert consensus standard named ’Identification Standard for the Common Syndrome Elements of Liver Cirrhosis".2 The second part is the method of clinical epidemiology investigation by using the clinical multi center, randomized, blind and control. During the period from December 2013 to January 2015,144 patients with chronic hepatitis B and liver cirrhosis were collected according to the strict diagnosis, inclusion and exclusion criteria. Patients were from the integrated traditional Chinese and Western medicine diagnosis and Research Center of the 302th hospital of the Chinese People Liberation Army(Center 1), the department of integrated traditional Chinese and Western medicine liver disease in Beijing Ditan Hospital Affiliated to Capital University of Medical Sciences(Center 2) and the department of liver diseases in the China Academy of Chinese Medical Sciences Xiyuan Hospital(Center 3) Outpatient and ward patients. The 144 patients were randomly divided into 3 groups. All the groups of patients adopt the treatment of Western Medicine (nucleoside antiviral drugs) as the foundation treatment. Then the 3 groups of patients were given the A, B,C group of drugs respectively for a period of 6 months of intervention. Before and after the treatment, the serum levels of CRH, ACTH and GC were detected. To observe the effect of traditional Chinese medicine intervention on the serum levels of CRH, ACTH and GC in patients with compensated cirrhosis。This study used statistical software of the IBM SPSS Statistics 20.0, according to different types of data to select the appropriate statistical analysis methods (including t-test, chi-square test, nonparametric test, etc.).Result:1 General information The first Part:A total of 688 patients with hepatitis B cirrhosis were collected and the patients were analyzed respectively whose serum ACTH and GC value were measured. Measured ACTH level of patients with a total of 618 cases, which 463 male patients,155 cases of female; 227 cases of compensated, decompensated 391; 232 cases of child-Pugh A group, Child-B level of 249 cases, Child-C 137; active 478 cases, quiescent 140 cases.615 cases of GC measured values of patients, including 153 cases of male, female 462 cases; 227 cases of compensated and decompensated 388 Cases; Child-232 cases of Grade A, 248 cases of grade Child-B, Child-C grade 135 cases; 475 patients in active phase and 140 cases in stationary phase. The second part:A total of 144 cases of patients with compensated liver cirrhosis were collected. The patients were analyzed respectively whose serum GC, ACTH and CRH were measured in both of the before and after of the treatmentPatients measured GC value of 132 patients with a mean age of (48.63±8.35) years, male 92 cases, female 40 cases; the treatment group A 42 cases, the treatment group B 46 cases,44 cases in simulant C group; activities of 50 Example, resting 82 cases. Patients measured ACTH value of 92, mean age (48.67±8.10) years, male 64 cases, female 28 cases; the treatment group A 29 cases, the treatment group B 30 cases and 33 cases in simulant C group; 37 cases in active phase and 55 cases in stationary phase. Patients measured CRH value of the total 75 cases, mean age (47.87±7.94) years, of which 54 cases of male, female 21 cases; the treatment group A 23 cases, the treatment group B 24 cases and 28 cases of group C; activities of 22 Example, resting 53 cases.2 Comparison of serum ACTH and GC levels in patients with different stages of hepatitis B cirrhosisThe level of serum ACTH:compensation period is greater than that of decompensated period, Child-A Group>Child-B Group>Child-C Group, activity period> rest period, and the difference between them was not significant (P> 0.05);Serum GC level:decompensated> compensatory, Child-C> Child-B> Child-A, activity period> rest period, and the difference between them were statistically significant (P< 0.05).3 The distribution of syndromes elements in different stages of hepatitis B patients with cirrhosis:The frequency of blood stasis, Qi deficiency, Yang deficiency, water retention syndrome elements in compensated was significantly higher than that of decompensated (P< 0.05); the frequency of blood stasis, dampness-heat, Qi deficiency, "Yang deficiency, water retention syndromes in Child-C group>Child-B>Child-A, and the differences has statistical significance (P< 0.05); the frequency of blood stasis, yin deficiency, Qi deficiency,Yang deficiency, water retention syndromes in active stag was significantly higher than that of stationary phase (P< 0.05).4 Comparison of serum ACTH and GC levels in patients hepatitis B cirrhosis of syndrome elements identified group and unidentified groupNot in stages (not divided the patients in groups based on different criterias, such as decompensated/compensated, Child-Pugh classification, static/active), overall:Serum ACTH level:the serum ACTH level in all identified groups except for the water retention group was higher than that of the unidentified group, with a significant higher level especially in the yin deficiency group and qi stagnation group (P<0.05).Serum GC level:the serum GC level in all identified groups was higher than that of the unidentified group, with a significant higher level especially in the blood stasis, qi deficiency, yang deficiency, and water retention group (P<0.05).Through various stages (compensatory/decompensated, Child-Pugh classification and static/active stage stratified), and then compare of serum ACTH and GC levels in patients hepatitis B cirrhosis of syndrome elements identified group and unidentified group. We found that the serum ACTH and GC level in the most of the syndrome elements identified group and unidentified group showing a opposite trend when the difference is large between the severity of the disease and the damage of the liver function, such as compensated with uncompensated, Child-Pugh A grade with Child-C grade, While the serum ACTH and GC level showed the same trend between the patients of syndrome identified group and unidentified group of the most of the syndrome elements when the severity was similar, such as compensatory with Child-A level, decompensated with Child-B, C-class and so on.5 Effects of traditional Chinese medicine on serum levels of GC, ACTH and CRH in patients with compensated liver cirrhosisAfter six months of traditional Chinese medicine intervention, the serum GC level of the A, B, C three groups of patients were significantly higher than that before intervention level (P< 0.05).The rate of the serum GC variation:group C> group B> group A, and the difference was not significant (P> 0.05). The change of serum GC in B group was the least; The rate of change of serum ACTH:group B> group A> group C, (P> 0.05), The growth rate of ACTH in B group were the largest; The change rate of serum CRH:group B> group A> group C, the difference was not statistically significant (P> 0.05), the growth rate of CRH of group B was slower than that of patients with group A.Conclusion1 With the severity of hepatitis B cirrhosis, the decrease of liver reserve function, the aggravation of liver inflammation activity, the level of serum GC showed an increasing trend, while the ACTH level showed a downward trend. It can be initially suggested that serum ACTH and GC levels in a certain extent can reflect the severity of liver cirrhosis, liver function damage and liver inflammation activity. With the aggravation of liver cirrhosis, the pathogenesis of the disease tends to be more complicated. And the preliminary results showed that the serum levels of ACTH and GC has certain correlation with common TCM syndrome elements of hepatitis B cirrhosis. There may be different pathological basis in the same TCM syndrome elements with different severity of disease, which need to be further studied in the future.2 Based on Chinese medicine intervention of decompensated liver cirrhosis patients with serum GC, ACTH, CRH levels influence study found to "replenishing qi to invigorate the spleen, soothing the liver and regulating the circulation of Qi, Ruanjian Tongluo" for the rule is a party, on the basis of Party A with "Ziyin Yangxue (Rou Gan)" drug B and placebo C on the patient’s serum GC, the effects of ACTH and CRH levels no statistical difference.Combined with hierarchical factors separate comparison of a and B both sides of decompensated liver cirrhosis patients with serum GC, ACTH and CRH effect trend differences, preliminary findings on the basis of Party A with "Ziyin Yangxue (Rou Gan)" drug B to male patients in active stage serum GC intervention effect to lower than a party; Party B for female patients, quiescent patients, male patients in active stage of serum ACTH intervention effect is lower than that of a party; Party B on the stationary phase in female patients serum CRH intervention effect is lower than that of party A.It suggest that face the complex pathogenesis of chronic hepatitis B with hepatic cirrhosis disease in clinic, to take full account of the disease at different stages (such as the resting stage and active stage, etc.) and the patient’s individual differences (such as male and female, etc.) caused by different pathological response and adjustment of medication. Follow the basic treatment principles of TCM syndrome differentiation. |
PDF Full Text Request