Analysis Of Prognostic Factors Of Minimal Hepatic Encephalopathy And Discussion On Differentiation Of Syndromes And Treatment Of Traditional Chinese Medicine

Objective:Through the retrospective cohort study,to explore the prognostic factors for minimal hepatic encephalopathy(MHE),so as to provide a reference for early diagnosis,treatment and prognosis of MHE.And discussed the minimal hepatic encephalopathy of treatment with syndrome differentiation of Traditional Chinese medicine(TCM),in order to improve the clinical curative effect of MHE.Methods:(1)108 patients who developed liver cirrhosis minimal hepatic encephalopathy and hosptitalized in the first affiliated hospital of guangxi university of Chinses medicine between July 2016 and July 2018 were included in the study.A retrospective cohort study was conducted,with the date of diagnosis of MHE as the starting point for follow-up,followed up by telephone or readmission in the hospital to understand the patient's survival.The end point of the follow-up was death or loss of the patients,and the time was up to January 31,2019.At the same time,clinical datas,auxiliary examination and other relevant indicators of the MHE patients were collected.Cox proportional risk model was used to analyze the survival of MHE patients,and relevant factors affecting the prognosis of MHE were screened out for analysis.(2)A total of 108 patients with liver cirrhosis complicated with MHE were included in the discussion of TCM syndrome differentiation,In the control group,57 patients were treated with oraling lactulose on the basic of western medicine comprehensive treatment,such as a low-protein diet and composite coenzyme to protect liver,In the treatment group,51 cases were treated with TCM syndrome differentiation on the basis of western medicine comprehensive treatment.The TCM syndrome differentiation and classification of MHE was refered to the TCM syndrome differentiation and classification of cirrhosis according to the opinions of the consensus on the diagnosis and treatment of cirrhosis with integrated Chinese and western medicine.Mainly common TCM syndrome differentiationn with MHE were choosed.There were 25 cases of stagnation of liver qi syndrome,19 cases of dampness-heat syndrome,13 cases of blood stasis syndrome in the control group.In the treatment group,24 cases of stagnation of liver qi syndrome,15 cases of dampness-heat syndrome,12 cases of blood stasis syndrome were choosed.Before and after treatment with changes of NCT-A,DST,Child-pugh grading and TCM syndrome score between the control group and the treatment group were compared.Finally,evaluating the clinical curative effective of two groups treatment.Results:(1)Through Cox regression analysis,4 indicators with statistical significance were selected as NCT-A?Child–pugh grading,infection,treatment.Log Rank test was used to compare the survival rate of the two groups,the results showed that the survival rate of the TCM treatment group was higher than that of the control group.(2)In this TCM syndrome differentiation discussing,the control group had marked effect of 18 cases,improvement of 22 cases,invalid of 17 cases,the total effective rate was70.1%.while the treatment group had marked effective of 19 cases,improvement of 25 cases,ineffective of 7 cases,the total effective rate was86.2%.Chi-square test is calculated,?~2=4.04,P=0.04<0.05,the difference was statistically significant(P<0.05).Before and after treatment,the indicators of NCT-A,DST,Child-pugh grading and TCM syndrome score were compared between the control group and the treatment group.In the terms of TCM syndrome differentiation score,the results showed that the therapeutic effect of the treatment group was better than control group,and the difference was statistically significant(P<0.05).In terms of Child-pugh grading,the curative effect was nearly the same as that of the two group(P>0.05).In terms of the NCT-A and DST,the improvement of stagnation of liver qi syndrome and blood stasis syndrome group in the TCM syndrome differentiation was better than lactulose group(P<0.05),the curative effect between two group was nearly the same as that of the dampness-heat syndrome(P>0.05).Conclusion:(1)Cox proportional risk model was used to analyze the prognostic factors of patients with liver cirrhosis complicated with MHE,and NCT–A,Child-pugh grading,infection and treatment were selected as independent prognostic factors of MHE.(2)The treatment with TCM syndrome differentiation of MHE total effective rate was higher than the lactulose group.The effect of TCM syndrome differentiation group on improving syndrome integral of MHE was better than lactulose.In reducing Child-pugh grading score,the curative effect was nearly the same as that of the two group.In terms of shortening NCT-A time and improving DST score,the curative effect of liver-qi stagnation and blood stasis syndrome was better than lactulose group,and the curative effect of damp-heat syndrome was similar to lactose group.