A Retrospective Real-world Cohort Study Of Chronic Hepatitis B Intervention With Integrated Traditional Chinese And Western Medicine

Objective:Based on real-world research methods,this study explored the differences in the incidence of liver cirrhosis and liver cancer and clinical efficacy in patients with chronic hepatitis B under the intervention of integrated traditional Chinese and western medicine,and explored related influencing factors for the occurrence of liver cirrhosis and liver cancer in patients with chronic hepatitis B.Methods:Based on real-world research methods,a retrospective cohort study was adopted,and 175 patients who were initially started antiviral treatment at the liver disease research clinic of Hubei Provincial Hospital of Traditional Chinese Medicine from June 2012 to August 2016 and have been followed up for a long time are the research objects.According to the different degree of exposure of patients to traditional Chinese medicine,they are divided into integrated traditional Chinese and western medicine group（120 cases）and western medicine group（55 cases）.Month as the end point of observation.Standardized and retrospective collection of clinical data from patients’initial diagnosis to the end of observation.Statistical analysis was performed using SPSS 26.0 to compare the incidence of liver cirrhosis,liver cancer,HBV DNA negative conversion rate,and liver function recovery in the two cohorts.It analyzes the related risk factors of liver cirrhosis and liver cancer,and explores the effect of integrated traditional Chinese and Western medicine on delaying the occurrence of liver cirrhosis and liver cancer.Results:（1）The median follow-up time of the integrated traditional Chinese and western medicine group was 5.79 years,and the median follow-up time of the western medicine group was 6.15years.By the end of the study,the cumulative incidence of liver cirrhosis was 3.33%in the integrated traditional Chinese and western medicine treatment group and 12.73%in the western medicine group.There was a statistical difference between the two groups（P=0.017）.The cumulative incidence of liver cancer was 0.83%in the integrated traditional Chinese and western medicine treatment group and 7.27%in the western medicine group.There was a statistical difference between the two groups（P=0.018）.（2）The Kaplan-Meier survival analysis method was used to analyze the cumulative incidence of liver cirrhosis and liver cancer in the two groups.The cumulative incidence of liver cirrhosis and liver cancer in the integrated traditional Chinese and Western medicine treatment group was lower than that in the western medicine group,and the Log Rank test was statistically different.(P _{liver cirrhosis}=0.023,P _{liver cancer}=0.017).（3）Using the Cox proportional hazards model to analyze the risk of liver cirrhosis in patients with chronic hepatitis B by multivariate analysis,HBe Ag was positive at baseline（HR=5.85,95%CI:1.13-30.35,P=0.035）,Drinking alcohol（HR=9.56,95%CI:1.50-60.85,P=0.017）is a risk factor for liver cirrhosis,and integrated traditional Chinese and Western medicine treatment（HR=0.17,95%CI:0.04-0.77,P=0.021）is a risk factor for liver cirrhosis.Hardening protective factor.High-level AFP（HR=9.64,95%CI:1.29-72.30,P=0.027）is a risk factor for liver cancer;combined treatment of traditional Chinese medicine may be a potential protective factor for liver cancer（HR=0.108,95%CI:0.011-1.040,P=0.054）,but it is not statistically significant（P=0.054）.（4）Integrated Chinese and Western medicine treatment can significantly reduce the level of HBV DNA,improve the liver function（ALT,AST,TBIL,DBIL,etc.）,AFP level,with statistical significance before and after comparison（P<0.05）,but there is no statistical difference compared with the western medicine group（P>0.05）.Conclusion:（1）The treatment of chronic hepatitis B with integrated traditional Chinese and western medicine can reduce the incidence of liver cirrhosis and liver cancer.（2）Multivariate analysis shows that HBe Ag positive and alcohol consumption at baseline are risk factors for liver cirrhosis,and the use of integrated traditional Chinese and western medicine is a protective factor for liver cirrhosis;high levels of AFP are risk factors for liver cancer.（3）Integrated traditional Chinese and western medicine treatment can significantly reduce the patient’s HBV DNA level,promote virological response,improve liver function（ALT,AST,TBIL,DBIL,etc.）,AFP level,but there is no significant difference compared with the western medicine group（P>0.05）...