Correlation Analysis Between TCM Syndrome Types And Different Titers Of TRAb In Newly Diagnosed Graves' Disease With Liver Damag

Purpose:By analyzing the correlation between various indexes of liver function and different titers of thyroid hormone receptor antibodies（TRAb）in newly diagnosed diffuse toxic goiter（GD）patients with liver damage,we hope to provide a basis for the prevention and diagnosis of GD patients with liver damage.At the same time,by analyzing the distribution characteristics of traditional Chinese medicine syndrome types and the correlation between traditional Chinese medicine syndrome types and TRAb in newly diagnosed GD patients with liver damage,we aim to provide a new clinical approach for the treatment of GD patients with liver damage through the combination of traditional Chinese and Western medicine.Material and method:We selected patients with GD and liver damage who met the inclusion criteria and were diagnosed for the first time at the Endocrinology Clinic of Liaoning University of Traditional Chinese Medicine Affiliated Hospital from May 2021 to December 2022 as the study population.Collect the gender and age of patients.Venous blood was drawn on an empty stomach in the morning and serological physical and chemical indexes were detected,including:alkaline phosphatase（ALP）,glutamyl transpeptidase（GGT）,alanine transaminase（ALT）,aspartate transaminase（AST）,total bilirubin（TBIL）,direct bilirubin（DBIL）Indirect bilirubin（IBIL）,free triiodothyronine（FT₃）,free thyroid hormone（FT₄）,thyroid hormone（TSH）,anti-thyroid autoantibodies（TGAb）,Thyroid peroxidase antibody（TPOAb）,TRAb and other physical and chemical indicators;Collect detailed information on the four diagnostic methods of traditional Chinese medicine,determine the types of traditional Chinese medicine syndromes,and input the collected general information,physical and chemical indicators,and other information into an Excel table.Apply SPSS26.0statistical software for analysis,and use K-S test for data normality.The measurement data conforming to the normal distribution is expressed as mean±standard deviation（（?）±S）,and the measurement data not conforming to the normal distribution is expressed as median（quartile）[M(P₂₅,P₇₅)].The t test is used for meeting the normal distribution between two groups,and the variance analysis is used for meeting the normal distribution between multiple groups,and the nonparametric test is used for failing to meet the requirements;The counting data is represented by composition ratio and percentage（n,%）,usingχ²Inspection;Pearson test is used for those who conform to normal distribution in correlation analysis,and Spearman test is used for those who do not conform to normal distribution;Risk factor analysis was conducted using logistic regression,with OR values and 95%confidence intervals recorded;Confirm the accuracy of predicting ALP increase by increasing TRAb titer through ROC curve.The difference is statistically significant when P<0.05.Results:1.General situation of GD patients with liver damageThis study included a total of 212 patients with GD accompanied by liver damage,including 42 males（19.8%）and 170 females（80.2%）,with an average age of 39.09 years.2.Distribution of Traditional Chinese Medicine Syndrome Types in Patients with GD Complicated with Liver DamageThe distribution of five types of syndromes in patients with GD accompanied by liver damage,from most to least,is as follows:Qi and Yin deficiency syndrome（35%）>Liver depression and spleen deficiency syndrome（27%）>Liver fire hyperactivity syndrome（23%）>Qi stagnation and phlegm coagulation syndrome（12%）>Heart liver yin deficiency syndrome（3%）.3.Comparison of clinical indicators in patients with GD accompanied by liver damage（1）212 patients with GD accompanied by liver damage were divided into three groups according to TRAb titer,namely the low titer group[1.75≤TRAb（IU/L）<10.0],the medium titer group[10.0≤TRAb（IU/L）<30.0],and the high titer group[TRAb（IU/L）≥30.0].After testing,there was a statistical difference in the age mean distribution of patients with different TRAb titers（P<0.05）,and there was a significant statistical difference in the FT₃mean distribution of patients with different TRAb titers（P<0.01）;There was a significant statistical difference in the mean distribution of FT₄among patients with different TRAb titers（P<0.01）;There were statistical differences in the mean distribution of ALP among patients with different TRAb titers（P<0.05）.（2）In patients with GD accompanied by liver damage,elevated ALT is the most common,accounting for about 73%,followed by GGT,accounting for about 38%.（3）Spearman correlation analysis showed that TRAb titer was positively correlated with ALP,with a significant statistical difference（P<0.01）.（4）Logistic regression analysis of TRAb and ALP levels:Using whether the ALP indicators are abnormal as the dependent variable and TRAb,FT₃,FT₄,gender,age,GGT,ALT,AST,TBIL,DBIL,IBIL as the independent variables,binary logistic regression analysis was conducted.The results showed that ALP increased with the increase of TRAb titer,and the difference was statistically significant（P<0.01）.After controlling for factors such as FT₃,FT₄,gender,age,GGT,ALT,AST,TBIL,DBIL,IBIL,etc,Analysis still shows an association between elevated ALP and TRAb.（5）The ROC curve was used to confirm the prediction of abnormal elevation of ALP by TRAb titer level.Sensitivity and specificity calculations showed that when TRAb≥18.33IU/L,the risk of ALP elevation increased.4.Comparison of Traditional Chinese Medicine Syndrome Types and Clinical Indicators in Patients with GD Complicated with Liver Damage（1）Through non parametric rank sum test analysis,it was found that there was a significant statistical difference in the overall distribution of TRAb among different traditional Chinese medicine syndrome types（P<0.01）.The comparison of TRAb levels among different traditional Chinese medicine syndrome types from high to low was as follows:Qi Yin deficiency syndrome>Heart liver Yin deficiency syndrome>Liver stagnation and spleen deficiency syndrome>Liver fire hyperactivity syndrome>Qi stagnation and phlegm coagulation syndrome.（2）Through non parametric rank sum test analysis,it was found that there was a significant statistical difference in the overall distribution of ALP among different traditional Chinese medicine syndrome types（P<0.01）.The comparison of ALP levels among different traditional Chinese medicine syndrome types from high to low was as follows:Qi Yin deficiency syndrome>Heart liver Yin deficiency syndrome>Liver stagnation and spleen deficiency syndrome>Liver fire hyperactivity syndrome>Qi stagnation and phlegm coagulation syndrome.Conclusion:1.Qi and Yin deficiency syndrome,liver stagnation and spleen deficiency syndrome,and liver fire hyperactivity syndrome are the main traditional Chinese medicine syndromes of GD with liver damage.In clinical practice,attention should be paid to the application of treatment methods such as supplementing qi and nourishing yin,soothing liver and strengthening spleen,and clearing liver and purging fire.2.TRAb may be a contributing factor to the elevation of ALP,especially when TRAb is≥18.33IU/L,which suggests paying attention to the liver function indicators of patients in clinical practice.3.The comparison of TRAb among different traditional Chinese medicine syndrome types,from high to low,is as follows:Qi Yin deficiency syndrome>Heart liver Yin deficiency syndrome>Liver depression spleen deficiency syndrome>Liver fire hyperactivity syndrome>Qi stagnation phlegm coagulation syndrome.This suggests that with the increase of TRAb,GD accompanied by liver damage is more common in the distribution of traditional Chinese medicine syndrome types.