关键词: 肝衰竭, 中医证型, 疾病分期, 临床预后

Abstract:

Objective: To explore the relation of TCM(Triditional Chinese medicine syndrome) type in traditional Chinese medicine with liver failure staging in Western medicine in the patients with liver failure, and analyze the corresponding laboratory indicators and prognostic characteristics of the patients with different TCM syndrome type, and provide reference to treat liver failure through integrated traditional Chinese medicine and Western medicine. Methods: A total of 165 patients with liver failure were enrolled. Basic information of the patients was collected and the patients were divided into prophase, early stage, middle stage and late stage according to the severity of liver failure. The distribution of TCM syndrome types and their clinical manifestations, serological indicators and prognosis were analyzed. Results: In 165 inpatients with liver failure, there were four syndrome types, including liver depression and spleen deficiency, damp-heat accumulation, liver and kidney Yin deficiency, blood stasis and collateral obstruction. Among them, 81 cases belonged to the type of liver depression and spleen deficiency(49.09%). Hepatitis B virus(HBV) infection was the main cause for liver failure, accounting for 70% (65% combined with cirrhosis). In all patients with liver failure, there were 26 cases in the prophase, 87 cases in the early stage, 31 cases in the middle stage and 21 cases in the late stage. In the prophase stage of liver failure, 53.84% cases showed liver depression and spleen deficiency (14/26). 56.32% cases had liver depression and spleen deficiency (49/87) In the early stage of liver failure, and 38.71% cases in the middle stage of liver failure showed liver depression and spleen deficiency (12/31) and 38.71% cases had damp-heat accumulation (12/31). 52.38% patients with advanced liver failure belonged to in damp-heat accumulation type (11/21). The type of liver depression and spleen deficiency had the best prognosis, and the clinical improvement rate was more than 80%. While the type of liver and kidney Yin deficiency had the worst prognosis, and the proportion of clinical deterioration was 50%. Compared with the liver and kidney Yin deficiency type, the clinical improvement rate of damp-heat accumulation type blood stasis and collateral obstruction type were better and their improvement rate were over 50%, while alanine transaminase(ALT）[(655.0±143.4) IU/L] and aspartate transaminase（AST）[(504.0±117.7) IU/L] in the type of damp-heat accumulation were significantly higher than those in other syndrome types (P<0.05). In liver-kidney Yin deficiency type, prothrombin time[(PT)(21.57±0.95) s] was significantly prolonged (P<0.05), and total bilirubin (TBil)[(307.5±33.00) μmol/L] was significantly higher than that in other syndrome types (P<0.05). Conclusions: There was no difference in TCM syndrome type distribution among different stages of liver failure. Among the patients with liver failure, the proportion of liver depression and spleen deficiency was the highest, which had the best prognosis (clinical improvement rate over 80%). While the patients with liver and kidney Yin deficiency showed the worst prognosis (clinical deterioration rate accounted for 50%). However, the biochemical indexes of liver function of damp-heat accumulation type were worse than those of other syndromes,.

Key words: Liver failure, :Triditional Chinese medicine syndrome, Disease staging, Clinical prognosis