TCM constitution distribution and clinical features of patients with hepatitis B cirrhosis and dysplastic nodules / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the characteristics of TCM constitution distribution in hepatitis B cirrhosis patients with dysplastic nodules （DN）， and to provide a basis for the prevention and treatment of precancerous lesions of liver cancer. MethodsThis study was conducted among 113 hepatitis B cirrhosis patients with DN， 105 hepatitis B cirrhosis patients with regenerative nodules （RN）， and 70 hepatitis B cirrhosis patients with small hepatocellular carcinoma （sHCC） who were hospitalized in Guangdong Provincial Hospital of Traditional Chinese Medicine from May 2015 to March 2023. Related data were collected， including age， sex， liver function Child-Pugh class， TCM constitution type， and laboratory markers. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups； the chi-square test was used for comparison of categorical data between groups， and the Bonferroni correction method was used for further comparison between two groups. ResultsThe main TCM constitution types of hepatitis B cirrhosis patients with DN were Qi-deficiency constitution （27 patients， 23.89%）， blood-stasis constitution （26 patients， 23.01%）， and phlegm-dampness constitution （23 patients， 20.35%）. There were significant differences between the three groups in the proportion of patients with phlegm-dampness constitution or damp-heat constitution （χ2=6.822 and 6.383， both P<0.05）； the hepatitis B cirrhosis patients with RN had the highest proportion of patients with phlegm-dampness constitution （30.48%）， followed by those with DN （20.35%） and those with sHCC （14.29%）， while the hepatitis B cirrhosis patients with sHCC had the highest proportion of patients with damp-heat constitution （27.14%）， followed by those with DN （16.81%） and those with RN （12.38%）. There were significant differences between the hepatitis B cirrhosis DN patients with different TCM constitution types in sex， age， Child-Pugh class， prealbumin， albumin （Alb）， aspartate aminotransferase， total bilirubin （TBil）， total bile acid， and alpha-fetoprotein （all P<0.05）. Compared with the male hepatitis B cirrhosis DN patients， female patients showed a significantly higher proportion of patients with Qi-deficiency constitution （χ2=4.895， P=0.027）. Among the patients with Qi-deficiency constitution， the patients with Child-Pugh class A liver function accounted for a significantly lower proportion than those with Child-Pugh class B liver function （χ2=6.380， P=0.012）， while among the patients with phlegm-dampness constitution， the patients with Child-Pugh class A liver function accounted for a significantly higher proportion than those with Child-Pugh class B liver function （χ2=8.515， P=0.004）. The patients with phlegm-dampness constitution had significantly higher levels of prealbumin and Alb than those with the other four constitutions （all P<0.05）， as well as significantly lower levels of TBil and total bile acid than those with damp-heat constitution （P<0.05）； the patients with Yin-deficiency constitution had a significantly lower level of Alb than those with qi-deficiency constitution， blood-stasis constitution， or phlegm-dampness constitution （all P<0.05）； the patients with Yin-deficiency constitution had a significantly lower proportion of patients with abnormal alpha-fetoprotein than those with non-Yin-deficiency constitutions （χ2=4.448， P=0.035）. ConclusionHepatitis B cirrhosis patients with DN mainly have the TCM constitution types of Qi deficiency， blood stasis， and phlegm dampness. The patients with phlegm-dampness constitution seem to have a low probability of carcinogenesis， while those with damp-heat constitution and Yin-deficiency constitution have a relatively high risk of carcinogenesis.