Distribution of Traditional Chinese Medicine patterns in 324 cases with hepatitis B-related acute-on-chronic liver failure: a prospective, cross-sectional survey

ObjectiveTo determine the distribution of Traditional Chinese Medicine (TCM) patterns in hepatitis B-related acute-on-chronic liver failure (HB-ACLF) in different stages for guiding clinical prescriptions and treatments.MethodsA prospective, cross-sectional survey method was used in this study. A total of 324 cases with HB-ACLF in China were involved.ResultsThe general frequency of TCM patterns in HB-ACLF were as follows: Heat Toxin Stagnation Pattern (134/324, 41.36%), Damp-heat Obstruction Pattern (66/324, 20.37%), Yang Qi Deficiency Pattern (52/324, 16.05%), and Liver and Kidney Yin Deficiency Pattern (26/324, 8.02%). In the early stage of HB-ACLF, there was a remarkably higher percentand late stage. The incidence of Heat Toxin Stagnation reached 58.57% (82/140) in the early stage, while it was 33.96% (36/106) in the middle stage and 20.51% (16/78) in the late stage. In the early stage of HB-ACLF, excessive patterns, such as the Heat Toxin Stagnation Pattern, were more prevalent than those in the middle and late stages (P<α′ = 0.003). However, in the late stage of HB-ACLF, deficient patterns, such as the Yang Qi Deficiency Pattern, were more prevalent than those in the early and middle stages. The Yang Qi Deficiency Pattern had a higher rate of 41.03% (32/78) in the late stage compared with that of 20.75% (22/106) in the middle stage and 8.57% (12/140, P<α′ =0.003) in the early stage. The distribution of the other patterns was not significant between the three stages (P>0.003).ConclusionsThere are four major patterns of HB-ACLF, including the Heat Toxin Stagnation Pattern, the Damp-heat Obstruction Pattern, the Yang Qi Deficiency Pattern, and the Liver and Kidney Yin Deficiency Pattern. The Heat Toxin Stagnation and Yang Qi Deficiency Patterns are the representative patterns in the early and late stages of HB-ACLF. In the middle stage of HB-ACLF, the TCM patterns vary in a complicated manner, with no significant difference among the patterns. Treatment for HB-ACLF should vary with the different representative patterns in the early and late stages.