Objective

2

To clarify the evolutionary laws of syndromes and syndrome elements at different stages during the malignant transformation of chronic hepatitis B （CHB）.

Methods

2

A total of 671 patients with hepatitis B virus infection， who were admitted to the outpatient and inpatient departments of Dongzhimen Hospital of Beijing University of Chinese Medicine and The Fifth Medical Center of Chinese PLA General Hospital from July 1st， 2020 to June 30th， 2021， were included， involving 120 cases of CHB， 340 cases of hepatitis B liver cirrhosis （HBLC）， 64 cases of precancerous lesions with hepatitis B liver cirrhosis （PLHC）， and 147 cases of hepatitis B liver cirrhosis with hepatocellular carcinoma （HCC）. A

Survey form of traditional Chinese medicine syndrome during malignant transformation of chronic hepatitis B

was designed， and the general information， auxiliary examination and the four examinations results were collected. Factor analysis and K-means clustering were used to determine and statistically analyze the syndrome and syndrome elements.

Results

2

Five traditional Chinese medicine （TCM） syndrome types were identified in CHB patients， while there were six TCM syndrome types in HBLC， PLHC and HCC stages. Among CHB patients， the main syndromes were liver constraint and spleen deficiency （53.33%） and liver-gallbladder damp-heat （21.67%）， and the dominant syndrome elements were

qi

stagnation （27.60%）， heat （17.71%） and

qi

deficiency （17.71%）. In the HBLC stage， the syndromes were mainly blood stasis obstructing the collaterals （23.83%） and liver constraint and spleen deficiency （22.35%）， with dominant syndrome elements being blood stasis （19.25%）， dampness （17.46%）， and

qi

deficiency （15.01%）. For the PLHC stage， the primary syndrome types were blood stasis obstructing the collaterals （29.68%） and liver-kidney

yin

deficiency （20.31%）， and the leading syndrome elements were blood stasis （22.12%），

yin

deficiency （15.93%）， and

qi

deficiency （15.04%）. In the HCC stage， the syndrome was dominated by blood stasis obstructing the collaterals （33.34%） and liver-kidney

yin

deficiency （19.73%）， with the main syndrome elements being blood stasis （24.52%），

yin

deficiency （16.09%）， and

qi

deficiency （15.33%）. During the progression of CHB to malignancy， there was a gradual decrease in excess syndromes including liver-gallbladder damp-heat and water-dampness internal obstruction from 21.67% to 19.04%. In contrast， deficiency syndromes including liver-kidney

yin

deficiency and spleen-kidney

yang

deficiency increased from 15.83% to 31.97%. Additionally， excess syndrome elements including

qi

stagnation， heat and dampness decreased from 59.89% to 34.48%， while deficiency syndrome elements including

qi

deficiency，

yin

deficiency and

yang

deficiency increased from 32.30% to 41.00%.

Conclusion

2

During the malignant transformation of CHB， there exists a progression of syndrome and syndrome elements， shifting from

qi

stagnation， heat and

qi

deficiency to blood stasis （predominantly excess）， dampness and

qi

deficiency， and then to blood stasis （predominantly deficiency），

yin

deficiency and

qi

deficiency， characterized by “deficiency-excess complex， and shift from excess to deficiency”.