Objective

2

To analyze the traditional Chinese medicine （TCM） syndromes rules in patients with liver fibrosis of chronic hepatitis B （CHB）.

Methods

2

A total of 644 chronic hepatitis B （CHB） patients with liver fibrosis stages S1~S4 on histopathological examination were recruited from January 1， 2019， to December 31， 2023， across 17 tertiary-level Class A TCM hospitals nationwide. A database was established containing patients' basic information， clinical data， and clinical symptoms. Common clinical symptoms were extracted using principal component analysis to identify factors. Through factor analysis and cluster analysis， the pathological location， nature， and pathogenic symptoms of each common factor were comprehensively evaluated. Following expert discussion， these factors were categorized into several TCM syndrome patterns. The classification characteristics of TCM syndromes in CHB patients with liver fibrosis were summarized， and the distribution patterns of TCM syndromes were compared across different fibrosis stages and inflammation grades.

Results

2

The top 5 symptoms were fatigue， yellow urination， dry mouth， visual fatigue and bitter mouth. Factor analysis with each symptom showed that 11 common factors were obtained （

P

＜0.001）， with a cumulative contribution rate of 60.479%. The disease location elements mainly involved liver， spleen and kidney， while the disease characteristic elements mainly include

qi

deficiency，

yin

deficiency， blood stasis and dampness-heat. After cluster analysis of 11 common factors， it was summarized into four types of TCM syndromes after expert discussion， which are spleen-kidne

y deficiency syndrome （262 cases， 40.68%）， liver depression and spleen deficiency syndrome （156 cases， 24.22%）， dampness-heat in liver meridian syndrome （142 cases， 22.05%）， spleen-liver depression and blood stasis syndrome （84 cases， 13.04%）. There was no significant difference in the distribution of TCM syndromes among gender， age， BMI grade， as well as HBeAg negative/positive status and hepatic tissue histopathological inflammation grades （

P

＞0.05）. There were statistically significant differences in the distribution characteristics of the four syndrome types in patients with different liver fibrosis stages （

P

= 0.034）. As the degree of fibrosis processed （S1 to S4）， the proportion of patients with deficiency syndrome increased.

Conclusion

2

The pathological locations of liver fibrosis of CHB primarily involve the liver， spleen， and kidneys. The main pathogenesis are spleen-kidney deficiency， as well as dampness-heat and blood stasis. TCM syndromes can be divided into spleen-kidney deficiency syndrome， liver depression and spleen deficiency syndrome， dampness-heat in the liver meridian syndrome， and liver-spleen blood stasis syndrome， among which pattern of spleen-kidney deficiency syndrome is the most common.