Abstract
Objective To evaluate the impact of long-term Traditional Chinese Medicine (TCM) syndrome differentiation combined with antiviral therapy with Nucleos (t) ide analogues (NAs) on the incidence of cirrhosis in patients with chronic hepatitis B. Methods This retrospective cohort study included 521 patients with chronic hepatitis B who underwent a treatment course of ≥3 years from 1998–2019. Of the 521 patients, 261 were defined as TCM users while 260 were TCM nonusers (control group). All the enrolled subjects were followed up until February 2019 to measure the incidence and hazard ratio (HR) of cirrhosis, and the Cox proportional hazards regression model was used to analyze the independent factors affecting the occurrence of cirrhosis. Results The cumulative incidence of TCM users and nonusers was 6.9% and 13.5%, respectively (P=0.013). Results of the Kaplan–Meier analysis demonstrated that TCM users had a significantly lower cumulative incidence of cirrhosis than TCM nonusers (P=0.011), and TCM users had a significantly lower liver cirrhosis risk than TCM nonusers (adjusted HR = 0.416, 95% CI, 0.231–0.749). The histological evaluation revealed improved fibrosis in 45.0% of TCM users and 11.1% of TCM nonusers (P=0.033). The analysation of the prescriptions including total 119 single Chinese herbs medicinal demonstrated that “replenish qi and fortify the spleen,” “clear heat and dispel dampness,” and “soothe the liver and regulate qi” are the main treatment methods of TCM for CHB. Conclusions Our study demonstrated that long-term TCM use may attenuate liver cirrhosis risk in patients with chronic hepatitis B (CHB).
Highlights
Hepatitis B virus (HBV) infection is a public health concern worldwide, and persistent HBV infection can cause chronic hepatitis B (CHB), which is a serious threat to human health, leading to a huge social burden
Data obtained for analysis included data from electronic medical records (EMR), laboratory information system (LIS), and picture archiving and communication systems (PACS), as well as the detailed procedures, medication, and Traditional Chinese medicine (TCM) prescriptions from paper-based medical records
767 patients were excluded from the study based on the following exclusion criteria: presence of cirrhosis, nucleoside antiviral therapy for
Summary
Hepatitis B virus (HBV) infection is a public health concern worldwide, and persistent HBV infection can cause chronic hepatitis B (CHB), which is a serious threat to human health, leading to a huge social burden. According to the latest data in 2018, there were approximately 292 million hepatitis B carriers worldwide in 2016, and the rate of hepatitis B surface antigen positivity in China was 6.1%, indicating that there were approximately 81 million people with HBV infection [1]. E 5-year cumulative cirrhosis rate of patients with chronic HBV infection is 8–20%. Several guidelines for hepatitis B prevention emphasize that the long-term treatment goal of CHB is to continuously inhibit and eliminate HBV DNA and to prevent and delay complications such as cirrhosis and HCC [4,5,6]. Numerous clinical trials have demonstrated that long-term NA therapy has been shown to improve long-term clinical outcomes, long-term antiviral therapy alone does not completely prevent the occurrence of cirrhosis and HCC and face the challenge of patients’ poor compliance
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