3. Liver Function and Pathogen Testing

All 2,021 hepatitis B patients underwent liver function tests, plasma protein electrophoresis, and testing for the three hepatitis B markers—HBV—DNA—P. The results of liver function tests and γ-globulin levels are shown in Table 1, while changes in serum pathogens for each type of hepatitis B are shown in Table 2.

Table 1 Changes in Liver Function and γ-Globulin Levels for 2,021 Cases

+:----:+:----:+:-----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----:+:----......

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Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Item | SGPT (Goldman) | Jaundice Index | TTT | TFT | ZnT | γ-Globulin % | | | | | | | Objective | | | | | | +------+-------+------+------+------+------+------+------+------+------+------+------+------+------+------+------+------+------+------+------+ | 150 | 150～ | 300 | 3↓ | 6～ | 20 | 6↓ | 6～ | 20 | --- | ++ | 卅 ↑ | 12 | 12～ | 20 ↑ | 20 | 20～ | 25 | | | | | | | | | | | | | | | | | | ↓ | 300 | ↑ | | 20 | ↑ | | 20 | ↑ | | | | ↓ | 20 | | ↓ | 25 | ↑ Number of cases | 1214 | 686 | 121 | 1820 | 171 | 30 | 1491 | 420 | 110 | 1321 | 525 | 175 | 1422 | 490 | 109 | 1282 | 470 | 269 % | 60.1 | 33.9 | 6.0 | 90.0 | 8.5 | 1.5 | 73.8 | 20.8 | 5.4 | 65.0 | 26.0 | 8.6 | 70.4 | 24.2 | .5.4 | 63.4 | 23.3 | 13.3 Table 2: Distribution of Serological Indicators for Various Types of Hepatitis B in 2021 Cases

+:--------------:+:----:+:-----:+:----:+:----:+:----:+:---:+:----:+:----:+:----:+:---:+:----:+ Type | HBsAg | Anti---HBs | Anti-HBc | Anti--- | HBeAg | Anti-HBe | HBV- | | | | | | | Positive | | | | HBcIgM | | | DNA-P | | | | | | | Number of cases | | | | | | | | | | | | | | Project | | | | | | | +------+-------+------+------+------+------+-----+------+------+------+------+------+-----+------+ | | % | | % | | % | | % | | % | | % | | % Acute n=366 | 366 | 18. | 64 | 49. | 12 | 0.8 | 349 | 38.1 | 291 | 27.8 | 169 | 13.0 | 196 | 24.4 | | 1 | | 6 | | | | | | | | | | Chronic n = 861 | 861 | 42. | 56 | 43. | 702 | 48. | 298 | 32. | 364 | 34.8 | 591 | 45.6 | 211 | 26. | | 6 | | 4 | | 0 | | 6 | | | | | | 3 Chronic active n = 429 | 429 | 21. | 2 | 1.6 | 421 | 28.8 | 163 | 17.8 | 298 | 28.4 | 202 | 15.9 | 291 | 36. | | 2 | | | | | | | | | | | 2 Carrying virus n=297 | 297 | 14.7 | 6 | 4.6 | 267 | 18. | 19 | 9.9 | 61 | 5. | 293 | 22.6 | 64 | 7. | | | | | | 3 | | | | 8 | | | | 9 Liver cirrhosis n = 68 | 68 | 3. 4 | 1 | 0.8 | 61 | 4. | 14 | 1.5 | 32 | 3. | 41 | 3. | 41 | 5. | | | | | | 2 | | | | 1 | | 2 | | 1 Total number and positive rate % | 2021 | 100. | 129 | 6.4 | 1643 | 72. | 915 | 45.3 | 1046 | 51.8 | 1296 | 64. | 803 | 39. | | 0 | | | | 4 | | | | | | 1 | | 7

II. Discussion

The male-to-female incidence ratio in this group of cases is 2.36:1, with a higher incidence among adolescents.

The age group under 36 accounts for 60.0% of all cases, which is broadly consistent with domestic literature reports. The peak months for onset are April to September, accounting for 73.2% of all annual cases, aligning with the typical pattern of gastrointestinal infectious diseases. Only 8.1% of cases had a history of iatrogenic blood transfusion or injection, a significant difference compared with domestic literature reports, while family contacts accounted for 35.7% and social contacts for 56.2%. Among family contacts, mothers were infected in 82% of cases, and fathers in 19%, with statistically significant differences between these two groups, consistent with domestic data. This indicates that contact transmission still plays a significant role in the spread of hepatitis B, particularly mother-to-child vertical transmission, which holds special significance in the modes of hepatitis B transmission, as reported domestically. Domestic literature also highlights the importance of horizontal transmission through saliva, semen, and vaginal secretions between spouses; however, in this group of cases, among 376 married adults aged 31–45, only 56 couples were both infected, representing 14.8%. We once observed a five-member family where the wife and three children were all hepatitis B patients, each with a disease course of more than three years, yet the husband, who lived and ate with them without any disinfection or isolation, remained uninfected. This suggests that although horizontal transmission between spouses has epidemiological significance, the body's own immune function plays an important role, a point that requires further investigation. In this group, acute hepatitis B cases numbered only 366, accounting for 18.1%, significantly lower than reported in domestic literature. Among acute hepatitis B cases, only 39 had a history of infection by either parent, representing 10.6%; 346 had a history of hepatitis B exposure, accounting for 87.2%, with statistically significant differences between the two (P<0.05), indicating that vertical transmission does not play a significant role in acute hepatitis B infections, whereas contact transmission—i.e., horizontal transmission—has relatively greater significance.

Among the liver function changes in 2021 hepatitis B patients (see Table 1), only 201 cases had a jaundice index exceeding 6 units, accounting for just 10.0% of all cases; clinical jaundice was observed in only 101 cases, representing 4.6% of all cases, suggesting that jaundice is not a major symptom of hepatitis B. Gamma-globulin levels above 20% were found in 739 cases, with chronic active hepatitis accounting for 382 of these, or 51.7%, indicating that elevated gamma-globulin levels are important for diagnosing chronic active hepatitis. All 2021 cases of various types of hepatitis B tested positive for HBsAg, followed by 1,463 cases positive for anti-HBc, accounting for 72.3%. Only 129 cases were positive for anti-HBs, representing 6.4%. Among acute hepatitis B cases, 349 were positive for anti-HBsAg, accounting for 88.1%, highlighting the importance of this indicator in diagnosing acute hepatitis B. The positive rate for anti-HBe was highest among carriers at 98.6%, followed by chronic active hepatitis at 68.6%, demonstrating the "protective significance" of this indicator. The positive rates for HBV-DNA-P, from highest to lowest, were chronic active hepatitis (67.8%), liver cirrhosis (60.3%), acute hepatitis (53.6%), chronic migratory hepatitis (24.5%), and carriers (21.5%), results largely consistent with those reported by Suzuki Hiroshi, further confirming its "protective significance."

We divided the cases into mild and severe groups based on disease severity to observe the relationship between various indicators and disease severity: ① HBsAg positive or anti-HBe negative; ② Liver function showing flocculent++ or higher, turbidity above normal, or SGPT over 300; ③ Obvious subjective symptoms and physical signs. If two of these three criteria are met, the case is classified as "severe." ① HBeAg negative or anti-HBe positive; ② Liver function showing flocculent+ or -, turbidity within normal limits, or SGPT below 300; ③ Subjective symptoms and physical signs are not obvious. If two of these three criteria are met, the case is classified as "mild." Whether subjective symptoms and physical signs are "obvious" or "not obvious" is determined by the following indicators: among weakness, liver distension, abdominal bloating, and hepatomegaly, if three of these four are present, it is considered "obvious"; otherwise, it is considered "not obvious." The relationship between hepatitis B severity and age is shown in Table 3, the relationship between hepatitis B severity and HBsAg ratio in Table 4, the relationship between hepatitis B severity and anti-HBe in Table 5, and the relationship between hepatitis B severity and HBV-DNA-P in Table 6.

Table 3 shows that among all age groups, elderly patients aged 46 and above have a higher proportion of "severe" cases, with statistically significant differences. Could the decline in immunity among elderly patients be the reason? However, since the incidence of this disease is low among elderly patients, what explains this phenomenon? Further research is needed. Table 4 shows that there is no significant difference in hepatitis B severity across different HBsAg ratio ranges, leading to the conclusion that there is no positive correlation between the ratio and the severity of hepatitis B. Persich et al. reported that HBsAg titers are negatively correlated with chronic active hepatitis < chronic migratory hepatitis < carriers, but this trend was not observed in our cases. Although HBsAg titers cannot reflect disease severity, higher titers do indicate greater infectivity, a view widely accepted by scholars. Table 5 shows that patients positive for anti-HBe tend to have milder conditions, while those negative for anti-HBe tend to have more severe conditions, with highly significant statistical differences, further proving the protective effect of anti-HBe. Table 6 indicates that among patients positive for HBV-DNA-P, there are fewer mild cases and more severe ones; among those negative for HBV-DNA-P, there are fewer severe cases and more mild ones, with statistically significant differences, thus suggesting that measuring the activity of hepatitis B virus DNA polymerase is important for determining the severity of hepatitis B.

III. Conclusion

Through analysis of the epidemiological and clinical observations of 2021 hepatitis B patients, this paper concludes that, in addition to the commonly recognized routes of transmission such as blood transfusion, injection, and vaccination, contact transmission still holds significant epidemiological importance, especially mother-to-child transmission within families, which is particularly crucial. Given that many cohabiting couples have one partner who remains uninfected for a long time, it is reasonable to assume that the body's immune system plays an important role in preventing hepatitis B infection. The serological pathogenic characteristics of various types of hepatitis B in this group of cases are broadly consistent with most domestic and international reports. There is no clear relationship between hepatitis B severity and age or HBsAg ratio, with no statistically significant differences; however, there is a clear relationship between anti-HBe and HBV-DNA-P positivity/negativity and disease severity.

Table 3 Relationship Between Hepatitis B Severity and Age

---

 Age Group          Mild           Severe          Total          P-value

Under 15 years        289          302          591        P\>0. 05

16–30 years        371          338          709        P\>0. 05

31–45 years        229          192          421        P\>0. 05

46–60 years         46          168          224        P\>0. 05

Over 60 years         24           52           76        P\>0. 05

---

Note: There is no significant difference in severity across age groups, but when 45 and older are grouped together as the elderly and those under 45 are grouped as middle-aged and young, the statistical differences become highly significant, P<0.01, with the elderly group having more severe cases than the middle-aged and young group.

Table 4 Relationship Between Hepatitis B Severity and HBsAg Ratio

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HBsAg Mild Severe Total P-value

1: (16–64)       402          360          762        P>0.05

1: (128–256) 351 336 687 P>0.05

  1: 256          273          289          562        P>0.05

---

Table 5: Relationship between Hepatitis B Severity and Anti-HBe Negative Status

+:-------------:+:-------------:+:-------------:+:-------------:+:-------------:+ | Mild | Severe | Total | P-value Positive | 933 | 363 | 1296 | P<0.01 Negative | 224 | 501 | 725 | P<0.01 Table 6: Relationship between Hepatitis B Severity and HBV-DNA-P Positive/Negative Status Severity | Mild | Severe | Total | P-value | | | | Number of Cases | | | | | | | | Positive | 202 | 601 | 803 | P<0.01 Negative | 817 | 401 | 1218 | P<0.01 Statistical analysis showed significant differences.

Note: ① Wu Xiaosu. Journal of Suzhou Medical College. 1986, 1:95

② Liu Fengju et al. Materials from the Fifth National Conference on Viral Hepatitis. 1987, 11

③ Zhang Guangshu. Military Medical Journal. 1986, 3:210

④ Zhao Ruohui et al. Chinese Journal of Epidemiology. 1984, 1:16

⑤ Liang Ruilin. Chinese Journal of Epidemiology. 1984, 6:372

(Gansu Medicine, 1989.4)

Traditional Chinese Medicine Syndrome Differentiation Treatment for Diabetes

Comparative Observation Report on 76 Cases

Pei Zhengxue, Li Wei, Chen Ling

Although there are many Western medical treatments for diabetes, due to the high likelihood of drug dependence, truly curative cases remain rare. The author treated 76 cases of this disease using TCM syndrome differentiation and compared them with a group of 28 patients receiving Western hypoglycemic medication. After two years of follow-up, the results demonstrated satisfactory efficacy of TCM syndrome differentiation treatment.

I. Case Overview

Treatment group: 76 cases—39 males, 37 females. Among them, 65 were aged 40–60, 9 over 60, and 2 under 20. Of these, 56 had a disease duration of 5–10 years, 15 less than 5 years, and 5 more than 10 years. Control group: 28 cases—16 males, 12 females. Among them, 20 were aged 40–60, 6 over 60, and 2 under 60. Of these, 15 had a disease duration of 5–10 years, 8 less than 5 years, and 5 more than 10 years. All cases exhibited positive urinary glucose upon admission, with fasting blood glucose >130 mg/dL and 2-hour postprandial blood glucose >200 mg/dL. Statistically, the two groups were comparable in terms of age, disease duration, and clinical condition, with P>0.05.

In the treatment group of 76 cases, there were 2 cases of ketoacidosis, 4 cases of acute or chronic infection, 4 cases of pulmonary tuberculosis, 7 cases of arteriosclerosis, 5 cases of cataract, and 2 cases of gout; in the control group of 28 cases, there was 1 case of ketoacidosis, 3 cases of pulmonary tuberculosis, 3 cases of arteriosclerosis, and 2 cases of cataract.

II. TCM Syndrome Differentiation and Prescribed Formulas

Based on TCM syndrome differentiation, the cases were divided into three types: ① Yangming Heat Excess: Symptoms include intense thirst and excessive drinking, spontaneous sweating and fatigue, palpitations and increased appetite, frequent and painful urination, a large and forceful pulse, a red tongue body, and a yellow, greasy coating. Treatment principle is to clear heat and reduce fire, tonify qi and generate fluids. The formula used is modified Renshen Baihu Tang: raw gypsum, zhimu, shanyao, gancao, dangshen, maidong, wuweizi, huanglian, and hua fen, decocted in water and taken once daily. ② Kidney Yang Deficiency: Symptoms include dizziness and tinnitus, lower back pain and leg weakness, aversion to cold, frequent and copious urination, fatigue and spontaneous sweating, a deep and fine pulse, weak chi pulse, a plump tongue body, and a thin, white, greasy coating. Treatment principle is to tonify the kidney and strengthen yang, while also tonifying qi and generating fluids. The formula used is modified Guifu Bawei Wan plus Shengmai San: shengdi, shanyu, danpi, fuling, zexie, rougui, fupian, dangshen, maidong, wuweizi, huanglian, and hua fen, decocted in water and taken once daily. ③ Chronic Disease Entering the Collateral Channels: Symptoms include darkened complexion, emaciation, bone-steaming heat, five-heart vexation, dry mouth and throat, joint pain, a deep and string-like pulse, and a red tongue body with stasis spots. Treatment principle is to activate blood circulation and remove stasis, while clearing heat and eliminating steaming. The formula used is modified Huoxue Zengye Tang: chishao, honghua, yuan shen, shengdi, danshen, ge gen, danpi, maidong, chuan xiong, zhimu, jiangxiang, huangbo, shanyao, cangzhu, huanglian, and hua fen, decocted in water and taken once daily.

III. Treatment Methods and Medication Adjustments

(1) Treatment Group: Based on syndrome differentiation, in addition to the prescribed formula, for thirst add 30 grams of raw gypsum and 10 grams of hua fen; for fatigue add 30 grams of huangqi and 15 grams of dangshen; for increased appetite add 6 grams of huanglian; for yellow, greasy tongue coating add 3 grams of huanglian, for prominent bone-steaming heat add 10 grams of danpi and 20 grams of danshen, 6 grams of zhimu; for shortness of breath add 10 grams of maidong and 3 grams of wuweizi; for poor appetite add 6 grams of cangzhu.

(2) Control Group: Regardless of the type, all patients were given Pnenformin 50 mg, three times daily, taken half an hour before meals.

(3) Both the treatment group and the control group considered a 10-day course of medication as one treatment cycle.

IV. Treatment Outcomes