NAFLD患者中医证候类型与血脂、肝功能酶学、血清瘦素及胰岛素抵抗指数的关系

TCM syndrome type distribution and its correlations with blood lipids,hepato-enzymes,serum leptin and insulin resistance in patients with non-alcoholic fatty liver disease

目的探讨非酒精性脂肪性肝病(NAFLD)中医证候类型及其与血脂、肝功能酶学、血清瘦素以及胰岛素抵抗指数等的关系,以更好地指导NAFLD的辨证论治。方法对诊断为NAFLD的576例患者进行中医证候分型,并观察其证型与血脂、肝功能酶学、血清瘦素及胰岛素抵抗指数的关系。结果 576例NAFLD患者中,脾肾阳虚证202例,肝郁脾虚证218例,占全部病例的72.9%。脾肾阳虚证患者的血脂(TC、TG、LDL)、肝功能酶学(ALT、AST、GGT)水平、血清瘦素以及胰岛素抵抗指数较其他证候类型患者明显增高,HDL则明显低于其他证候类型。结论脾肾阳虚证和肝郁脾虚证可能是广西地区NAFLD发病的主要体质类型;脾肾阳虚证患者较其他证候类型更易出现血脂、肝功能酶学、血清瘦素以及胰岛素抵抗指数异常;脾肾阳虚可能是NAFLD发病的关键脏腑病机。

Objective It is to investigate the distribution of TCM syndromes of non-alcoholic fatty liver disease （NAFLD） and its correlations with blood lipids, hepato-enzymes, serum leptin and insulin resistance （IR） to guild better for the syn- drome differentiation and treatment of this disease. Methods The syndromes of 576 NAFLD patients were categorized, and its correlations with blood lipids, hepato-enzymes, serum leptin and IR were analyzed. Results Among the 576 patients, 202 were categorized as Yang-deficiency of both spleen and kidney type, and 218 as stagnation of liver Qi and spleen deficiency type, accounting for 72.9%. Levels of blood lipids （TC, TG, LDL） , hepato-enzymes （ALT, AST, GGT） , leptin and IR in patients of Yang-deficiency of both spleen and kidney type were higher than those in patients of other types, HDL were lower than those in patients of other types, the differences were statistically significant. Conclusion Yang-deficiency of both spleen and kidney type and stagnation of liver Qi and spleen deficiency type are the dominant syndromes in patients with NAFLD in Guangxi province; abnormal blood lipids, hepato-enzymes, leptin and IR may present in those of Yang-deficiency of both spleen and kidney type more frequently. Yang-deficiency of spleen is the key pathology of NAFLD.