非酒精性脂肪肝病患者虚实证型与体脂水平及代谢特征的相关性

Correlation Between Deficiency or Excess Syndromes and Body Fat Levels /Metabolic Characteristics in NonAlcoholic Fatty Liver Disease Patients

目的观察不同证型非酒精性脂肪肝病(NAFLD)患者体脂水平、代谢特征及其相关性。方法收集NAFLD患者27例,其中实证组13例,虚证组14例,另设18例健康者为对照组。记录各组受试者体脂水平[包括腰围、体质量指数(BMI)、肝/脾、腹内脂肪面积(VA)/腹壁脂肪面积(SA)],检测代谢指标[包括空腹血糖(FBG)、空腹胰岛素(FINS)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆固醇(TC)、甘油三酯(TG)、抵抗素、脂联素],采用Spearman检验进行各指标相关性分析。结果实证组患者FINS、ALT、AST、TG以及抵抗素与对照组比较均明显增高,虚证组FGB、FINS、ALT、AST、TG以及抵抗素与对照组比较均明显增高,实证组、虚证组间VA/SA、ALT、AST及TC差异有统计学意义(P<0.05或P<0.01)。相关性分析显示,实证组脂联素与VA/SA存在负相关、与肝/脾存在正相关(P<0.05);虚证组肝/脾与TG、ALT、FINS存在负的相关(P<0.05)。结论虚实证型NAFLD患者的代谢特征有明显差异,虚证患者有更明显的糖脂代谢异常和胰岛素抵抗的存在,这种代谢差异可能与患者体脂水平有关。

Objective To observe the body fat levels and metabolic characteristics in non-alcoholic fatty liver disease（ NAFLD） patients with different syndromes and to study the correlation between the syndromes and the body fat levels /metabolic characteristics.Methods Totally 27 cases of NAFLD were collected and divided into the excess syndrome group of 13 cases and deficiency syndrome group of 14 cases.Eighteen healthy persons were chosen as the control group.The levels of waist circumference,body mass index（ BMI）,liver /spleen ratio,visceral fat area（ VA） /abdominal subcutaneous fat area（ SA）,adiponectin（ APN） and resistin were recorded.The levels of fasting blood glucose（ FBG）,fasting insulin（ FINS）,alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,total cholesterol（ TC）,triglyceride（ TG）,resistin and APN were detected.The correlation between various indicators was analyzed with Spearman test.Results Comparing with the control group,the levels of FINS,ALT,AST,TG and resistin were significantly increased in the excess syndrome group and the levels of FGB,FINS,ALT,AST,TG and resistin were significantly increased in the deficiency syndrome group.There were significant differences between the excess syndrome group and deficiency syndrome group in the levels of VA /SA,ALT,AST and TC（ P〈0.05 or P〈0.01）,The correlation analysis showed that APN was negatively correlated with VA /SA but positively correlated with liver /spleen ratio in the excess syndrome group（ P〈0.05）.The liver /spleen ratio was negatively correlated with TG,ALT and FINS in the deficiency syndrome group（ P〈0.05）.Conclusion There is a significant difference between excess syndrome and deficiency syndrome in the metabolic characteristics in NAFLD patients.NAFLD patients with deficiency syndrome have more obvious abnormal lipid metabolism and insulin resistance,which may be relevant to the body fat levels.