非酒精性脂肪性肝病不同中医证型与血清TNF-α、IL-6水平的关系研究

Study on the Relationship between Different Patterns of Nonalcoholic Fatty Liver Disease and the Levels of TNF-α and IL-6

目的:观察非酒精性脂肪性肝病(NAFLD)患者不同中医证型与血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)表达水平的关系,为NAFLD中医辨证分型提供客观参数。方法:将NAFLD患者130例按中医辨证分型标准分为5型,即脾虚湿痰证(32例)、肝郁脾虚证(30例)、痰瘀互结证(30例)、湿热内蕴证(34例)和肝肾不足证(4例,因样本数太少,未纳入统计分析),测定患者血清TNF-α、IL-6水平,并以同期不嗜酒的30名健康人为健康对照组进行比较。结果:NAFLD不同中医各证型患者血清TNF-α、IL-6水平均高于健康对照组,差异有统计学意义(P<0.01);血清TNF-α、IL-6水平在中医各证型间按脾虚湿痰证→肝郁脾虚证→痰瘀互结证→湿热内蕴证依次升高,湿热内蕴证患者血清TNF-α、IL-6水平高于其他三个证型(P<0.05);痰瘀互结型血清TNF-α、IL-6水平高于脾虚湿阻证、肝郁脾虚证(P<0.05),但肝郁脾虚与脾虚湿痰两证型比较未见明显差异(P>0.05)。结论:NAFLD患者血清TNF-α、IL-6水平在不同中医证型间的表达存在差异性。

Objective： To provide objective reference for syndrome differentiation and treatment of nonalcoholic fatty liver disease（NAFLD） by observing the relationship between different patterns of NAFLD and the levels of TNF-α and IL-6. Methods： All 130 patients were classified into five types according to the standard of syndrome differentiation： spleen deficiency and dampness-phlegm（32 cases）, liver depression and spleen deficiency（30 cases）,intermingled phlegm and stagnation（30 cases）, internal accumulation of dampness-heat（34 cases） and liver-kidney depletion（4 cases, not included in statistical analysis because of small sample size）. The levels of TNF-α and IL-6 of the patients were detected, at the same time, 30 healthy people were chosen as the control group and compared with the other groups. Results： NAFLD patients of different patterns in the groups were higher than the control group in the levels of TNF-α and IL-6, and the difference had statistical meaning（P〈0.01）; the levels of TNF-α and IL-6raised gradually in the order of spleen deficiency and dampness-phlegm, liver depression and spleen deficiency, intermingled phlegm and stagnation and internal accumulation of dampness-heat, the patients of internal accumulation of dampness-heat pattern were higher than others in the levels of TNF-α and IL-6（P〈0.05）; intermingled phlegm and stagnation was higher than spleen deficiency and dampness-phlegm and liver depression and spleen deficiency in the levels of TNF-α and IL-6（P〈0.05）, but there was no obvious difference in the comparison between liver depression and spleen deficiency and spleen deficiency and dampness-phlegm（P〉0.05）. Conclusion： The study shows that TNF-α and IL-6 express differently in NAFLD patients of different patterns.