非酒精性脂肪肝同病异证与肝活检病理学的相关性研究

Correlation study of different syndromes of non-alcoholic fatty liver disease and liver biopsy pathology

目的:观察非酒精性脂肪肝(NAFLD)患者不同中医证型与临床指标、肝活检病理学的关系。方法:选择312例NAFLD患者进行辨证分型,均进行肝组织活检,常规判定NAFLD活动度积分(NAS)和肝纤维化分期。结果:NAFLD患者的中医证型频数分布为痰湿内阻证>肝郁脾虚证>湿热蕴结证>肝郁气滞证>痰瘀互结证。NAFLD患者性别、年龄、病程、血生化、体质量指数、肝硬度值、NAS积分等指标在不同中医证型的分布差异具有统计学意义(P<0.05)。结论:NAFLD患者痰湿内阻证、痰瘀互结证、湿热蕴结证三型NAS积分较高,故NAFLD的治疗应着重于健脾化痰、清热利湿、活血化瘀。

Objective:To observe the relationship between different TCM syndrome types and clinical indicators and liver biopsy pathology in patients with nonalcoholic fatty liver disease(NAFLD).Methods:A total of 312 patients with NAFLD were selected for syndrome differentiation,liver biopsy was performed,and NAFLD activity score(NAS)and liver fibrosis stage were routinely determined.Results:The frequency distribution of TCM syndromes in patients with NAFLD was stagnation and blockade of phlegm-damp syndrome>liver stagnation and spleen deficiency syndrome>dampness-heat amassment pattern>liver depression and qi stagnation syndrome>syndrome of intermin-gled phlegm and blood stasis.The distribution of gender,age,course of disease,BMI,liver stiffness value,NAS integral etc.in NAFLD patients with different syndromes were statistically significant(P<0.05).Conclusion:The three types of NAS scores of stagnation and blockade of phlegm-damp syndrome,syndrome of intermin-gled phlegm and blood stasis and dampness-heat amassment pattern of patients with NAFLD are higher.The treatment of NAFLD should focus on invigorating spleen and resolving phlegm,clearing heat and promoting diuresis,activating blood circulation to dissipate blood stasis.