海南地区非酒精性脂肪肝中医湿证与脂肪度的关联性

Relevance between the damp syndrome and fat deposit degrees of nonalcoholic fatty liver in Hainan province

目的:探讨非酒精性脂肪肝(NAFLD)中医湿证、非湿证各组与FibroScan-CAP检测结果、血脂、肝功能等指标的关联性。方法:NAFLD患者110例分为中医湿证(湿浊证、湿热证、痰瘀证)组、非湿证(气滞证)组,同时招募30名健康志愿者作为正常对照组,对各组进行FibroScan-CAP检测并抽血检测血脂、肝功能等,比较各组FibroScan-CAP检测结果、血脂、肝功能等指标的关系。结果:110例NAFLD患者中,湿证组90例占81.8%,非湿证组20例占18.2%。湿证、非湿证各组的脂肪肝程度比较:非湿证组中脂肪肝程度(中度)比例显著高于湿浊证组、湿热证组、痰瘀证组(P<0.05);非湿证组中脂肪肝程度(重度)比例显著低于湿浊证组、湿热证组、痰瘀证组(P<0.05);湿浊证组中脂肪肝程度(重度)比例显著低于痰瘀证组(P<0.05)。各组别不同程度脂肪肝生化指标比较:与正常对照组比较,非湿证组、湿浊证组、湿热证组、痰瘀证组TC、TG、AST、ALT、ALP、GGT水平显著升高(P<0.05);与非湿证组比较,湿浊证组、湿热证组、痰瘀证组AST、ALT、TG、GGT水平升高(P<0.05),痰瘀证组TC、TG、AST、ALT、GGT水平升高最为显著,痰瘀证组脂肪肝程度与TC(R=0.446,P=0.003)、TG(R=0.377,P=0.014)、AST(R=0.403,P=0.008)、ALT(R=0.449,P=0.003)、ALP(R=0.408,P=0.007)有较强正相关性。提示各组脂肪肝程度排序,从轻到重依次为:非湿证(气滞证)→湿浊证/湿热证→痰瘀证。结论:NAFLD的发生和发展与中医湿证密切相关,且湿证脂肪肝程度与FibroScan-CAP检测结果、血脂、肝功能等指标呈正相关,为NAFLD的中医湿证客观化研究提供数据支持。

Objective:To explore the relevance between the damp syndrome groups and the non-damp syndrome group with FibroScan-CAP results,blood lipid,liver function and other indicators of nonalcoholic fatty liver(NAFLD).Methods:A total of 110 cases of NAFLD were collected,including the damp syndrome groups(divided into:damp pathogen syndrome group,damp-heat syndrome group,phlegm-blood stasis syndrome group),non-damp syndrome group(qi stagnation syndrome group),meanwhile,30 healthy volunteers were recruited as the normal control group.Then we compared the relevance between syndromes and FibroScan-CAP results,blood lipid,liver function and other indicators.Results:A total of 110 patients with NAFLD,90 cases(81.8%)were damp syndrome cases,and 20 cases(18.2%)were nondamp syndrome cases.The degree of fatty liver in each group was compared,the degree of fatty liver(moderate)of non-damp syndrome group was significantly higher than damp pathogen syndrome group,damp-heat syndrome group,and phlegm-blood stasis syndrome group(P<0.05);the degree of fatty liver(severe degree)of non-damp syndrome group was significantly lower than damp pathogen syndrome group,damp-heat syndrome group,and phlegm-blood stasis syndrome group(P<0.05);the degree of fatty liver(severe degree)of damp pathogen syndrome group was significantly lower than phlegm-blood stasis syndrome group(P<0.05).Comparison of biochemical indexes of different degrees of fatty liver in each group,compared with the normal control group,TC,TG,AST,ALT,ALP,GGT were significantly elevated of non-damp syndrome group,damp pathogen syndrome group,damp-heat syndrome group,phlegm-blood stasis syndrome group(P<0.05);compared with the non-damp syndrome group,AST,ALT,TG,GGT were significantly elevated of damp pathogen syndrome group,damp-heat syndrome group,phlegm-blood stasis syndrome group(P<0.05);TC,TG,AST,ALT,GGT of phlegm-blood stasis syndrome group was most pronounced,there was a strong positive correlation between the degree of fatty liver phlegm-blood stasis syndrome group and TC(R=0.446,P=0.003),TG(R=0.377,P=0.014),AST(R=0.403,P=0.008),ALT(R=0.449,P=0.003),ALP(R=0.408,P=0.007).It was suggested that the degree of fatty liver in each group should be ranked,from light to heavy:non-damp syndrome group(qi stagnation syndrome group),damp pathogen syndrome group/dampheat syndrome group,phlegm-blood stasis syndrome group.Conclusion:The occurrence and development of NAFLD are closely related to damp syndrome of TCM,and the degree of fatty liver of damp syndrome is positively correlated with the result of FibroScan-CAP,blood lipid and liver function,which can provide data for objective study of damp syndrome of TCM of NAFLD.