湿热质非酒精性脂肪性肝病患者的证素分布规律及与肝组织学的相关性

Relationship between liver histology and the distribution rules of syndrome elements in non-alcoholic fatty liver disease with damp-heat constitution

目的:探讨湿热质非酒精性脂肪性肝病(NAFLD)的证素分布规律及与肝组织学的关系。方法:收集湿热质NAFLD患者的证素积分、一般资料并进行肝组织活检。结果:(1)湿热质NAFLD中非酒精性脂肪性肝炎(NASH)所占的比例最大,中年人居多,身体质量指数(BMI)状态大多升高。(2)湿热质NAFLD中常见病位证素分布依次为脾>肝>胆>胃;常见病性证素分布依次为湿>热>痰>气滞>阴虚。病位、病性证素组合以三病性及以上居多,虚实证素组合以虚实夹杂证居多。(3)非酒精性单纯性脂肪肝(NAFL)以肝证素多见,而NASH、NASH肝硬化以脾证素多见;NAFL、NASH都以湿证素多见,NASH肝硬化以热证素多见。(4)湿热质NAFLD的肝组织学多表现为NAFLD活动度积分(NAS)较高而肝纤维化程度较低,脾证素在NAS积分≥5分频数分布最高。结论:不同病变阶段湿热质NAFLD的证素分布存在差异,对于湿热质NAFLD应适当健脾疏肝和胃利胆、清热利湿和化痰。

Objective:To explore the relationship between liver histology and the distribution rule of syndrome elements in non-alcoholic fatty liver disease(NAFLD)with damp-heat constitution.Methods:Collect the general information and the syndrome element integral of the patients,carry out liver biopsy.Results:(1)Among NAFLD with damp-heat constitution,Nonalcoholic steatohepatitis(NASH)took up the largest proportion and the majority are middle-aged people,BMI status mostly increased.(2)The majority location syndrome elements are spleen and liver.The majority location syndrome elements are wet,hot and phlegm.The majority combination of location syndrome elements and nature syndrome elements were 3 or more than 3 syndrome elements.The majority of the combination of deficiency and excess syndrome elements were intermingled deficiency and excess.(3)The majority location syndrome elements of NAFL were liver syndrome element while the majority location syndrome elements of NASH and NASH related cirrhosis were spleen syndrome elements.The majority nature syndrome elements of NAFL and NASH were hydatid syndrome elements while NASH cirrhosis was heat syndrome elements.(4)The liver histology of NAFLD with damp-heat constitution manifested as higher NAS score and lower degree of liver fibrosis.Spleen syndrome element had the highest frequency distribution above 5 points of NAS scores.Conclusion:Different pathological stages have certain effects on the distribution of syndrome elements in NAFLD with damp-heat constitution.For NAFLD with dampheat constitution should be properly invigorated the spleen,soothed the liver and stomach,cleared away heat and dampness and dissipated phlegm.