基于文献分析的非酒精性脂肪肝中医证型分布特点

Traditional Chinese Medicine Syndrome Types of Nonalcoholic Fatty Liver Disease Based on Literature Data Mining

目的:对现有数据库资料进行挖掘,研究非酒精性脂肪肝(NAFLD)的中医证型分布。方法:检索国内外2000年1月至2021年5月已发表的NAFLD中医证候的临床研究文献,筛选符合纳排标准的文献并构建数据库。运用Excel表统计数据库中所有NAFLD证型频率及证型构成比;对数据库中采用同一NAFLD中医证候诊断参考标准,异质性较小的文献数据运用Stata16.0进行Meta分析计算NAFLD证型合并构成比。结果:共纳入110篇文献进行中医证候频率及证型构成比的分析。其中NAFLD中医证型频率>10%的证型(由高到低)为:湿热内蕴证、痰瘀互结证、肝郁脾虚证及痰湿内阻证;证型构成比>10%的证型(由高到低)为:湿热内蕴证、肝郁脾虚证、痰湿内阻证和痰瘀互结证。统一NAFLD证候诊断标准2011年《非酒精性脂肪性肝病的中西医结合诊疗共识意见》后选取8篇文献进行Meta分析。NAFLD证型合并构成比>10%的证型(由高到低)为:痰湿内阻证合并构成比为28%,95%CI为0.26~0.30、肝郁脾虚证合并构成比为25%,95%CI为0.23~0.28、湿热蕴结证合并构成比为20%,95%CI为0.18~0.22和肝郁气滞证合并构成比为15%,95%CI为0.13~0.16。结论:结合文献分析和Meta分析结果提示痰湿内阻证、肝郁脾虚证、湿热内蕴证是NAFLD主要的证型。

Objective:To study the distribution of traditional Chinese medicine(TCM)syndromes of nonalcoholic fatty liver disease(NAFLD)by mining the existing database data.Methods:The literature of clinical research on TCM syndromes of NAFLD published from January 2000 to May 2021 was retrieved.The literature that met the standards of NAFLD was screened out,and a database was constructed.The frequency and proportion of cases of all NAFLD syndromes in the database were analyzed by Excel table.Stata16.0 was used to conduct a single rate meta-analysis of literature data that adopted the same TCM syndrome diagnosis reference standard for NAFLD and had little heterogeneity.Results:A total of 110 papers were included.The frequency of TCM syndromes of NAFLD with a proportion of more than 10%was ranked from high to low as follows,syndrome of dampness-heat accumulation,syndrome of phlegm-blood stasis inter-junction,syndrome of liver stagnation and spleen deficiency,and syndrome of phlegm-dampness internal obstruction.The number of syndromes with syndrome types that accounted for more than 10%of the syndromes were syndrome of internal dampness-heat,syndrome of liver stagnation and spleen deficiency,syndrome of phlegm-dampness internal obstruction,and syndrome of phlegm-blood stasis inter-junction.Eight papers were selected for Meta-analysis after unifying the criteria for syndrome diagnosis and treatment of NAFLD in 2011 Consensus Opinions on the Diagnosis and Treatment of Non-alcoholic Fatty liver Disease with Integrated Chinese and Western Medicine.The syndrome types with a ratio>10%were syndrome of phlegm-dampness internal obstruction(0.2895%CI 0.26 to 0.30),syndrome of liver stagnation and spleen deficiency(0.2595%CI 0.23 to 0.28),syndrome of dampness-heat accumulation(0.2095%CI 0.18 to 0.22),and syndrome of liver depression and qi stagnation(0.1595%CI 0.13 to 0.16).Conclusion:Combined with literature analysis and Meta-analysis,it is suggested that the syndrome of phlegm-dampness internal obstruction,syndrome of liver stagnation and spleen deficiency,and syndrome of dampness-heat accumulation are the main syndromes of NAFLD.