非酒精性脂肪性肝病患者甲状腺功能与中医证型、肝组织纤维化程度的关系

Relationship between Thyroid Function and Chinese Medicine Syndromes and Degree of Hepatic Fibrosis in Patients with Non-alcoholic Fatty Liver Disease

目的通过观察非酒精性脂肪性肝病(NAFLD)患者甲状腺功能与中医证型、肝组织纤维化程度的关系,为中医药防治NAFLD提供客观依据。方法160例均为厦门市中医院肝病中心2019年1月—2021年12月NAFLD患者,120例符合纳入标准,对其进行中医辨证,分为肝郁脾虚证、痰湿内阻证、湿热蕴结证、痰瘀互结证4型,同时选取健康体检者30名作为对照组。观察NAFLD患者甲状腺功能与不同中医证型、肝组织纤维化程度的关系。结果120例NAFLD患者中,各中医证型均以男性患者居多,但各证型间比较,差异无统计学意义(P>0.05);痰瘀互结证较其他3型年龄更大,病程更长(P<0.05);肝郁脾虚证体重指数较其他3型更轻(P<0.05)。NAFLD患者三碘甲状腺原氨酸(T3)、甲状腺激素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平较健康对照组低,促甲状腺激素(TSH)水平较健康对照组高,差异均有统计学意义(P<0.05)。各不同中医证型中,痰瘀互结证NAFLD患者血清T3、T4、FT3、FT4水平最低,TSH水平最高,与肝郁脾虚证比较,差异有统计学意义(P<0.05)。肝纤维化程度S 2 NAFLD患者血清T3、T4、FT3、FT4水平较S<2 NAFLD患者低,TSH水平更高,差异有统计学意义(P<0.05)。结论不同中医证型及不同肝组织纤维化程度NAFLD患者甲状腺功能不同;甲状腺功能在一定程度上可为NAFLD中医辨证及肝纤维化程度提供参考。故在NAFLD的诊治过程中,除了监测肝功能及代谢相关指标外,还应密切监测甲状腺功能的波动,及时对病情进行干预。

Objective To provide objective evidence for Chinese medicine(CM)prevention and treatment of non-alcoholic fatty liver disease(NAFLD)by observing the relationship between thyroid function in patients with NAFLD and different CM syndromes and degree of liver fibrosis.Methods From January 2019 to December 2021,160 NAFLD patients who met the inclusion criteria were enrolled at Xiamen Hospital of Traditional Chinese Medicine for CM syndrome typing.They were divided into four types:Gan depression Pi deficiency syndrome,phlegm dampness internal resistance syndrome,damp heat accumulation syndrome,phlegm blood stasis intermingling syndrome.At the same time,30 healthy subjects were enrolled as the control group.The relationships between thyroid function of NAFLD patients and different CM syndrome types/degrees of liver fibrosis were observed.Results The majority of patients with NAFLD were men,but there were no significant differences among the four syndrome types(P>0.05).There were significant differences in age and course of disease between phlegm and blood stasis intermingling syndrome and the other three types(P<0.05).Body mess index(BMI)was milder in Gan depression Pi deficiency syndrome than in the other three types(P<0.05).Triiodothyronine(T3),thyroid hormone(T4),free triiodothyronine(FT3),free thyroxine(FT4)levels were lower,and thyroid stimulating hormone(TSH)levels were higher in NAFLD patients than those in healthy subjects(P<0.05).Among the CM syndrome types,the levels of T3,T4,FT3,and FT4 were the lowest and the level of TSH was the highest in patients with phlegm and blood stasis intermingling syndrome,showing significant difference from those with Gan depression Pi deficiency syndrome(P<0.05).Compared with NAFLD with mild liver fibrosis(S<2),the levels of serum T3,T4,FT3,and FT4 in the group with obvious liver fibrosis(S 2)were lower,and the level of TSH was higher(P<0.05).Conclusions The thyroid functions were different in NAFLD patients with different CM syndrome types/degrees of liver fibrosis.Thyroid function provided references for CM syndrome differentiation of NAFLD patients and liver fibrosis degrees to some extent.In diagnosis and treatment of NAFLD,the fluctuation of thyroid functions should be closely monitored and timely intervention should be performed,in addition to monitoring related indicators of liver function and metabolism.