瘦人非酒精性脂肪性肝病与中医证型及相关危险因素的Logistic回归分析

Logistic Regression for TCM Syndromes with Risk Factors of Lean Nonalcoholic Fatty Liver Disease

目的探讨瘦人非酒精性脂肪性肝病(Lean nonalcoholic fatty liver disease,Lean NAFLD)中医证型的分布规律及与发病相关危险因素的关系。方法选取2019年9月—2021年2月期间上海地区498例入组人群(Lean NAFLD患者98例,非瘦型NAFLD患者302例,正常健康人群98例)进行中医证型判定,运用单因素和多因素Logistic回归分析中医证型与相关危险因素的关联性。结果Lean NAFLD患者的中医证型主要集中在肝郁脾虚证、痰浊内阻证和肝郁气滞证。其相关因素的单因素logistic回归显示,腰围、年龄(45~60岁)、TC是Lean NAFLD的危险因素。保持运动习惯是Lean NAFLD的保护因素。Lean NAFLD基本证型的多因素logistic回归显示:肝郁脾虚证中,腰围、FINS是独立危险因素;痰浊内阻证中,HOMA-IR、年龄是独立危险因素;肝郁气滞证中,Hb是独立危险因素。结论肝郁脾虚证、痰浊内阻证和肝郁气滞证为Lean NAFL D的主要中医证型,其中肝郁脾虚证与腹型肥胖、胰岛素抵抗有关,痰浊内阻证与年龄、胰岛素抵抗有关,肝郁气滞证与血红蛋白有关。

Objective To explore the relationship between traditional Chinese medicine(TCM)syndromes and risk factors in the patients with lean nonalcoholic fatty liver disease(NAFLD).Methods The TCM syndromes of 498 en⁃rolled individuals(98 lean NAFLD patients,302 non-lean NAFLD patients,and 98 healthy participants)in Shanghai from September 2019 to February 2021 were identified.The correlations between TCM syndromes and risk factors were analyzed by univariate and multivariate logistic regression.Results The TCM syndromes of lean NAFLD patients were mainly liver depression and spleen deficiency,phlegm turbidity and internal obstruction,and liver depression and qi stagnation.The uni⁃variate logistic regression showed that waist circumference,age(45-60 years old),and total cholesterol(TC)were the risk factors of lean NAFLD,while the habit of keeping exercise was the protective factor.The multivariate logistic regression showed that waist circumference and fasting insulin(FINS)were independent risk factors in the patients with the syndrome of liver depression and spleen deficiency;Homeostatic Model Assessment for Insulin Resistance(HOMA-IR)and age were independent risk factors in the patients with the syndrome of phlegm turbidity and internal obstruction;hemoglobin(Hb)was an independent risk factor in the patients with the syndrome of liver depression and qi stagnation.Conclusion Liver depression and spleen deficiency,phlegm turbidity and internal obstruction,and liver depression and qi stagnation are the main TCM syndromes of lean NAFLD.Among them,the syndrome of liver depression and spleen deficiency is related to ab⁃dominal obesity and insulin resistance;the syndrome of phlegm turbidity and internal obstruction is related to age and insu⁃lin resistance;and the syndrome of liver depression and qi stagnation is related to Hb.