非酒精性脂肪肝中医证型及临床生化指标相关性研究

目的 探讨非酒精性脂肪肝（NAFLD）患者的中医证型分布规律、特征及其临床因素的相关性。方法 以249例NAFLD患者为研究对象，将其辨证分为湿浊内停证、肝郁脾虚证、湿热蕴结证、痰瘀互结证、脾肾两虚证共5种证型，探讨各中医证型与年龄、性别、BMI及血清生化指标的相关性。结果 ①证型占比:湿浊内停证30.1%，肝郁脾虚证28.1%、湿热蕴结证25.7%、痰瘀互结证8.8%、脾肾两虚证7.2%;②男女比例约1.39∶1，湿热内蕴、湿浊内停证患者以男性为主（P<0.05）；肝郁脾虚证者则以女性为主（P<0.01）;③湿热内蕴证组ALT升高最为显著，与湿浊内停证、肝郁脾虚证组比较存在统计学差异（P<0.05）。湿浊内停证TC升高最为显著，与肝郁脾虚证、湿热内蕴证、脾肾两虚证组相比，均存在统计学差异（P<0.05）。结论 NAFLD中医证型以湿浊内停证、肝郁脾虚证、湿热内蕴证最为常见；男性发病率高于女性；湿热内蕴证患者更易出现ALT损伤；湿浊内停证更容易出现TC升高。 

Correlation Between Traditional Chinese Medicine Syndrome and Clinical Biochemical Indexes of Non-Alcoholic Fatty Liver

OBJECTIVE To explore the distribution law， characteristics and clinical factors of traditional Chinese medicine (TCM) syndrome types in patients with non-alcoholic fatty liver disease (NAFLD). METHODS 249 patients with NAFLD were enrolled in the study， and their syndrome differentiation was divided into five types: damp-turbidity stagnation syndrome， liver depression and spleen deficiency syndrome， accumulation of damp-heat syndrome， obstruction of phlegm and stasis syndrome and spleen-kidney deficiency syndrome. To explore the correlation between TCM syndrome types， age， gender， BMI and blood purification indicators. RESULTS ①Proportion of syndrome types: damp-turbidity stagnation syndrome accounting for 30.1%， 28.1% for liver depression and spleen deficiency syndrome， accumulation of damp-heat syndrome 25.7%， obstruction of phlegm and stasis syndrome 8.8%， spleen-kidney deficiency syndrome 7.2%.②The ratio of male to female was about 1.39∶1. The patients with accumulation of damp-heat syndrome and damp-turbidity stagnation syndrome were mainly male (P<0.05); those with liver depression and spleen deficiency syndrome were mainly female (P<0.01). ③The alanine transaminase (ALT) elevation in the accumulation of damp heat syndrome was the most significant， and there was statistical difference compared with that of patients with damp-turbidity stagnation syndrome and the liver depression and spleen deficiency syndrome group (P<0.05). The total cholesterol (TC) elevation was the most significant in the damp-turbidity stagnation syndrome， and there was a statistical difference compared with the liver depression and spleen deficiency syndrome， accumulation of damp-heat syndrome， and spleen-kidney deficiency syndrome group (P<0.05). CONCLUSION The most common TCM syndrome types of NAFLD are damp-turbidity stagnation syndrome， liver depression and spleen deficiency syndrome and accumulation of damp-heat syndrome. The male incidence rate is higher than that of female; accumulation of damp-heat syndrome is more liable to induce ALT injury; damp-turbidity stagnation syndrome is more likely to cause TC elevation.