基于CAP技术探讨非酒精性脂肪肝中医湿证与脂肪度的关联性研究  

Study on the Relationship between Dampness Syndrome and Fatness in Non-Alcoholic Fatty Liver Disease Based on CAP

作　　者：程亚伟[1] 丁一 蔡媛媛[1] 王婷 黄家彦 王珊 薛兰霞[1] Cheng Yawei;Ding Yi;Cai Yuanyuan;Wang Ting;Huang Jiayan;Wang Shan;Xue Lanxia(Hainan Provincial Hospital of TCM,Haikou 570203,China)

机构地区：[1]海南省中医院

出　　处：《世界科学技术-中医药现代化》2019年第8期1766-1771,共6页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家中医药管理局全国名中医工作室建设项目（琼财社[2018] 186号）：张永杰全国名中医工作室，负责人：邱晓堂;国家中医药管理局中医药传承与创新“百千万”人才工程(岐黄工程)（琼财社[2018]186号）;海南省卫生健康委员会海南省重点专科建设项目（琼卫中医函〔2019〕9号）：海南省治未病中医重点专科建设项目;负责人：程亚伟;第六批全国老中医药专家学术经验继承项目，负责人：程亚伟

摘　　要：目的探讨非酒精性脂肪肝(Non-alcoholic fatty liver disease,NAFLD)中医湿证、非湿证各组与FibroScan-CAP检测结果、血脂、肝功能等指标的关联性。方法 2017年3月至2018年3月,在海南省中医院按照课题纳入标准和排除标准收集NAFLD患者110例,按照中医辨证分为中医湿证组90例(包括:湿浊证组41例、湿热证组33例、痰瘀证组16例)、非湿证组20例(气滞证组),另外收集正常对照组30例。对各组进行肝纤维化脂肪肝一体化诊断检查仪(FibroScan-CAP,502B)检查并抽血检测血脂、肝功能等,比较中医湿证(湿浊证、湿热证、痰瘀证)、非湿证(气滞证)不同组与FibroScan-CAP检测结果、血脂、肝功能等指标的关系。结果①课题组收集到符合要求的NAFLD患者110例,其中,非湿证组(气滞证组)20例(18.2%),湿证组90例(81.8%),湿证患者比例远远大于非湿证患者,提示NAFLD的发生发展与中医湿证关系密切;②中度脂肪肝中,非湿证组(气滞证组)75%占比最大,与湿证三组比较均存在统计学差异(P <0.05)。重度脂肪肝中,非湿证组(气滞证组)与湿证三组比较,差异均存在统计学意义(P <0.05),且痰瘀证组68.7%占比最大,与非湿证组、湿浊证组比较差异存在统计学意义(P <0.05)。提示各组脂肪肝程度排序,从轻到重依次为:非湿证(气滞证)-湿浊证/湿热证-痰瘀证;③对照组、非湿证组、湿证三组之间CAP值、LMS值比较显示递增趋势,依次为:对照组-非湿证组-湿浊证-湿热证-痰瘀证;④对照组、非湿证组、湿证三组之间TC、TG、AST、ALT和GGT表达水平呈递增趋势,依次为对照组-非湿证组-湿浊证-湿热证-痰瘀证。结论非酒精性脂肪肝的发生和发展与中医湿证密切相关,且湿证与FibroScan-CAP检测结果、血脂、肝功能等指标呈正相关,为中医"聚湿成痰、痰瘀互结"理论提供了数据支持,为NAFLD的早诊断、早干预及制定更合理化的管理及诊治方案提供了数�Objective To explore the correlation between dampness syndrome group and non-dampness syndrome group of non-alcoholic fatty liver disease(NAFLD) with the results of FibroScan-CAP, blood lipid, liver function and so on.Methods From March 2017 to March 2018, 110 patients with NAFLD were enrolled in Hainan Province Hospital of Traditional Chinese Medicine according to subject inclusion criteria and exclusion criteria. According to TCM syndrome differentiation, 90 cases were divided into dampness syndrome group(Including: 41 cases of wet muddy syndrome group,33 cases of damp heat syndrome group, 16 cases of phlegm and stasis syndrome group) and 20 cases of non-dampness syndrome group(qi stagnation group). In addition, 30 cases of normal control group were collected. For each group, the liver fibrosis fatty liver integrated diagnostic tester(FibroScan-CAP, 502 B) was used for examination, and blood sampling to detect blood lipids, liver function, etc. The relationship between different dampness syndrome groups(phlegm turbid syndrome group, damp heat syndrome group, phlegm and stasis syndrome group) and non-dampness syndrome group(qi stagnation group) were compared with FibroScan-CAP test results, blood lipids, liver function and other indicators. Results ① Our team collected 110 patients with NAFLD who met the requirements, including 20 cases(18.2%) of non-dampness syndrome group and 90 cases(81.8%) of dampness syndrome group, dampness syndrome group was much larger than the dampness syndrome group, suggesting that the occurrence and development of NAFLD was closely related to dampness syndrome;②In the moderate fatty liver, non-dampness syndrome group(qi stagnation syndrome group) was 75% which it had the largest proportion. Comparison with 3 groups of dampness syndrome, there was a statistical difference(P<0.05) in the severe fatty liver, between the 3 groups of dampness syndrome. Nondampness syndrome group(qi stagnation syndrome group)was compared with three groups of dampness syndrome, and the differences were

关 键 词：非酒精性脂肪肝 中医湿证 FibroScan-CAP 血脂 肝功能 

分 类 号：R2-031[医药卫生—中西医结合]