基于因子分析探讨代谢相关脂肪性肝病中医病机特征  

Feature of Pathogenesis of Metabolism-Dysfunction-Related Fatty Liver Disease in Traditional Chinese Medicine:based on Factor Analysis

作　　者：孙学华[1] 罗宇 游丽萍 张景豪 郑超[1] 吕桦[1] 孔晓妮 王灵台[1] 高月求[1] SUN Xuehua;LUO Yu;YOU Liping;ZHANG Jinghao;ZHENG Chao;LYU Hua;KONG Xiaoni;WANG Lingtai;GAO Yueqiu(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,201203)

机构地区：[1]上海中医药大学附属曙光医院,上海201203

出　　处：《中医杂志》2022年第14期1337-1342,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82074336,81874436);上海市科学技术委员会科技计划项目(20S21901600)。

摘　　要：目的探讨代谢相关脂肪性肝病患者的中医病机特征。方法采用横断面研究方法,收集2020年6月至2021年2月在我国华东、华南、华中、华北、西北、西南地区共23家医院就诊的代谢相关脂肪性肝病(MAFLD)患者,采用问卷调查方法制定“代谢相关脂肪性肝病临床流行病学调查表”用于临床信息收集,包括腹部触诊、望面色、饮食、睡眠、腹部问诊、汗出、肢体、胃脘、胸胁、二便、寒热、口渴饮水与口味、头部不适、情志共14个方面的症状体征。运用Excel软件建立代谢相关脂肪性肝病信息数据库,选取其中频率≥10%的症状体征作为统计分析的变量指标。因子提取采用主成分分析法,归纳总结出若干个公因子,对公因子进行病位、病性、病邪证候要素分析后,归纳为若干个中医证型,并统计出现频率。另将MAFLD患者分成未成年组、青年组、中年组、老年组,观察各中医证型在不同年龄组的分布情况。结果共共发放问卷2287份,回收2287份,有效问卷2261份。出现频率≥10%以上的症状指标共48项,以各个症状体征变量作为因子,提取初始特征值>1的因子共15个,累计贡献率达到51%;综合分析公因子的病位、病性、病邪要素情况,病位证素主要在肝、脾、肾,病性证素以实热、阳虚、气虚为主,病邪证素以湿、热、血瘀为主。MAFLD患者最常见证型由高到低分别为脾虚痰湿证、胃热脾虚证、痰瘀互结证、脾肾两虚证、肝郁脾虚证、肝肾阴虚证和湿热蕴结证,频率分别为34.1%、16.1%、14.1%、12.9%、7.3%、6.5%、4.4%。与其他年龄组相比,青年组胃热脾虚证发生频率较高,脾肾两虚证发生频率较低(P<0.05)。结论MAFLD患者主要病位在肝、脾、肾,病性虚实兼夹,证型以脾虚痰湿为主,兼有胃热、痰瘀、阳虚、阴虚等表现,胃热脾虚证在青年患者中多见。Objective(MAFLD)in traditional Chinese medicine(TCM).Methods the MAFLD patients admitted to the 23 hospitals in the East China,South China,Central China,North China,Northwest and Southwest China from 2020 June to 2021 February.The“questionnaire for the clinical epidemiology of MAFLD”was used,and information on 14 kinds of symptoms and signs including abdominal palpation,inspection of the complexion,diet,sleep,abdominal inquiry,sweating,limbs,stomach cavity,chest and rib-side,stool and urine,cold-heat,thirst-drinking water and taste,head discomfort,and emotions were collected.Excel software was used to establish a MAFLD information database,and the symptoms and signs with a frequency of≥10%were selected as the variables for statistical analysis.The principal component analysis was used for factor extraction,by initially identifying common factors and then analyzing the disease location,disease nature,pathological and syndrome elements of the common factors,so as to summarize them into several TCM syndromes and calculate the frequency.MAFLD patients were divided into juvenile group,youth group,middle-aged group and elderly group,and to observe the distribution of TCM syndromes in different age groups.Results valid.There were 48 symptom variables with a frequency≥10%.Taking each symptom and sign variable as a factor,a total of 15 factors with an initial eigenvalue>1 were extracted,and the cumulative contribution rate reached 51%.The disease location,disease nature,and pathogenic factors of the common factors were analyzed,showing that the syndrome elements regarding the disease location were mainly involved with the liver,spleen,and kidney,while that relating to disease nature were mainly excess heat,yang deficiency and qi deficiency,and that relating to pathogenesis were mainly dampness,heat and blood stasis.The most common syndromes of MAFLD patients were spleen deficiency and phlegm-damp syndrome(34.1%),stomach heat and spleen deficiency syndrome(16.1%),binding of phlegm and stasis syndrome(14.1%),spleen

关 键 词：代谢相关脂肪性肝病 中医证型 胃热脾虚证 因子分析 

分 类 号：R259[医药卫生—中西医结合]