基于肝脏磁共振质子密度脂肪分数研究非酒精性脂肪肝病患者中医证候分布及临床特征  

The distribution of TCM syndromes and the clinical characteristics of nonalcoholic fatty Liver disease on the base of magnetic resonance imaging proton density fat fraction

作　　者：徐祥涛[1] 史会连[1] 陈冉 陈沁磊 张帆 乔飞[1] XU Xiang-tao;SHI Hui-lian;CHEN Ran;QIAO Fei(Department of Infectious Diseases,Jiangsu Province Hospital of Chinese Medicine,(Nanjing,210029),China.)

机构地区：[1]江苏省中医院感染科,江苏南京210029

出　　处：《中西医结合肝病杂志》2023年第9期790-794,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家自然科学基金学青年科学基金项目(No.81903974);江苏省自然科学基金(No.BK20221421);江苏省科学技术厅2022年江苏省第一批产学研合作项目(No.BY2022016)。

摘　　要：目的:探讨基于肝脏磁共振质子密度脂肪分数(MRI-PDFF)下非酒精性脂肪性肝病(NAFLD)患者的中医证候分布及临床特征。方法:选取2018年1月1日至2022年9月1日于江苏省中医院感染科就诊的NAFLD患者165人,进行身高、体重、体脂百分比的测量及中医辨证分型,检测患者的天门冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、碱性磷酸酶(AKP)、谷氨酰转移酶(GGT)、总胆红素(TBil)、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)水平,在此基础上计算血脂代谢模型:TC/HDL、LDL/HDL、TG/HDL、LDL/(TBil+HDL)、TC/(TBil+HDL)。对部分住院患者行肝穿刺活检病理检查。结果:165例NAFLD患者中医证型分布:肝郁脾虚证(35.2%)>湿浊内停证(27.9%)>湿热蕴结证(26.7%)>痰瘀互结证(6.7%)>脾肾两虚证(3.6%),不同MRI-PDFF水平的脂肪肝患者之间的中医证候分布、年龄、性别、BMI、体脂百分比均无明显差异。不同MRI-PDFF水平的脂肪肝患者之间ALT、AST、GGT、TC、LDL、ApoB、ApoE有统计学差异;重度NAFLD患者中,ALT>2×ULN的比例明显高于轻度和中度(χ^(2)=6.825,P=0.033)。血脂代谢模型中,各组之间的TC/HDL、LDL/HDL有统计学差异。不同程度MRI-PDFF水平的肝脏病理下的脂肪量有统计学差异,而炎症分级、纤维化分级无统计学差异。结论:肝郁脾虚证为NAFLD最常见的证候,肝脏的脂肪含量的与肝功能异常及脂质代谢的异常有一定的相关性。Objective:To investigate the distribution of TCM syndromes and the clinical characteristics of nonalcoholic fatty liver disease(NAFLD)on the base of magnetic resonance imaging proton density fat fraction.Methods:A total of 165 patients with NAFLD were recruited from January 2018 to September 2022,the height,weight and TCM syndromes were tested in all patients and alanine aminotransferas(ALT),aspartate aminotransfrase(AST),alkaline phosphatase(AKP),glutamyltransferase(GGT),total bilirubin(TBil),triglyceride(TG),total cholesterol(TC),lowdensitylipoprotein(LDL),highdensitylipoprotein(HDL),appolipoprotein A1(ApoA1),appolipoprotein B(ApoB),appolipoprotein E(ApoE)were also analyzed.Lipid metabolism models including TC/HDL,LDL/HDL,TG/HDL,LDL/(TBil+HDL),and TC/(TBil+HDL)were calculated.Results:The distribution of comparison of TCM syndromes among NAFLD was liver depression and spleen deficiency(35.2%)>internal obstruction syndrome of dampness(27.9%)>dampness-heat accumulating(26.7%)>phlegm and blood knot(6.7%)>deficiency of liver and kidney(3.6%).The age,gender,BMI,and body fat percentage have no significant difference among different levels of MRI-PDFF,while ALT,AST,GGT,TC,LDL,ApoB,ApoE,TC/HDL,LDL/HDL differed significantly among different levels of MRI-PDFF.The rate of severe NAFLD patients with ALT>2×ULN was significantly higher than moderate and light NAFLD.The fat degeneration of liver histological pathology differed significantly among different levels of MRI-PDFF,while the live inflammation and live fibrosis had no significant difference among different levels of MRI-PDFF.Conclusion:Liver depression and spleen deficiency was the most common syndrome of NAFLD patients.The liver fat content has a correlation with liver function and lipid metabolism.

关 键 词：非酒精性脂肪肝病 中医证候 磁共振成像 质子密度脂肪分数 

分 类 号：R575[医药卫生—消化系统]