饮食习惯对非酒精性脂肪性肝病的影响及其中医证型与血脂、血糖的相关性研究

发布时间：2018-03-28 02:34

  本文选题：非酒精性脂肪性肝病　切入点：饮食习惯　出处：《北京中医药大学》2017年硕士论文

【摘要】：背景非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是一种无过量饮酒史,以肝实质细胞脂肪变性和脂肪沉积为特征的临床病理综合征。随着人们生活水平提高、饮食结构和生活方式的改变,我国NAFLD的患病率逐年攀升。然而NAFLD的发病机理并不完全清楚,可能是多种因素共同作用的结果,与肥胖、糖耐量异常或糖尿病、血脂异常等代谢危险因素密切相关,可能与饮食习惯有关。目的调查和研究NAFLD患者的临床特点、饮食习惯和中医证型,分析饮食与NAFLD的关系,中医证型与血脂、血糖的关系,为NAFLD患者提供临床建议和合理的饮食指导。对象和方法招募于2016年6月至2017年2月在中日友好医院健康体检中心体检的非酒精性脂肪性肝病(NAFLD)患者和健康志愿者,需符合纳入标准,进行问卷调查。全面收集其临床资料,检验血清学生化指标,进行中医辨证。最后,采用病例对照研究方法进行统计学分析。结果1.一般资料共收集到有效资料118例。其中病例组88例,健康对照组30例。病例组中男性54例(61.36%),女性34例(38.64%),男女比例为1.59:1。病例组中年龄最大69岁,最小23岁,平均42.26± 11.29岁;男性平均年龄39.19±1.42岁,女性平均年龄47.15±1.90岁。从年龄结构可以看出,女性以50-59年龄段分布最多,占女性患者的41.2%,而男性则以30-39年龄段分布最多,占男性患者的53.70%。病例组与健康对照组在性别、年龄方面均无差异(P=0.848,P=0.450)。2.体重指数(BMI)病例组BMI正常范围者21例,体重指数高于正常者67例,其中超重者39例,肥胖者28例。病例组BMI显著高于健康对照组(P=0.000)。3.腰围病例组腰围值有效例数84例(其中男性51例,女性33例)。病例组男性腰围正常范围者7例,中心型肥胖前期者6例,中心型肥胖者38例;女性腰围正常范围者5例,中心型肥胖前期者8例,中心型肥胖者20例。病例组男、女腰围显著高于健康对照组(P=0.000,P=0.007)。4.腰臀比病例组与健康对照组在腰臀比方面未见差异(P=0.185)。5.生化指标病例组的肝功能(ALT、AST、GGT、ALP)、血糖、血脂(CHO、TG、LDL-C)尿酸水平均高于健康对照组(P0.05或P0.01);病例组的HDL-C水平显著低于健康对照组(P=0.000)。但病例组 AST、GGT、ALP、DBIL、GLU、HDL-C、UA均值水平均处于正常范围内,故不能认为病例组与健康对照组该指标方面存在统计学差异。6.饮食习惯与健康对照组相比,病例组在进食肉食等食物、油炸食物、烧烤食物、干炒食物、进食辛味食物/调料频次方面显著增加(P值均0.01);而在规律饮食、饮食搭配、进食辣椒的频次方面无差异(P值均0.05)。7.病例组中医证型的分布证型由多向少依次为:湿热内蕴证44例(50%)、痰湿内阻证20例(22.73%)、痰瘀互结证16例(18.18%)、脾虚湿滞证8例(9.09%)。8.NAFLD不同证型血糖、血脂水平比较痰湿内阻证、湿热内蕴证的TG水平高于脾虚湿滞证(P=0.049,P=0.018)。其他各组间血脂、血糖比较未见统计学差异(P值均0.05)。结论1.肥胖尤其是腰围增加者应该警惕NAFLD的发生,从超重和中心型肥胖前期开始加强监测,及早进行干预;2.对于NAFLD患者或高危患者应建议减少高脂肪、高蛋白食物的摄入;对健康者建议减少高脂肪、高蛋白食物的摄入以保持健康;3.NAFLD的中医证型可能以实证最为常见;4.NAFLD的痰湿内阻证、湿热内蕴证与高脂饮食关系密切。
[Abstract]:The background of nonalcoholic fatty liver disease (nonalcoholic fatty liver disease, NAFLD) is a kind of no history of excessive alcohol consumption, with hepatocyte steatosis and fat deposition characteristics of clinical pathological syndrome. With the improvement of people's life, diet and lifestyle changes, the prevalence of NAFLD in China is increasing year by year. However, the pathogenesis of NAFLD is not entirely clear, may be the result of many factors, and obesity, glucose intolerance or diabetes, dyslipidemia and other metabolic risk factors are closely related, may be related to eating habits. The investigation and Research on the clinical features of NAFLD patients, eating habits and TCM syndrome types, analysis of the relationship between diet with NAFLD, TCM syndrome type and blood lipids, blood glucose, and provide clinical recommendations and reasonable diet guidance for patients with NAFLD. The objects and methods of recruitment in June 2016 to February 2017 in the Sino Japanese Friendship Nonalcoholic fatty liver disease hospital health examination center examination (NAFLD) patients and healthy volunteers, to meet the inclusion criteria, conducted a questionnaire survey. All the clinical data collection, serological test and biochemical index, TCM differentiation. Finally, a case-control study was used for statistical analysis. Results of the 1. general data collected effective data in 118 cases. 88 cases, 30 cases of healthy control group. Patients in 54 male patients (61.36%), 34 cases of female (38.64%), the proportion of men and women aged 1.59:1. patients in 69 years, the minimum age of 23, average 42.26 + 11.29 years old; male with an average age of 39.19 + 1.42 years old, the average woman age 47.15 + 1.90 years old. From the age structure can be seen, women in 50-59 age distribution of most female patients accounted for 41.2%, while men in the 30-39 age distribution of male patients accounted for most cases of 53.70%. group and the healthy control group 鍦ㄦ，

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