非酒精性脂肪性肝病中医证型与谷氨酰转肽酶及其组分的相关性研究

发布时间：2018-05-10 16:35

本文选题：非酒精性脂肪性肝病 + 中医证型　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：文献检索发现,当前关于NAFLD中医证型的研究关注重点,主要包括证型与肝功能、血脂、肝纤维化、血液流变学、体质等因素的关系,很少有从炎症氧化应激状态层面探讨该病证型分布特点。因此本文选择与本病炎症氧化应激密切相关的GGT为主要观测指标,分析GGT及其组分(GGT2、GGT3、GGT6)与本病中医证型的关系,有助于了解它们在发病机制中的作用,以期提高在临床诊断中的利用率。方法：对收集到的281例非酒精性脂肪肝患者进行问卷调查,收集患者的相关资料。观察内容包括：性别、年龄、身高、体重、肝功能(ALT, AST, GGT)、血脂(TC、TG, HDLC、LDLC)、空腹血糖、B超等；检测GGT组分(GGT2、 GGT3、GGT6);根据填写的中医证候积分表,按2011年制定的《中西医诊疗共识意见》中医分型标准,判定患者的中医证型。最后对指标进行统计,并分析GGT组分与中医证型的相关性。结果：1.281例患者中,男性232人,女性49人。患者的年龄集中在30到60岁之间,并且发病有年轻化趋势。2.NAFLD常见于超重及肥胖者,占80.4%,其中超重患者所占比重最大,占58%,部分NAFLD患者的BMI无明显升高,占19.6%。3.281例患者中合并高血压137例,糖尿病41例,血脂紊乱174例,所占比例分别为48.7%、14.5%、61.9%。4.在281例患者中,十种中医证型所占比例从高到低依次为：肝郁化火、肝郁脾虚、湿热蕴结、肝气郁结、湿浊内停、肝胃不和、脾虚湿阻、阴虚内热、肝肾阴虚、肝火炽盛以及少数病例无证可辨。其中以肝郁化火证型最多,所占比例为23.1%。5.肝郁化火、肝郁脾虚、湿热蕴结、肝气郁结、湿浊内停这五组证型在ALT、AST、TG、TC、HDLC、LDLC方面的差异均无统计学意义,而各组GGT之间差异有统计学意义@=0.041)。6.五组证型中,湿热蕴结组GGT2、GGT3及GGT6分布相对集中,GGT2指标与各证型之间差异有统计学意义,F值=2.565,P=-0.041,其余GGT3、GGT6指标各证型之间差异无统计学意义。结论：1.非酒精性脂肪性肝病的高发年龄,多集中于30-60岁的超重及肥胖者,男性多余女性。2.本病的合并症中,以血脂异常患者所占比例最高。3.本病的中医分型,以肝郁化火证人数最多。4.GGT三个组分与湿热蕴结证关系密切。
[Abstract]:Objective: to find that the current research focus on TCM syndromes of NAFLD mainly includes the relationship between syndromes and liver function, lipids, liver fibrosis, hemorheology, physique and so on. It is rare to explore the distribution of the syndrome types from the state of inflammatory oxidative stress. Therefore, GGT closely related to inflammatory and oxidative stress was selected as the main observation index, and the relationship between GGT and its component, GGT2, GT3, GGT6, and TCM syndromes of the disease was analyzed, which was helpful to understand their role in the pathogenesis of the disease. In order to improve the utilization rate in clinical diagnosis. Methods: 281 patients with non-alcoholic fatty liver were investigated by questionnaire. The contents of the observation include: sex, age, height, weight, liver function, alt, AST, GGTG, TCG, HDLCL, fasting blood glucose, B-ultrasound, etc. The components of GGT, such as GGT2, GGT3, GGT6, were detected. According to the traditional Chinese medicine diagnosis and treatment consensus made in 2011, Chinese medicine classification standard, to determine the patient's TCM syndrome type. Finally, the index was statistically analyzed, and the correlation between GGT components and TCM syndromes was analyzed. Results among 1.281 patients, 232 were male and 49 were female. The age of the patients was between 30 and 60 years old, and the incidence of NAFLD was younger. 2. NAFLD was common in overweight and obesity patients, accounting for 80.4% of them. The proportion of overweight patients was the largest (58%), and the BMI of some NAFLD patients had no significant increase. There were 137 cases of hypertension, 41 cases of diabetes mellitus and 174 cases of dyslipidemia in 19.63.281 patients. The proportion of them were 48.7 and 14.51.9. In 281 patients, the proportion of ten TCM syndromes was from high to low: liver stagnation and fire, liver stagnation and spleen deficiency, damp-heat accumulation knot, liver qi stagnation, dampness and turbid internal arrest, liver and stomach disharmony, spleen deficiency dampness obstruction, yin deficiency internal heat, liver and kidney yin deficiency. The liver-fire was incandescent and a few cases could not be distinguished. The syndrome of liver depression and fire was the most common, accounting for 23.1. 5. There was no significant difference in the five syndrome types of liver depression and fire, liver depression and spleen deficiency, dampness and heat accumulation, liver qi stagnation and dampness stagnation in all the five groups. There was no significant difference in GGT between the five groups, but there was a significant difference between the five groups. Among the five syndrome types, there were significant differences in GGT2 GGT3 and GGT6 distribution between GGT2GGT3 and GGT2 and each syndrome type, but there was no significant difference between the other GGT3 and GGT6 indexes in the five syndrome types (P < 0. 565, P < 0. 041, P < 0. 041), while there was no significant difference between the other GGT3 / GGT6 and the other GGT3 / GGT6. Conclusion 1. The high incidence age of non-alcoholic fatty liver disease is mainly concentrated in overweight and obese people aged 30-60 years, male superfluous female. 2. In the complications of the disease, dyslipidemia accounted for the highest proportion of. 3. According to the TCM classification of this disease, the three components of GGT were closely related to dampness and heat accumulation syndrome.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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