体检人群NAFLD患者不同中医证型与血糖、血脂、hs-CRP相关性研究

发布时间：2018-11-19 12:55

【摘要】：研究背景:随着肥胖及代谢综合征(metabolic syndrome,MS)的全球流行化,非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)目前已成为欧美等发达国家及许多亚洲国家常见的慢性肝病之一。与地区、年龄、种族、性别、饮食、运动、职业等均有差异性。NAFLD发病机制复杂,目前存在多个假说,其中"二次打击"被普遍认同。胰岛素抵抗(insulin resistance,IR)为引起第一次打击的主要环节,氧化应激、脂质过氧化损伤、慢性炎症等促成对肝脏的第二次打击,长期、反复的氧化损伤、慢性炎作用诱发病情发展,可由单纯性脂肪肝发展至脂肪性肝炎,重者进展为纤维化,甚至肝硬化、肝细胞肝癌。目前大量动物实验及临床研究显示NAFLD患者随着病情轻重出现相应生化指标的改变,通过应用现代检验技术更深入地检测如炎症因子等可客观了解患病机体内部病理状态。中医辨证结合NAFLD实验室相关指标,对运用中医治疗NAFLD的疗效评价具有重要价值。研究目的:本研究旨在通过对体检群体中筛查NAFLD患者进行辨证分型,检测不同证型患者生化指标及hs-CRP水平,以进一步探究其与不同证型的相关性,为临床上判断疾病预后及为患者的健康教育提供客观化依据。研究方法:收集中日医院健康体检中心从2016年6月至2017年2月诊断为NAFLD的患者88例,并设立健康对照组30例。进行问卷调查,全面收集相关资料。参考相关指南及标准,将病例组分为痰瘀互结证组,共16例;痰湿内阻证组,共20例;湿热内蕴证组,共44例;脾虚湿滞证组,共8例;健康组设为E组,共30例。采用卡方检验方法了解疾病组与健康组年龄、性别构成情况,以及分析不同证型血糖、血脂异常者差异比较;将计量指标符合正态分布者采用单因素方差分析对多个样本均数进行比较。偏态分布的计量资料则使用非参数检验对中位数进行比较分析。通用软件进行数据统计分析。研究各指标在不同组中的异常率,及组间比较有无差异。结果:(1)病例组中男性54例(61.36%),女性34例(38.64%),男女比例为1.59:1。病例组平均42.26 ± 11.29岁;健康对照组男性19例(63.33%),女性 11 例(36.67%),男女比例为 1.73:1,平均 41.77±10.87岁。(2)不同证型组与血糖的关系:GLU异常占总例数的21.8%。GLU异常率湿热内蕴证痰瘀互结证痰湿内阻证脾虚湿滞证。(3)不同证型组与血脂的关系:CHO异常者占总人数的37.5%,TG异常者占总人数的38.6%,HDL-C异常者占总人数的23%,LDL-C异常者占总人数的20.7%。CHO异常率为:痰湿内阻证脾虚湿滞证湿热内蕴证痰瘀互结证,组间异常率具有统计学差异(P=0.031);TG异常率为:痰湿内阻证湿热内蕴证痰瘀互结证脾虚湿滞证;组间异常率具有统计学差异(P=0.000);HDL-C异常率为:湿热内蕴证痰瘀互结证、痰湿内阻证脾虚湿滞证,组间异常率比较具有统计学意义(P=0.029);LDL-C异常率为:痰瘀互结证痰湿内阻证湿热内蕴证脾虚湿滞证,组间异常率比较有统计学差异(P=0.005)。TG数值组间比较示:痰瘀互结证、痰湿内阻证、湿热内蕴证组与健康组有统计学差异(P=0.001,P=0.000,P=0.000),痰湿内阻证、湿热内蕴证组与脾虚湿滞证组有统计学差异(P=0.049,P=0.018);(4)不同证型与hs-CRP的关系:hs-CRP数值组间比较示:痰瘀互结证组、湿热内蕴证组与健康对照组比较有显著统计学差异(P=0.001,P=0.000)。结论:(1)本研究表明,NAFLD患者中医证型,以湿热内蕴证占多数,脾虚湿滞证最少。(2)湿热内蕴证、痰瘀互结证中血糖、血脂异常率较高,且慢性炎症较为突出。
[Abstract]:Background: With the global prevalence of obesity and metabolic syndrome (MS), nonalcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver diseases in developed countries and many Asian countries. There are differences in the area, age, race, sex, diet, sports, occupation, etc. The pathogenesis of NAFLD is complex, and there are many hypotheses, in which the "secondary blow" is generally accepted. Insulin resistance (IR) is the main link to the first strike, oxidative stress, lipid peroxidation injury, chronic inflammation, etc., which contribute to the second blow to the liver, long-term, repeated oxidative damage, and chronic inflammatory action to induce the development of the disease. can be developed from simple fatty liver to steatohepatitis, and the serious disease is fibrosis, even liver cirrhosis, and hepatocellular carcinoma. At present, a large number of animal experiments and clinical studies have shown that the NAFLD patients have changed the corresponding biochemical indexes with the severity of the disease, and the internal pathological state of the diseased body can be objectively known through the application of modern test technology, such as the inflammatory factors. The TCM syndrome differentiation combined with the relevant index of the NAFLD is of great value to the evaluation of the effectiveness of the treatment of NAFLD by using the traditional Chinese medicine. Objective: The purpose of this study was to test the biochemical index and hs-CRP level in the patients with NAFLD in the physical examination group to further explore the correlation with the different syndrome types. so as to provide an objective basis for clinically determining the prognosis of the disease and providing the health education of the patient. Methods: 88 patients with NAFLD were diagnosed as NAFLD from June 2016 to February 2017, and 30 healthy controls were established. Questionnaire survey and comprehensive collection of relevant data. With reference to the relevant guidelines and standards, the cases were divided into two groups of phlegm and blood stasis, 16 cases were in total, there were 20 cases of the phlegm-dampness internal resistance syndrome group, total of 20 cases of the damp-heat internal syndrome group, total of 44 cases, and the spleen-deficiency-dampness-stagnation syndrome group, 8 cases, and the healthy group was set to the E group and the total of 30 cases. The age and sex composition of the disease group and the healthy group were studied by means of the card-side test method, and the differences of blood glucose and blood lipid were compared with those of the normal distribution, and the average number of the multiple samples was compared with the one-factor analysis of variance. The measured data of the off-state distribution is compared and analyzed using the non-quantitative test. General software is used for data statistical analysis. The abnormal rate of each index in different groups and the difference between groups were studied. Results: (1) There were 54 males (61. 36%) and 34 females (38. 64%) in the case group. The male and female ratio was 1.59: 1. The mean 42. 26-11. 29-year-old in the case group, 19 (63. 33%) in the healthy control group, 11 (36. 67%) in the female, and 1.73: 1 in the male and female, with an average of 41. 77 and 10. 87 years. (2) The relationship between the different syndrome group and the blood sugar: GLU was 21. 8% of the total number. The abnormal rate of GLU was damp-heat, the phlegm and blood stasis and the phlegm-damp internal resistance syndrome and the dampness-stagnation syndrome. (3) The relationship between the different syndrome type group and the blood fat: the total number of the CHO-abnormal patients was 37. 5%, the total number of the patients with TG was 38. 6%, the total number of the abnormal HDL-C was 23%, and the LDL-C was 26.7% of the total. The abnormal rate of CHO was: the phlegm-dampness internal resistance syndrome, the damp-heat internal syndrome of the damp-heat and the syndrome of the phlegm and blood stasis in the damp-heat syndrome, The abnormal rate among the groups was statistically different (P = 0. 031); the abnormal rate of TG was: the phlegm-dampness internal resistance syndrome, the damp-heat internal syndrome, the syndrome of phlegm and blood stasis, and the dampness-stagnation syndrome; the abnormal rate among the groups was statistically different (P = 0.000); the abnormal rate of HDL-C was: the syndrome of phlegm and blood stasis, the syndrome of phlegm and blood stasis, the phlegm-dampness internal resistance and the dampness-stagnation syndrome. The abnormal rate among the groups was statistically significant (P = 0. 029), and the abnormal rate of LDL-C was: the syndrome of phlegm and blood stasis and the syndrome of damp-heat in the damp-heat of the phlegm-damp internal resistance syndrome, and the abnormal rate among the groups was statistically different (P = 0.05). There was a significant difference between the group and the healthy group (P = 0.001, P = 0.000, P = 0.000), the internal resistance of the phlegm and the internal resistance of the phlegm, the combination of the damp-heat and the damp-heat syndrome group (P = 0. 049, P = 0. 018), and (4) the relation between the different syndrome type and the hs-CRP. There was a significant difference between the group and the healthy control group (P = 0.001, P = 0.000). Conclusion: (1) The present study shows that the syndrome of the traditional Chinese medicine of NAFLD is the majority of the syndrome of dampness and heat, and the syndrome of spleen deficiency and dampness is the least. (2) The abnormal rate of blood glucose and blood fat in the syndrome of damp-heat and phlegm-blood stasis is higher, and the chronic inflammation is more prominent.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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