非酒精性脂肪性肝病中医证型分布及证候特点研究

作者	单位
叶蕾	浙江大学医学院附属第一医院中医科
吴国琳	浙江大学医学院附属第一医院中医科
卢雯雯	浙江大学医学院附属第一医院中医科
李剑平	浙江省中医院肝病科
范小芬	浙江大学医学院附属第一医院中医科
邓银泉	浙江大学医学院附属第一医院中医科
陈夏凉	浙江省中医院肝病科

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中文摘要:

目的探索非酒精性脂肪性肝病中医证型的分布及中医证候特点,为建立中医证型辨证标准提供依据。方法采用临床流行病学调查方法对928例非酒精性脂肪性肝病患者症状、体征、舌脉象四诊资料进行调查,并运用聚类分析及因子分析法对调查结果进行数理统计分析。结果聚类分析提示脂肪肝患者中医证型分为湿热内蕴、脾虚湿痰、肝郁脾虚、痰瘀互结、肝肾不足5类证型比较符合临床实际。因子分析提示超重/肥胖、胁胀、胁痛、肝区不适是脂肪肝患者共有的"病情因子";湿热内蕴、脾虚湿痰、肝郁脾虚、痰瘀互结、肝肾不足5个"证候因子"对证型分类具有鉴别意义。结论非酒精性脂肪性肝病的基本中医证型为湿热内蕴证、脾虚湿痰证、肝郁脾虚证、痰瘀互结证、肝肾不足证。脂肪肝患者的四诊资料经数理统计分析可分为疾病共有的"病情因子"和反映中医证型特点的"证候因子"两大类,可为初步建立脂肪肝辨证标准提供一定的依据。

英文摘要:

Objective To supply evidence for establishing the standard for Chinese medicine (CM) syndrome differentiation by investigating the distribution and characteristics of CM syndromes in patients with nonalcoholic fatty liver disease (NAFLD). Methods 928 NAFLD patients′ symptoms, signs, tongue and pulse parameters were studied by clinical epidemiologic survey. And the results were analyzed by the cluster analysis and factor analysis. Results The results of cluster analysis showed that the CM syndrome typings of fatty liver patients were mainly classified as dampness heat accumulation, Pi deficiency with dampness phlegm, Gan-qi stagnation and Pi deficiency, phlegm stasis accumulation, and Gan-Shen insufficiency, which were in accordance with clinical practice. The results of factor analysis indicated that overweight/obesity, abdominal distension, hypochondriac pain, discomfort in the hepatic region were common "condition factors" of fatty liver patients. The 5 "syndrome factors" such as dampness heat accumulation, Pi deficiency with dampness phlegm, Gan-qi stagnation and Pi deficiency, phlegm stasis accumulation, and Gan-Shen insufficiency showed identification significance in syndrome typing. Conclusions The basic CM syndrome typings of NAFLD were dampness heat accumulation, Pi deficiency with dampness phlegm, Gan-qi stagnation and Pi deficiency, phlegm stasis accumulation, and Gan-Shen insufficiency. The four parameters of fatty liver patients could be classified by statistical analysis as condition factors and syndrome factors (which could reflect CM syndrome characteristics), which could provide certain evidence for establishing CM syndrome differentiation standards.

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