本文選題：非酒精性脂肪性肝病　切入點(diǎn)：飲食習(xí)慣　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是一種無過量飲酒史,以肝實(shí)質(zhì)細(xì)胞脂肪變性和脂肪沉積為特征的臨床病理綜合征。隨著人們生活水平提高、飲食結(jié)構(gòu)和生活方式的改變,我國NAFLD的患病率逐年攀升。然而NAFLD的發(fā)病機(jī)理并不完全清楚,可能是多種因素共同作用的結(jié)果,與肥胖、糖耐量異�；蛱悄虿　⒀惓５却x危險因素密切相關(guān),可能與飲食習(xí)慣有關(guān)。目的調(diào)查和研究NAFLD患者的臨床特點(diǎn)、飲食習(xí)慣和中醫(yī)證型,分析飲食與NAFLD的關(guān)系,中醫(yī)證型與血脂、血糖的關(guān)系,為NAFLD患者提供臨床建議和合理的飲食指導(dǎo)。對象和方法招募于2016年6月至2017年2月在中日友好醫(yī)院健康體檢中心體檢的非酒精性脂肪性肝病(NAFLD)患者和健康志愿者,需符合納入標(biāo)準(zhǔn),進(jìn)行問卷調(diào)查。全面收集其臨床資料,檢驗(yàn)血清學(xué)生化指標(biāo),進(jìn)行中醫(yī)辨證。最后,采用病例對照研究方法進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.一般資料共收集到有效資料118例。其中病例組88例,健康對照組30例。病例組中男性54例(61.36%),女性34例(38.64%),男女比例為1.59:1。病例組中年齡最大69歲,最小23歲,平均42.26± 11.29歲;男性平均年齡39.19±1.42歲,女性平均年齡47.15±1.90歲。從年齡結(jié)構(gòu)可以看出,女性以50-59年齡段分布最多,占女性患者的41.2%,而男性則以30-39年齡段分布最多,占男性患者的53.70%。病例組與健康對照組在性別、年齡方面均無差異(P=0.848,P=0.450)。2.體重指數(shù)(BMI)病例組BMI正常范圍者21例,體重指數(shù)高于正常者67例,其中超重者39例,肥胖者28例。病例組BMI顯著高于健康對照組(P=0.000)。3.腰圍病例組腰圍值有效例數(shù)84例(其中男性51例,女性33例)。病例組男性腰圍正常范圍者7例,中心型肥胖前期者6例,中心型肥胖者38例;女性腰圍正常范圍者5例,中心型肥胖前期者8例,中心型肥胖者20例。病例組男、女腰圍顯著高于健康對照組(P=0.000,P=0.007)。4.腰臀比病例組與健康對照組在腰臀比方面未見差異(P=0.185)。5.生化指標(biāo)病例組的肝功能(ALT、AST、GGT、ALP)、血糖、血脂(CHO、TG、LDL-C)尿酸水平均高于健康對照組(P0.05或P0.01);病例組的HDL-C水平顯著低于健康對照組(P=0.000)。但病例組 AST、GGT、ALP、DBIL、GLU、HDL-C、UA均值水平均處于正常范圍內(nèi),故不能認(rèn)為病例組與健康對照組該指標(biāo)方面存在統(tǒng)計(jì)學(xué)差異。6.飲食習(xí)慣與健康對照組相比,病例組在進(jìn)食肉食等食物、油炸食物、燒烤食物、干炒食物、進(jìn)食辛味食物/調(diào)料頻次方面顯著增加(P值均0.01);而在規(guī)律飲食、飲食搭配、進(jìn)食辣椒的頻次方面無差異(P值均0.05)。7.病例組中醫(yī)證型的分布證型由多向少依次為:濕熱內(nèi)蘊(yùn)證44例(50%)、痰濕內(nèi)阻證20例(22.73%)、痰瘀互結(jié)證16例(18.18%)、脾虛濕滯證8例(9.09%)。8.NAFLD不同證型血糖、血脂水平比較痰濕內(nèi)阻證、濕熱內(nèi)蘊(yùn)證的TG水平高于脾虛濕滯證(P=0.049,P=0.018)。其他各組間血脂、血糖比較未見統(tǒng)計(jì)學(xué)差異(P值均0.05)。結(jié)論1.肥胖尤其是腰圍增加者應(yīng)該警惕NAFLD的發(fā)生,從超重和中心型肥胖前期開始加強(qiáng)監(jiān)測,及早進(jìn)行干預(yù);2.對于NAFLD患者或高�；颊邞�(yīng)建議減少高脂肪、高蛋白食物的攝入;對健康者建議減少高脂肪、高蛋白食物的攝入以保持健康;3.NAFLD的中醫(yī)證型可能以實(shí)證最為常見;4.NAFLD的痰濕內(nèi)阻證、濕熱內(nèi)蘊(yùn)證與高脂飲食關(guān)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，

本文編號：1674397