體檢人群NAFLD患者不同中醫(yī)證型與血糖、血脂、hs-CRP相關(guān)性研究
發(fā)布時(shí)間：2018-11-19 12:55
【摘要】：研究背景:隨著肥胖及代謝綜合征(metabolic syndrome,MS)的全球流行化,非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)目前已成為歐美等發(fā)達(dá)國(guó)家及許多亞洲國(guó)家常見(jiàn)的慢性肝病之一。與地區(qū)、年齡、種族、性別、飲食、運(yùn)動(dòng)、職業(yè)等均有差異性。NAFLD發(fā)病機(jī)制復(fù)雜,目前存在多個(gè)假說(shuō),其中"二次打擊"被普遍認(rèn)同。胰島素抵抗(insulin resistance,IR)為引起第一次打擊的主要環(huán)節(jié),氧化應(yīng)激、脂質(zhì)過(guò)氧化損傷、慢性炎癥等促成對(duì)肝臟的第二次打擊,長(zhǎng)期、反復(fù)的氧化損傷、慢性炎作用誘發(fā)病情發(fā)展,可由單純性脂肪肝發(fā)展至脂肪性肝炎,重者進(jìn)展為纖維化,甚至肝硬化、肝細(xì)胞肝癌。目前大量動(dòng)物實(shí)驗(yàn)及臨床研究顯示NAFLD患者隨著病情輕重出現(xiàn)相應(yīng)生化指標(biāo)的改變,通過(guò)應(yīng)用現(xiàn)代檢驗(yàn)技術(shù)更深入地檢測(cè)如炎癥因子等可客觀了解患病機(jī)體內(nèi)部病理狀態(tài)。中醫(yī)辨證結(jié)合NAFLD實(shí)驗(yàn)室相關(guān)指標(biāo),對(duì)運(yùn)用中醫(yī)治療NAFLD的療效評(píng)價(jià)具有重要價(jià)值。研究目的:本研究旨在通過(guò)對(duì)體檢群體中篩查NAFLD患者進(jìn)行辨證分型,檢測(cè)不同證型患者生化指標(biāo)及hs-CRP水平,以進(jìn)一步探究其與不同證型的相關(guān)性,為臨床上判斷疾病預(yù)后及為患者的健康教育提供客觀化依據(jù)。研究方法:收集中日醫(yī)院健康體檢中心從2016年6月至2017年2月診斷為NAFLD的患者88例,并設(shè)立健康對(duì)照組30例。進(jìn)行問(wèn)卷調(diào)查,全面收集相關(guān)資料。參考相關(guān)指南及標(biāo)準(zhǔn),將病例組分為痰瘀互結(jié)證組,共16例;痰濕內(nèi)阻證組,共20例;濕熱內(nèi)蘊(yùn)證組,共44例;脾虛濕滯證組,共8例;健康組設(shè)為E組,共30例。采用卡方檢驗(yàn)方法了解疾病組與健康組年齡、性別構(gòu)成情況,以及分析不同證型血糖、血脂異常者差異比較;將計(jì)量指標(biāo)符合正態(tài)分布者采用單因素方差分析對(duì)多個(gè)樣本均數(shù)進(jìn)行比較。偏態(tài)分布的計(jì)量資料則使用非參數(shù)檢驗(yàn)對(duì)中位數(shù)進(jìn)行比較分析。通用軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。研究各指標(biāo)在不同組中的異常率,及組間比較有無(wú)差異。結(jié)果:(1)病例組中男性54例(61.36%),女性34例(38.64%),男女比例為1.59:1。病例組平均42.26 ± 11.29歲;健康對(duì)照組男性19例(63.33%),女性 11 例(36.67%),男女比例為 1.73:1,平均 41.77±10.87歲。(2)不同證型組與血糖的關(guān)系:GLU異常占總例數(shù)的21.8%。GLU異常率濕熱內(nèi)蘊(yùn)證痰瘀互結(jié)證痰濕內(nèi)阻證脾虛濕滯證。(3)不同證型組與血脂的關(guān)系:CHO異常者占總?cè)藬?shù)的37.5%,TG異常者占總?cè)藬?shù)的38.6%,HDL-C異常者占總?cè)藬?shù)的23%,LDL-C異常者占總?cè)藬?shù)的20.7%。CHO異常率為:痰濕內(nèi)阻證脾虛濕滯證濕熱內(nèi)蘊(yùn)證痰瘀互結(jié)證,組間異常率具有統(tǒng)計(jì)學(xué)差異(P=0.031);TG異常率為:痰濕內(nèi)阻證濕熱內(nèi)蘊(yùn)證痰瘀互結(jié)證脾虛濕滯證;組間異常率具有統(tǒng)計(jì)學(xué)差異(P=0.000);HDL-C異常率為:濕熱內(nèi)蘊(yùn)證痰瘀互結(jié)證、痰濕內(nèi)阻證脾虛濕滯證,組間異常率比較具有統(tǒng)計(jì)學(xué)意義(P=0.029);LDL-C異常率為:痰瘀互結(jié)證痰濕內(nèi)阻證濕熱內(nèi)蘊(yùn)證脾虛濕滯證,組間異常率比較有統(tǒng)計(jì)學(xué)差異(P=0.005)。TG數(shù)值組間比較示:痰瘀互結(jié)證、痰濕內(nèi)阻證、濕熱內(nèi)蘊(yùn)證組與健康組有統(tǒng)計(jì)學(xué)差異(P=0.001,P=0.000,P=0.000),痰濕內(nèi)阻證、濕熱內(nèi)蘊(yùn)證組與脾虛濕滯證組有統(tǒng)計(jì)學(xué)差異(P=0.049,P=0.018);(4)不同證型與hs-CRP的關(guān)系:hs-CRP數(shù)值組間比較示:痰瘀互結(jié)證組、濕熱內(nèi)蘊(yùn)證組與健康對(duì)照組比較有顯著統(tǒng)計(jì)學(xué)差異(P=0.001,P=0.000)。結(jié)論:(1)本研究表明,NAFLD患者中醫(yī)證型,以濕熱內(nèi)蘊(yùn)證占多數(shù),脾虛濕滯證最少。(2)濕熱內(nèi)蘊(yùn)證、痰瘀互結(jié)證中血糖、血脂異常率較高,且慢性炎癥較為突出。
[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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
本文編號(hào)：2342373
[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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
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