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学校代码:
10600
学号:
082003
学位类型:
科学学位
广西中医学院
硕士学位论文
非酒精性脂肪性肝病中医证型与血清生化指标的相关性研究
研究生:
邓静
导师:
黄彬教授
院系(部所):
瑞康临床医学院
专业:
中医内科学
研究方向:
肝脏疾病的中西医结合防治
完成日期:
2011年4月27日
目录
中文摘要················································1
英文摘要················································3
引言·················································6
正文·················································7
1文献研究················································7
2临床研究···············································17
2.1临床资料·············································17
2.2研究方法·············································21
3结果···················································23
4讨论···················································27
5存在的问题和展望·······································31
结论················································33
参考文献···············································34
附录················································37
综述················································39
致谢················································48
攻读学位期间发表的学术论文目录···························48
作者声明···············································50
个人简历···············································51
主要缩略词
英文缩写
英文全称
中文名称
NAFLD
nonalcoholicfattyliverdisease
非酒精性脂肪性肝病
NAFL
nonalcoholicsimplefattyliver
非酒精性脂肪肝
NASH
nonalcoholicsteatohepatitis
非酒精性脂肪性肝炎
IR
insulinresistance
胰岛素抵抗
ALT
alanineaminotransferase
丙氨酸氨基转移酶
AST
aspartateaminotransferase
天冬氨酸氨基转移酶
GGT
gamma-glutamyltranspeptidase
谷氨酰转移酶
ALP
alkalinephosphatase
碱性磷酸酶
TG
triglyceride
甘油三酯
TC
totalcholesterol
总胆固醇
HDL
high-densitylipoprpteincholesterol
高密度脂蛋白
LDL
low-densitylipoprpteincholesterol
低密度脂蛋白
FPG
fastingplasmaglucose
空腹血糖
-50-
中文摘要
目的:
研究非酒精性脂肪性肝病(NAFLD)患者中医证型与实验室常用血清生化指标之间的关系,为中医辨证分型提供客观依据,为中西医结合防治NAFLD提供理论依据。
方法:
采用横断面研究方法,对自2010年10月至2011年3月广西中医学院附属瑞康医院体检中心体检者中及肝胆内科就诊者中,符合入组条件的150例NAFLD患者进行中医辨证分型,并记录其实验室常用血清生化指标,应用统计学分析方法处理所获得的信息与资料。
结果:
(1)150例患者平均年龄44.46岁,中位数44.50岁,40~50岁者最多(43.33%),男女比例为1.94:
1;
(2)肝郁脾虚证为NAFLD最常见证型(39.33%),男女患者均多属肝郁脾虚证;(3)B超检查150例患者多为轻度弥漫性脂肪肝(56.66%);(4)ALT肝郁脾虚证与其余证型有极显著性差异(P<0.01),肝郁脾虚证检测结果在正常参考值范围,其余证型检测结果高于正常参考值上限,其中肝肾不足者升高最高,痰浊壅阻者升高最低,肝肾不足>痰瘀互结>湿热内蕴>痰浊壅阻;AST各证型间无差异(P>0.05),检测结果均在正常参考值范围;GGT湿热内蕴证与其余证型有极显著性差异(P<0.01),湿热内蕴证检测结果在正常参考值范围,其余证型检测结果高于正常参考值上限,其中痰瘀互结者升高最高,肝郁脾虚者升高最低,痰瘀互结>肝肾不足>痰浊壅阻>肝郁脾虚;ALP痰瘀互结证与肝郁脾虚证有极显著性差异(P<0.01),痰瘀互结证检测结果高于正常参考值上限,其余证型检测结果在正常参考值范围;(5)TG肝郁脾虚证与其余证型有极显著性差异(P<0.01),肝郁脾虚证检测结果在正常参考值范围,其余证型检测结果高于正常参考值上限,其中痰瘀互结者升高最高,湿热内蕴者升高最低,痰瘀互结>肝肾不足>痰浊壅阻>湿热内蕴;HDL痰瘀互结证与其余证型有显著性差异(P<0.05),各证型检测结果均较正常值减低,其中痰瘀互结者减低最明显。
TC、LDL各证型间无差异(P>0.05),检测结果均在正常参考值范围;(6)FPG肝郁脾虚证与其他证型有极显著性差异(P<0.01),肝郁脾虚证检测结果在正常参考值范围,其余证型检测结果高于正常参考值上限,其中肝肾不足者升高最高,痰瘀互结者升高最低,肝肾不足>痰浊壅阻>湿热内蕴>痰瘀互结。
结论:
①NAFLD患者年龄多在40岁~50岁之间,男性患病率明显高于女性;②NAFLD患者多见于肝郁脾虚证;③B超检查多数NAFLD患者为轻度弥漫性脂肪肝;④NAFLD患者肝功能损害均较轻,其中肝肾不足者肝功能损害最明显,痰浊壅阻、湿热内蕴、痰瘀互结者肝功能损害轻微,肝郁脾虚者肝功能几乎未受损害;⑤NAFLD患者TG升高,HDL降低,TC、LDL正常。
痰瘀互结者脂质代谢紊乱最重,湿热内蕴者脂质代谢紊乱轻微,肝郁脾虚者几乎不存在脂质代谢紊乱;⑥NAFLD患者除肝郁脾虚者FPG正常,其余患者FPG均增高,其中肝肾不足者FPG升高最明显,痰浊壅阻、湿热内蕴、痰瘀互结,FPG虽有升高,但个体间差异不大。
关键词:
非酒精性脂肪性肝病;中医证型;生化指标
ResearchonMultipleParametersofTypingaccordingtoSyndromeDifferentiationinNAFLD
Abstract
Objective:
Researchonrelationshipbetweenbiochemicalindexesandsyndromedifferentiationofpatientswithnonalcoholicfattyliverdisease(NA-
FLD),offordsobjectiveindexestosyndromedifferentiation.
Methods:
Applylingtocross-sectionalstudymethod,150NAFLDpatientsthatwererecruitedfromDec2010toMar2011weretypedbythetraditionalmedicinedifferentialdiagnosis,andrecordedtheirbiochemicalindexes,analyzedtheinvestigationresultbystatistics.
Results:
(1)Theaverageageofthe150NAFLDpatientsare44.46,medianis44.5,moreofthemare40~50yearsold(43.33%),theproportionbetweenmenandwomenis1.94:
1;
(2)GanyupixuisthemostcommonsymptomofNAFLD(39.33%).Mostofmenandwomenpatientsbelongtoganyupixusyndrome;(3)Mostofthe150NAFLDpatientsaremildNALFD(56.66%);(4)ComparedwithotherssyndromesinALTindex,theganyupixusyndromepresentsverysignificantdifferent(P<0.01),theALTindexofganyupisusyndromeisnormal,theALTindexofotherssyndromesarehigherthannormal,ganshenbuzusyndromeisthehighest,ganshenbuzu>tanyuhujie>shireneiyun>tanzhuoyunzu;ThereisnovariousdifferentineverysyndromeinASTindex(P>0.05);ComparedwithotherssyndromesinGGTindex,theshireneiyunsyndromepresentsverysignificantdifferent(P<0.01),theGGTindexofshireneiyunsyndromeisnormal,theGGTindexofotherssyndromesarehigherthannormal,tanyuhujiesyndromeisthehighest,tanyuhujie>ganshenbuzu>tanzhuoyunzu>gan