PDF下载 ( 2031 KB)
非酒精性脂肪性肝病中医证型及证素研究
DOI: 10.3969/j.issn.1001-5256.2021.01.018
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突，特此声明。
作者贡献声明：高改娅、李莎、薛敬东负责提出研究选题及研究方案的设计；高改娅、白艳艳、惠友谊负责研究过程的实施及数据的收集整理；高改娅负责数据的分析、论文框架的设计、文章的撰写；薛敬东负责论文的修改及最终定稿。
Traditional Chinese medicine syndrome types and syndrome elements of nonalcoholic fatty liver disease
-
摘要:
目的 探讨和归纳非酒精性脂肪性肝病(NAFLD)的证型及证素分布规律。 方法 检索知网、万方、维普数据库自建库至2020年7月关于NAFLD辨证的相关文献资料，由两名研究者依据纳、排标准分别独立进行文献筛选、证型收集总结，证名规范化、证型再分解、证素提取，建立Excel 2010数据库，导入SPSS 25.0统计软件进行数据频数分布统计。 结果 收集到符合条件文献45篇，报道病例总数8703例，经规范化后得到证型14种，证型拆解后获得病性证素10个，病位证素4个。证型分布以肝郁脾虚证(26.47%)、湿热蕴结证(22.16%)最为常见，其次是痰湿内阻证、痰瘀互结证、肝郁气滞证。病性证素以湿(23.75%)、气滞(19.82%)、气虚(17.12%)、痰(15.43%)、热(12.13%)最常见，其次是瘀、阴虚、阳虚，而火、寒则较少见，组合分布以气滞、气虚相兼(26.63%)，湿、热相兼(22.30%)，痰、湿相兼(16.17%)，痰、瘀相兼(12.19%)致病最多见。病位证素以肝、脾多见，占构成比的90.95%，组合分布以肝、脾同病为主，占54.01%。证素组合有一、二、三、四证素组合方式，以二证素组合为多，占76.03%。 结论 肝郁脾虚是NAFLD基本病机，肝、脾、湿、气滞、气虚、痰、热为常见证素，湿、痰、热是本病发生发展的重要因素。 Abstract:Objective To investigate the distribution of traditional Chinese medicine (TCM) syndrome types and syndrome elements of nonalcoholic fatty liver disease (NAFLD). Methods Related databases (CNKI, Wanfang Dota, and VIP)were searched for articles on the syndrome differentiation of NAFLD published up to July 2020. Two investigators independently performed literature screening and collection and summarization of syndrome types based on the inclusion and exclusion criteria, and an Excel 2010 database was established after the standardization of syndrome names, re-decomposition of syndrome types, and extraction of syndrome elements. The data were imported into SPSS 25.0 statistical software for the analysis of frequency distribution. Results A total of 45 qualified articles were collected, with a total of 8703 cases reported. A total of 14 syndrome types were obtained after standardization, and 10 syndrome elements reflecting the nature of disease and 4 syndrome elements of disease location were obtained after the syndrome types were disassembled. Stagnation of liver Qi and spleen deficiency syndrome (26.47%) and damp-heat accumulation syndrome (22.16%) were the most common syndrome types, followed by stagnation of phlegm dampness, intermingled phlegm and blood stasis, and stagnation of liver Qi and Qi stagnation. Dampness (23.75%), Qi stagnation (19.82%), Qi deficiency (17.12%), phlegm (15.43%), and heat (12.13%) were the most common syndrome elements reflecting the nature of disease, followed by stasis, Yin deficiency, and Yang deficiency, while fire and cold were relatively uncommon. Qi stagnation and Qi deficiency (26.63%), dampness and heat (22.30%), phlegm and dampness (16.17%), and phlegm and stasis (12.19%) were the most common combinations of syndrome elements. The liver and the spleen were the most common syndrome elements of disease location, accounting for 90.95% of the constituent ratio, and the combination of the liver and the spleen with the same disease accounted for 54.01%. The combination of one, two, three, or four syndrome elements was observed, and the combination of two syndrome elements accounted for 76.03%. Conclusion Stagnation of liver Qi and spleen deficiency are the basic pathogeneses of NAFLD, and liver, spleen, dampness, Qi stagnation, Qi deficiency, phlegm, and heat are common syndrome elements. Dampness, phlegm, and heat are important factors for the development and progression of this disease. -
Key words:
- Non-alcoholic Fatty Liver Disease /
- Symptom Complex /
- TCM Science
-
表 1 文献证型及证素提取表
证型 例数 证素 肝郁气滞证 779 肝，气滞 肝郁脾虚证 2304 肝，气滞，脾，气虚 脾虚湿盛证 420 脾，气虚，湿 痰湿内阻证 1399 痰，湿 湿热蕴结证 1929 湿，热 痰瘀互结证 1055 痰，瘀 肝肾亏虚证 432 肝，肾，阴虚 肝郁化火证 65 肝，气滞，火 脾肾两虚证 220 脾，肾，阳虚 瘀血阻络证 51 血瘀 气滞血瘀证 3 气滞，血瘀 肝胃不和证 2 肝，胃，气滞 肝火炽盛证 13 肝，火 寒湿困脾证 31 寒，湿，脾 
下载: 导出CSV
表 2 NAFLD证型分布特征
证型 例数(%) 肝郁脾虚证 2304(26.47) 湿热蕴结证 1929(22.16) 痰湿内阻证 1399(16.07) 痰瘀互结证 1055(12.12) 肝郁气滞证 779(8.95) 肝肾亏虚证 432(4.96) 脾虚湿盛证 420(4.83) 脾肾两虚证 220(2.53) 肝郁化火证 65(0.75) 瘀血阻络证 51(0.59) 寒湿困脾证 31(0.36) 肝火炽盛证 13(0.15) 气滞血瘀证 3(0.03) 肝胃不和证 2(0.02)
下载: 导出CSV
表 4 病位证素组合分布
病位证素 频次(次) 频率(%) 肝、脾 2304 54.01 肝 857 20.09 脾 451 10.57 肝、肾 432 10.13 脾、肾 220 5.16 肝、胃 2 0.05
下载: 导出CSV
表 5 病性证素分布特征
病性证素 频次(次) 频率(%) 湿 3779 23.75 气滞 3153 19.82 气虚 2724 17.12 痰 2454 15.43 热 1929 12.13 瘀 1109 6.97 阴虚 432 2.72 阳虚 220 1.38 火 78 0.49 寒 31 0.19
下载: 导出CSV
表 6 病性证素组合分布
病性证素 频次(次) 频率(%) 气滞、气虚 2304 26.63 湿、热 1929 22.30 痰、湿 1399 16.17 痰、瘀 1055 12.19 气滞 781 9.03 阴虚 432 4.99 气虚、湿 420 4.85 阳虚 220 2.54 寒、湿 31 0.36 气滞、火 65 0.75 火 13 0.15 气滞、血瘀 3 0.03
下载: 导出CSV
表 7 证素组合形式
组合形式 证素组合 频次(次) 频率(%) 一证素 一病性证素 51 0.35 二证素组合 二病性证素 10 386 70.64 一病位证素+一病性证素 792 5.39 三证素组合 一病位证素+二病性证素 516 3.51 二病位证素+一病性证素 654 4.45 四证素组合 二病位证素+二病性证素 2304 15.67
下载: 导出CSV
表 8 二证素组合分布
证素组合形式 病位证素 病性证素 组合证型 频次(次) 频率(%) 二病性证素 痰、湿 痰湿内阻证 1399 27.02 湿、热 湿热蕴结证 1929 37.25 痰、瘀 痰瘀互结证 1055 20.37 气滞、血瘀 气滞血瘀证 3 0.06 一病位证素+一病性证素 肝、气滞 肝郁气滞证 779 15.04 肝、火 肝火炽盛证 13 0.25
下载: 导出CSV
表 9 三证素组合分布
证素组合形式 病位证素 病性证素 组合证型 频次(次) 频率(%) 一病位证素+二病性证素 脾 气虚、湿 脾虚湿盛证 420 35.90 脾 寒、湿 寒湿困脾证 31 2.65 肝 气滞、火 肝郁化火证 65 5.56 二病位证素+一病性证素 肝、肾 阴虚 肝肾阴虚证 432 36.92 肝、胃 气滞 肝胃不和证 2 0.17 脾、肾 阳虚 脾肾阳虚证 220 18.80
下载: 导出CSV
-
[1] WANG FS, FAN JG, ZHANG Z, et al. The global burden of liver disease: The major impactof China[J]. Hepatology, 2014, 60(6): 2099-2108. DOI: 10.1002/hep.27406 [2] WEI GC, HE JY. TCM constitution identification for the treatment of nonalcoholic fatty liver disease[J]. J Changchun Univ Chin Med, 2018, 34(3): 518-521. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201803034.htm魏功昌, 何瑾瑜. 中医体质辨识治疗非酒精性脂肪性肝病[J]. 长春中医药大学学报, 2018, 34(3): 518-521. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201803034.htm [3] WANG MM, WANG GS, SHEN F, et al. Hepatic steatosis is highly prevalent in hepatitis B patients and negatively associated with virological factors[J]. Dig Dis Sci, 2014, 59(10): 2571-2579. DOI: 10.1007/s10620-014-3180-9 [4] ZHANG ZB, WANG YY. The establishment of a new system of syndrome differentiation[J]. J Beijing Univ Tradit Chin Med, 2005, 28(1): 1-3. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB200501001.htm张志斌, 王永炎. 辨证方法新体系的建立[J]. 北京中医药大学学报, 2005, 28(1): 1-3. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB200501001.htm [5] ZHU YF. Create a new system with syndrome differentiation as the core[J]. J Hunan Coll Tradit Chin Med, 2004, 24(6): 38-39. (in Chinese) DOI: 10.3969/j.issn.1674-070X.2004.06.013朱永锋. 创立以证素辨证为核心的新体系[J]. 湖南中医学院学报, 2004, 24(6): 38-39. DOI: 10.3969/j.issn.1674-070X.2004.06.013 [6] Fatty Liver and Alcoholic Liver Disease Group of the Chinese Medical Association Hepatology Branch. Guidelines for the diagnosis and treatment of non-alcoholic fatty liver disease[J]. J Pract Hepatol, 2007, 10(1): 1-3. (in Chinese) DOI: 10.3969/j.issn.1672-5069.2007.01.001中华医学会肝脏病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南[J]. 实用肝脏病杂志, 2007, 10(1): 1-3. DOI: 10.3969/j.issn.1672-5069.2007.01.001 [7] Fatty Liver and Alcoholic Liver Disease Group of the Chinese Society of Liver Diseases. Guidelines for the diagnosis and treatment of non-alcoholic fatty liver disease (2010 revised edition)[J]. J Clin Hepatol, 2010, 26(2): 120-124. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201207005.htm中华医学会肝病学会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南(2010年修订版)[J]. 临床肝胆病杂志, 2010, 26(2): 120-124. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201207005.htm [8] Digestive System Disease Professional Committee of Chinese Integrative Medicine Association.Consensus opinions on diagnosis and treatment of non-alcoholic fatty liver disease with integrated traditional Chinese and Western medicine[J]. Chin J Integr Tradit West Med, 2011, 31(2): 155-158. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW201711002.htm中国中西医结合学会消化系统疾病专业委员会. 非酒精性脂肪性肝病的中西医结合诊疗共识意见[J]. 中国中西医结合杂志, 2011, 31(2): 155-158. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW201711002.htm [9] Fatty Liver and Alcoholic Liver Disease Group, Chinese Medical Association Hepatology Branch, Fatty Liver Disease Expert Committee of Chinese Medical Doctor Association. Guidelines for prevention and treatment of non-alcoholic fatty liver disease (2018 Update)[J]. J Clin Hepatol, 2018, 34(5): 947-957. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.05.007中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007 [10] ZHU WF. Diagnostics of Traditional Chinese Medicine[M]. Beijing: China Press of Traditional Chinese Medicine, 2002: 139, 236. (in Chinese)朱文峰. 中医诊断学[M]. 北京:中国中医药出版社, 2002: 139, 236. [11] ZHU WF. Syndrome differentiation[M]. Beijing: People's Medical Publishing House, 2008: 36, 230-259. (in Chinese)朱文峰. 证素辨证学[M]. 北京:人民卫生出版社, 2008: 36, 230-259. [12] YAO NL. Differential diagnosis of TCM symdrome(2nd Edition)[M]. Beijing: People's Medical Publishing House, 2002: 122-455. (in Chinese)姚乃礼. 中医证候鉴别诊断学(第2版)[M]. 北京:人民卫生出版社, 2002: 122-455. [13] LI ZG, JIANG HX, JIAO YT, et al. Literature analysis on the distribution of TCM syndromes of non-alcoholic fatty liver disease[J]. Chin J Tradit Chin Med, 2017, 32(10): 4713-4715. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201710106.htm李志国, 姜韩雪, 焦云涛, 等. 非酒精性脂肪性肝病中医证型分布的文献分析[J]. 中华中医药杂志, 2017, 32 (10): 4713-4715. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201710106.htm [14] XU L, MI YQ, LI P. Study on the objectification of TCM syndromes of non-alcoholic fatty liver[J]. Chin J Tradit Chin Med, 2015, 30(7): 2544-2547. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201507092.htm徐亮, 宓余强, 李萍. 非酒精性脂肪肝中医证型客观化研究[J]. 中华中医药杂志, 2015, 30(7): 2544-2547. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201507092.htm [15] ZHU WF. A review of the ancient and modern concepts of syndrome elements[J]. Hunan J Tradit Chin Med, 2004, 10(11): 1. (in Chinese) DOI: 10.3969/j.issn.1672-951X.2004.11.001朱文锋. 对古今有关证素概念的梳理[J]. 湖南中医药导报, 2004, 10(11): 1. DOI: 10.3969/j.issn.1672-951X.2004.11.001 -
本文二维码
表(9)
计量
- 文章访问数: 940
- HTML全文浏览量: 176
- PDF下载量: 88
- 被引次数: 0
