目的 探讨非酒精性脂肪肝（Non-alcoholic fatty liver disease，NAFLD）中医湿证、非湿证各组与FibroScan-CAP检测结果、血脂、肝功能等指标的关联性。方法 2017年3月-2018年3月，在海南省中医院按照课题纳入标准和排除标准收集NAFLD患者110例，按照中医辨证分为中医湿证组90例（包括：湿浊证组41例、湿热证组33例、痰瘀证组16例）、非湿证组20例（气滞证组），另外收集正常对照组30例。对各组进行肝纤维化脂肪肝一体化诊断检查仪（FibroScan-CAP，502B）检查并抽血检测血脂、肝功能等，比较中医湿证（湿浊证、湿热证、痰瘀证）、非湿证（气滞证）不同组与FibroScan-CAP检测结果、血脂、肝功能等指标的关系。结果 ①课题组收集到符合要求的NAFLD患者110例，其中，非湿证组（气滞证组）20例（18.2%），湿证组90例（81.8%），湿证患者比例远远大于非湿证患者，提示NAFLD的发生发展与中医湿证关系密切；②中度脂肪肝中，非湿证组（气滞证组）75%占比最大，与湿证三组比较均存在统计学差异（P < 0.05）。重度脂肪肝中，非湿证组（气滞证组）与湿证三组比较，差异均存在统计学意义（P < 0.05），且痰瘀证组68.7%占比最大，与非湿证组、湿浊证组比较差异存在统计学意义（P < 0.05）。提示各组脂肪肝程度排序，从轻到重依次为：非湿证（气滞证）-湿浊证/湿热证-痰瘀证；③对照组、非湿证组、湿证三组之间CAP值、LMS值比较显示递增趋势，依次为：对照组-非湿证组-湿浊证-湿热证-痰瘀证；④对照组、非湿证组、湿证三组之间TC、TG、AST、ALT和GGT表达水平呈递增趋势，依次为对照组-非湿证组-湿浊证-湿热证-痰瘀证。结论 非酒精性脂肪肝的发生和发展与中医湿证密切相关，且湿证与FibroScan-CAP检测结果、血脂、肝功能等指标呈正相关，为中医“聚湿成痰、痰瘀互结”理论提供了数据支持，为NAFLD的早诊断、早干预及制定更合理化的管理及诊治方案提供了数据支持和思路。
Objective To explore the correlation between dampness syndrome group and non-dampness syndrome group of non-alcoholic fatty liver disease (NAFLD) with the results of FibroScan-CAP, blood lipid, liver function and so on.Methods From March 2017 to March 2018, 110 patients with NAFLD were enrolled in Hainan Province Hospital of Traditional Chinese Medicine according to subject inclusion criteria and exclusion criteria. According to TCM syndrome differentiation, 90 cases were divided into dampness syndrome group (Including: 41 cases of wet muddy syndrome group, 33 cases of damp heat syndrome group, 16 cases of phlegm and stasis syndrome group) and 20 cases of non-dampness syndrome group (qi stagnation group). In addition, 30 cases of normal control group were collected. For each group, the liver fibrosis fatty liver integrated diagnostic tester (FibroScan-CAP, 502B) was used for examination, and blood sampling to detect blood lipids, liver function, etc. The relationship between different dampness syndrome groups (phlegm turbid syndrome group, damp heat syndrome group, phlegm and stasis syndrome group) and non-dampness syndrome group (qi stagnation group) were compared with FibroScan-CAP test results, blood lipids, liver function and other indicators.Results ① Our team collected 110 patients with NAFLD who met the requirements, including 20 cases (18.2%) of non-dampness syndrome group and 90 cases (81.8%) of dampness syndrome group, dampness syndrome group was much larger than the dampness syndrome group, suggesting that the occurrence and development of NAFLD was closely related to dampness syndrome; ②In the moderate fatty liver, non-dampness syndrome group (qi stagnation syndrome group) was 75% which it had the largest proportion. Comparison with 3 groups of dampness syndrome, there was a statistical difference (P＜0.05) in the severe fatty liver, between the 3 groups of dampness syndrome. Non-dampness syndrome group (qi stagnation syndrome group）was compared with three groups of dampness syndrome, and the differences were statistically significant (P＜0.05). Phlegm and stasis syndrome group was 68.7% which it had the largest proportion. Comparison with the non-dampness syndrome group and the dampness turbid syndrome group, there was a statistical difference (P＜0.05). It is suggested that the degree of fatty liver in each group was ranked from light to heavy: non-dampness syndrome group (qi stagnation syndrome group) - phlegm turbid syndrome group/damp heat syndrome group-phlegm and stasis syndrome group;③Comparison of CAP value and LMS value among control group, non-dampness syndrome group, and dampness syndrome group showed an increasing trend, followed by: non dampness syndrome group – phlegm turbid syndrome group-damp heat syndrome group-phlegm and stasis syndrome group；④ TC, TG, AST, ALT and GGT expression in control group, non-dampness syndrome group, and dampness syndrome group showed an increasing trend, followed by: non-dampness syndrome group-phlegm turbid syndrome group-damp heat syndrome group-phlegm and stasis syndrome group.Conclusion The occurrence and development of NAFLD is closely related to dampness syndrome, and dampness syndrome is positively correlated with FibroScan-CAP test results, blood lipids, liver function and other indicators, provided data support for the theory of dampness together into phlegm and phlegm and blood often together, and provides data support and ideas for early diagnosis, early intervention, and more rational management, diagnosis and treatment plan for NAFLD.
＊ ＊海南省自然科学基金项目 817342;海南省治未病中医重点专科建设项目 琼卫中医函〔2019〕9号;国家中医药管理局“张永杰全国名中医工作室”项目 补充项目编号＊ ＊海南省自然科学基金项目（817342）：基于CAP技术探讨酒精性脂肪肝中医湿证与脂肪度的关联性研究，负责人：程亚伟；海南省治未病中医重点专科建设项目（琼卫中医函〔2019〕9号）：补充项目名称，负责人：程亚伟；国家中医药管理局“张永杰全国名中医工作室”项目（补充项目编号）：项目名称，负责人：邱晓堂。