香港地区非酒精性脂肪肝的危险因素和证候规律的研究
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摘要
非酒精性脂肪肝是指无过量饮酒史,而肝实质细胞变性和肝细胞内脂肪蓄积(主要为三酯甘油)为特征的临床病理综合征。它是肝脏脂肪代谢功能障碍,脂类物质动态平衡失调,致使肝细胞内脂肪蓄积过多的一种病理状态。中医学无非酒精性脂肪肝明确记载,根据发病特点及临床表现可归属于“积证”、“瘀证”、“胁痛”、“痰浊”及“肥气”等范畴,是消化系统常见的病症,也是一种发病率相对较高的疾病。
本论文通过理论研究与临床研究两部分,对脂肪肝的相关问题进行了探讨,利用文献研究与统计学的分析相结合,探求脂肪肝的辨证规律,结合中医理论与现代营养学,进一步发展辨证在饮食行为方面的研究。如此有利于学科日后对其发病机理的深入了解,为临床治疗与科研提供依据,并为预防和治疗非酒精性脂肪肝开辟新的途径。
理论研究
本研究部分总结了脂肪肝的概念、分类与主要诊断方法,以及流行病学研究概况;讨论了中医对脂肪肝证候的研究重点,并说明饮食因素在本病研究中的重要价值。希望通过研究的结果,进一步明确脂肪肝的发病危险因子,研究导致发病与症状加重的一般规律,归纳脂肪肝的中医证型。
临床研究
1.非酒精性脂肪肝患者发病危险因素研究
本研究分析了所有符合非酒精性脂肪肝病例标准的150例病例。主要调查指标包括患者的性别、年龄、体重指数分布情况。一般资料中,非酒精性脂肪肝患者的性别分布,总体男性多于女性。与国内外的研究结果,非酒精性脂肪肝患病发病率男性高于女性一致。年龄分布,普遍较年长,41～60岁的病例占了74.0%。在本调查中,41～50岁病例最多(39.0%)。肥胖所致脂肪肝约占发病人数的70%以上,肥胖病人常有不同程度的脂肪肝,常伴有高脂血症。
2.非酒精性脂肪肝患者症状与证候特征研究
本研究通过统计非酒精性脂肪肝症状的发生频率,筛选出非酒精性脂肪肝常见的症状,再将收集的每一位患者病历资料进行证候评定,筛选出非酒精性脂肪肝常见的证候。结果发现痰瘀互结、肝郁脾虚、湿热内蕴、气滞血瘀和肝肾阴虚为非酒精性脂肪肝患者临床证候出现频率较高者。综合非酒精性脂肪肝发病与症状加重因素,及非酒精性脂肪肝的症状与证候特征分析,显示本研究的结果与许多医家临床总结相近,认为肝失疏泄,脾失健运,湿热内蕴,痰浊内结,瘀血阻滞,最终形成痰瘀互结,痹阻于肝脏脉络。本病病位在肝,涉及脾、肾两脏功能失调。
3.非酒精性脂肪肝患者饮食特征研究
本研究调查非酒精性脂肪肝患者饮食特征,拜分析本病各常见中医证候的饮食规律。运用病例-对照研究法,由研究人员调查非酒精性脂肪肝组及正常对照组(各150例)的饮食习惯,包括寒、热偏嗜,荤、素偏嗜,蛋白质、脂类的偏嗜等三个专项;引入现代营养学的概念与计量方法,讨论几种饮食特征与本病及本病主要证候的联系。
结果发现,脂肪肝组偏低蛋白人数占13.33%,偏高脂人质数高达85.33%,相对于正常对照组而言,非酒精性脂肪肝组为偏高脂的饮食特征,和偏低蛋白饮食特征没有重要意义。高脂饮食的非酒精性脂肪肝患者的研究结果,提示了高脂饮食特征与非酒精性脂肪肝可能存在相关性。在非酒精性脂肪肝患者临床证候与寒热饮食特征的研究中,偏寒饮食的有43.93%为痰瘀互结证型,偏热饮食者湿热内蕴证型最多见,占30.23%,间接地证明了中医重视寒热饮食偏嗜,辨寒热证候的科学性。
Non-alcoholic fatty liver disease(NAFLD) is fatty inflammation (steatohepatitis) and scarring(steatonecrosis) of the liver caused by an accumulation of fat deposits in the liver tissue when this is not due to excessive alcohol use.The NAFLD is a kind of disease due to imbalance liver metabolic syndrome,resulting excessive fat deposits pathology. Fatty liver disease is not found in ancestor Chinese Medicine.According to its pathology and clinical manifestation,fatty liver disease should fall into Chinese Medicine categories of "accumulation","blood stasis", "chest pain" and "sputum",NAFLD is an extremely common medical condition with a kind of high morbidity disease.This paper discussed the several factors relationg to the onset of NAFLD,with respect to the revisiting of the theoretical principles and the statistical analysis of the clinical data being collected.
Theoretical studies
The project aimed to redefine the definition for NAFLD as well as to put the observed symptoms into several specific classifications.This project not only recapped the common methods currently used in clinical diagnosis,but also provided updates of the active progress in the present epidemiological research.The project focused on discussion of the existing groups of traditional symptom complexes,as well as the ability to identify these complexes using the diagnostic methods in traditional Chinese medicine.The great importance of dietary preferences of victims,in triggering the onset of NAFLD,was also highlighted.Upon this,it was then possible to summarize the various commonly encountered symptom complexes of NAFLD,applying the principles applied in TCM diagnostics.The explanation of the findings also integrated the knowledge of both the basic principles in TCM and those of modern nutritional studies.Thus,this study not only aided the accuracy in clinical diagnosis at the point of onset of the illness,but also provided significant scientific evidence for future clinical research and development.This has unknowingly open doors to prevention medicine and its related clinical treatments for NAFLD.
Clinical studies
1.The identification of life-threatening genes in NAFLD sufferers
150 related clinical case studies were collected and analyzed,using the diagnostic standards as reference for diagnosing NAFLD.The aim of this part of the project was to investigate the factors which might play a crucial role in triggering NAFLD,which included genders,age and obesity of the sufferers.In general,the findings showed that individuals between 40 to 50 years old made up the biggest proportion,standing at 39%from all the cases observed.Furthermore,obesity related NAFLD occupied 70%in the 150 cases.Obese patients having different level of NAFLD always come with hyperlipaemia or high blood content triglyceride.
2.The study of distinctive symptoms and specific characteristics of symptom complexes in diagnosing NAFLD.
A list of the common distinctive symptoms was put together using the outbreak frequencies done in the statistical analysis for NAFLD. Evaluation tests were then carried out for each case study by a Hong Kong Registered Chinese Medicine Practitioner,to filter out the viability of the several different common symptom complexes observed.The results showed that the most common symptom complexes are "sputum and blood stasis","congested live and weak spleen","damp and heat", "gas stasis and blood stasis" and "deficiency of liver and kidney".The analysis for the study of distinctive symptoms and specific characteristics of symptom complexes are aligned with most Chinese medicine practitioners.It is believed that the malfunctioning of liver and spleen,sputum,blood stasis,damp and heat all contributes to formation of liver meridian congestion of "sputum and blood stasis".Liver originated and imbalance of spleen and kidney are main pathogenesis of NAFLD.
3.The investigation of dietary preferences in NAFLD
Further studies were carried out to investigate the effects of dietary preferences had on NAFLD.Several dietary patterns unique to each common symptom complex were also explored using the TCM diagnostic skills.Combining the theoretical and clinical findings,both the tested groups and control groups(150 samples were observed for each group) were closely studied and compared.It was found that there were three distinctive dietary preferences which were commonly seen in victims of NAFLD.This included specified preferences to a) food of coldor warm-natural properties,b) diets of mixed or solely vegetarian orientation,and c) food with different amounts of proteins and fats.With the introduction of the principles and measuring methods applicable to modern nutritional studies,there were several types of dietary conditions which were found to be closely associated with NAFLD and its related symptom complexes.The results showed that those individuals,who had a strong preference in food of low-protein contents,exhibited no tendencies in NAFLD,at a rate of 13.33%.While those who preferred food with high fat-contents stood out at a proportion of only 85.33%.The result was significant after comparing with the control groups.In addition, it was found that cold-nature diet patients occupying 43.93%"sputum and blood stasis" symptom complex.It was also found that 30.23%of the overall cases were classified under the "damp and heat" symptom complex for individuals who preferred warm-nature diets.It indirectly proved that Chinese medicine diagnosis has its scientific basis in questioning the preferred ware and cold nature diets.
本论文通过理论研究与临床研究两部分,对脂肪肝的相关问题进行了探讨,利用文献研究与统计学的分析相结合,探求脂肪肝的辨证规律,结合中医理论与现代营养学,进一步发展辨证在饮食行为方面的研究。如此有利于学科日后对其发病机理的深入了解,为临床治疗与科研提供依据,并为预防和治疗非酒精性脂肪肝开辟新的途径。
理论研究
本研究部分总结了脂肪肝的概念、分类与主要诊断方法,以及流行病学研究概况;讨论了中医对脂肪肝证候的研究重点,并说明饮食因素在本病研究中的重要价值。希望通过研究的结果,进一步明确脂肪肝的发病危险因子,研究导致发病与症状加重的一般规律,归纳脂肪肝的中医证型。
临床研究
1.非酒精性脂肪肝患者发病危险因素研究
本研究分析了所有符合非酒精性脂肪肝病例标准的150例病例。主要调查指标包括患者的性别、年龄、体重指数分布情况。一般资料中,非酒精性脂肪肝患者的性别分布,总体男性多于女性。与国内外的研究结果,非酒精性脂肪肝患病发病率男性高于女性一致。年龄分布,普遍较年长,41～60岁的病例占了74.0%。在本调查中,41～50岁病例最多(39.0%)。肥胖所致脂肪肝约占发病人数的70%以上,肥胖病人常有不同程度的脂肪肝,常伴有高脂血症。
2.非酒精性脂肪肝患者症状与证候特征研究
本研究通过统计非酒精性脂肪肝症状的发生频率,筛选出非酒精性脂肪肝常见的症状,再将收集的每一位患者病历资料进行证候评定,筛选出非酒精性脂肪肝常见的证候。结果发现痰瘀互结、肝郁脾虚、湿热内蕴、气滞血瘀和肝肾阴虚为非酒精性脂肪肝患者临床证候出现频率较高者。综合非酒精性脂肪肝发病与症状加重因素,及非酒精性脂肪肝的症状与证候特征分析,显示本研究的结果与许多医家临床总结相近,认为肝失疏泄,脾失健运,湿热内蕴,痰浊内结,瘀血阻滞,最终形成痰瘀互结,痹阻于肝脏脉络。本病病位在肝,涉及脾、肾两脏功能失调。
3.非酒精性脂肪肝患者饮食特征研究
本研究调查非酒精性脂肪肝患者饮食特征,拜分析本病各常见中医证候的饮食规律。运用病例-对照研究法,由研究人员调查非酒精性脂肪肝组及正常对照组(各150例)的饮食习惯,包括寒、热偏嗜,荤、素偏嗜,蛋白质、脂类的偏嗜等三个专项;引入现代营养学的概念与计量方法,讨论几种饮食特征与本病及本病主要证候的联系。
结果发现,脂肪肝组偏低蛋白人数占13.33%,偏高脂人质数高达85.33%,相对于正常对照组而言,非酒精性脂肪肝组为偏高脂的饮食特征,和偏低蛋白饮食特征没有重要意义。高脂饮食的非酒精性脂肪肝患者的研究结果,提示了高脂饮食特征与非酒精性脂肪肝可能存在相关性。在非酒精性脂肪肝患者临床证候与寒热饮食特征的研究中,偏寒饮食的有43.93%为痰瘀互结证型,偏热饮食者湿热内蕴证型最多见,占30.23%,间接地证明了中医重视寒热饮食偏嗜,辨寒热证候的科学性。
Non-alcoholic fatty liver disease(NAFLD) is fatty inflammation (steatohepatitis) and scarring(steatonecrosis) of the liver caused by an accumulation of fat deposits in the liver tissue when this is not due to excessive alcohol use.The NAFLD is a kind of disease due to imbalance liver metabolic syndrome,resulting excessive fat deposits pathology. Fatty liver disease is not found in ancestor Chinese Medicine.According to its pathology and clinical manifestation,fatty liver disease should fall into Chinese Medicine categories of "accumulation","blood stasis", "chest pain" and "sputum",NAFLD is an extremely common medical condition with a kind of high morbidity disease.This paper discussed the several factors relationg to the onset of NAFLD,with respect to the revisiting of the theoretical principles and the statistical analysis of the clinical data being collected.
Theoretical studies
The project aimed to redefine the definition for NAFLD as well as to put the observed symptoms into several specific classifications.This project not only recapped the common methods currently used in clinical diagnosis,but also provided updates of the active progress in the present epidemiological research.The project focused on discussion of the existing groups of traditional symptom complexes,as well as the ability to identify these complexes using the diagnostic methods in traditional Chinese medicine.The great importance of dietary preferences of victims,in triggering the onset of NAFLD,was also highlighted.Upon this,it was then possible to summarize the various commonly encountered symptom complexes of NAFLD,applying the principles applied in TCM diagnostics.The explanation of the findings also integrated the knowledge of both the basic principles in TCM and those of modern nutritional studies.Thus,this study not only aided the accuracy in clinical diagnosis at the point of onset of the illness,but also provided significant scientific evidence for future clinical research and development.This has unknowingly open doors to prevention medicine and its related clinical treatments for NAFLD.
Clinical studies
1.The identification of life-threatening genes in NAFLD sufferers
150 related clinical case studies were collected and analyzed,using the diagnostic standards as reference for diagnosing NAFLD.The aim of this part of the project was to investigate the factors which might play a crucial role in triggering NAFLD,which included genders,age and obesity of the sufferers.In general,the findings showed that individuals between 40 to 50 years old made up the biggest proportion,standing at 39%from all the cases observed.Furthermore,obesity related NAFLD occupied 70%in the 150 cases.Obese patients having different level of NAFLD always come with hyperlipaemia or high blood content triglyceride.
2.The study of distinctive symptoms and specific characteristics of symptom complexes in diagnosing NAFLD.
A list of the common distinctive symptoms was put together using the outbreak frequencies done in the statistical analysis for NAFLD. Evaluation tests were then carried out for each case study by a Hong Kong Registered Chinese Medicine Practitioner,to filter out the viability of the several different common symptom complexes observed.The results showed that the most common symptom complexes are "sputum and blood stasis","congested live and weak spleen","damp and heat", "gas stasis and blood stasis" and "deficiency of liver and kidney".The analysis for the study of distinctive symptoms and specific characteristics of symptom complexes are aligned with most Chinese medicine practitioners.It is believed that the malfunctioning of liver and spleen,sputum,blood stasis,damp and heat all contributes to formation of liver meridian congestion of "sputum and blood stasis".Liver originated and imbalance of spleen and kidney are main pathogenesis of NAFLD.
3.The investigation of dietary preferences in NAFLD
Further studies were carried out to investigate the effects of dietary preferences had on NAFLD.Several dietary patterns unique to each common symptom complex were also explored using the TCM diagnostic skills.Combining the theoretical and clinical findings,both the tested groups and control groups(150 samples were observed for each group) were closely studied and compared.It was found that there were three distinctive dietary preferences which were commonly seen in victims of NAFLD.This included specified preferences to a) food of coldor warm-natural properties,b) diets of mixed or solely vegetarian orientation,and c) food with different amounts of proteins and fats.With the introduction of the principles and measuring methods applicable to modern nutritional studies,there were several types of dietary conditions which were found to be closely associated with NAFLD and its related symptom complexes.The results showed that those individuals,who had a strong preference in food of low-protein contents,exhibited no tendencies in NAFLD,at a rate of 13.33%.While those who preferred food with high fat-contents stood out at a proportion of only 85.33%.The result was significant after comparing with the control groups.In addition, it was found that cold-nature diet patients occupying 43.93%"sputum and blood stasis" symptom complex.It was also found that 30.23%of the overall cases were classified under the "damp and heat" symptom complex for individuals who preferred warm-nature diets.It indirectly proved that Chinese medicine diagnosis has its scientific basis in questioning the preferred ware and cold nature diets.
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7.胡德发.脂肪肝运动疗法的超声监测.临床肝胆病杂志,2004,20(1):34-35
8.黄达枢.微生态调节剂的临床应用.中国实用儿科杂志,1996,4:202.
9.贾继东.酒精性和非酒精性脂肪性肝病的诊疗现状.肝脏,2006,11(1):55-56.
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13.施均平,项柏康,陈芝云.PPARγ在非酒精性脂肪性肝病中的作用.医学研究杂志,2006,35(1):57-59
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17.赵鲁青,杜平华,朱世真.嗜酸乳杆菌的临床应用.中国药事.1998,12(4):239.
18.中华医学会肝脏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.肝脏,2006,11(1):68-70.