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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
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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
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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 
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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)
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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
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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
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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
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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
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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
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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
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