脂肪肝患者中医证型与超声血流动力学及血清学指标的关系

陈宇翔; 於海涛; 刘娟; 李林键; 杨志芳; 徐静

doi:10.16766/j.cnki.issn.1674-4152.004054

脂肪肝患者中医证型与超声血流动力学及血清学指标的关系

doi: 10.16766/j.cnki.issn.1674-4152.004054

1.
张家口市第一医院超声医学科，河北张家口 075000
2.
陆军第八十一集团军医院超声诊断科，河北张家口 075000
3.
张家口市第一医院健康体检科
4.
张家口市第一医院中医科

基金项目:

河北省中医药管理局2024年度中医药类科学研究课题计划项目 2024418

详细信息

通讯作者:
於海涛，E-mail：1806659581@qq.com

中图分类号: R575.5 R445.1
计量
- 文章访问数: 16
- HTML全文浏览量: 13
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-06
- 网络出版日期: 2025-09-04

The relationship of TCM syndrome types with ultrasound hemodynamic and serological indicators in patients with fatty liver

1.
Department of Ultrasound Medicine, Zhangjiakou First Hospital, Zhangjiakou, Hebei 075000, China

摘要

摘要: 目的探讨脂肪肝患者中医证型分布与彩色多普勒超声血流动力学变化及血清学指标的相关性。方法选取2022年10月—2023年10月张家口市第一医院收治的191例脂肪肝患者作为研究对象，根据中医辨证分型将患者分为A组(肝郁气滞证，41例)、B组(肝郁脾虚证，32例)、C组(痰湿内阻证，51例)、D组(湿热蕴结证，45例)、E组(痰瘀互结证，22例)，另选同期体检健康者50例作为对照组，均予多普勒超声检查，并进行血清学指标检测。结果各组门静脉平均流速(MPVV)、门静脉最大流速(PPVV)、肝动脉血流阻力指数(HARI)、血清铁蛋白(SF)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)水平比较，差异均有统计学意义(P＜0.05)。与A组及B组比较，C、D、E组MPVV、PPVV、HARI水平呈逐渐递减趋势(P＜0.05)，SF、Hcy、hs-CRP水平呈逐渐递增趋势(P＜0.05)。随着脂肪肝严重程度增加，患者MPVV、PPVV、HARI水平逐渐降低(P＜0.05)，SF、Hcy、hs-CRP水平逐渐升高(P＜0.05)。MPVV、PPVV、HARI判断痰瘀互结的灵敏度、特异度均较高(P＜0.05)。MPVV、PPVV、HARI与脂肪肝严重程度均呈负相关关系(r=-0.459、-0.436、-0.441，均P＜0.05)。MPVV、PPVV、HARI判断重度脂肪肝的灵敏度、特异度均较高(P＜0.05)。结论随着脂肪肝病变程度进展，脂肪肝患者MPVV、PPVV、HARI逐渐降低，SF、Hcy、hs-CRP水平逐渐升高，且痰瘀互结患者各指标变化最为明显。
- 脂肪肝 /
- 中医证候类型 /
- 血流动力学 /
- 血清学指标 /
- 相关性
Abstract: Objective To investigate the correlation among the distribution of traditional Chinese medicine (TCM) syndromes, color Doppler ultrasound hemodynamic changes and serological indexes in patients with fatty liver. Methods A total of 191 patients with fatty liver disease admitted to Zhangjiakou First Hospital from October 2022 to October 2023 were selected as the study objects. According to TCM syndrome differentiation, the patients were divided into group A (syndrome of liver-qi stagnation, n=41), group B (syndrome of liver-Qi and spleen deficiency, n=32), group C (syndrome of phlegm and dampness internal obstruction, n=51), group D (syndrome of dampness-heat accumulation, n=45), and group E (syndrome of phlegm and blood stasis interassociation, n=22). Another 50 healthy examinee were selected as the control group during the same period and were all given Doppler ultrasound examination. Serological indexes were detected. Results There were statistically significant differences in mean portal vein velocity (MPVV), peak portal vein velocity (PPVV), hepatic artery resistive index (HARI), serum ferritin (SF), homocysteine (Hcy) and hypersensitive C-reactive protein (hs-CRP) levels among all groups (P < 0.05). Compared with groups A and B, the levels of MPVV, PPVV and HARI in groups C, D and E showed a gradually decreasing trend (P < 0.05), while the levels of SF, Hcy and hs-CRP showed a gradually increasing trend (P < 0.05). With the aggravation of the severity of fatty liver, the levels of MPVV, PPVV and HARI were gradually decreased (P < 0.05), while the levels of SF, Hcy and hs-CRP were gradually increased (P < 0.05). MPVV, PPVV and HARI showed high sensitivity and specificity in determining phlegm stasis interjunction (P < 0.05). MPVV, PPVV, HARI were negatively correlated with the severity of fatty liver (r=-0.459, -0.436, -0.441, all P < 0.05). The sensitivity and specificity of MPVV, PPVV and HARI in determining severe fatty liver were higher (P < 0.05). Conclusion With the progression of fatty liver disease, MPVV, PPVV and HARI in patients decreases, and the levels of SF, Hcy and hs-CRP in the body gradually increases, and the changes are most obvious in patients with turbid phlegm and blood stasis.
- Fatty liver /
- Types of traditional Chinese medicine syndrome /
- Hemodynamics /
- Serological index /
- Correlation

HTML全文

图 1 彩超血流动力学参数诊断痰瘀互结的ROC曲线

Figure 1. The ROC curve of hemodynamic parameters of color Doppler ultrasound for diagnosing phlegm and blood stasis interlacing

下载: 全尺寸图片幻灯片

图 2 彩超血流动力学参数诊断重度脂肪肝的ROC曲线

Figure 2. The ROC curve of color Doppler ultrasound hemodynamic parameters in the diagnosis of severe fatty liver

下载: 全尺寸图片幻灯片

表 1 不同中医证型脂肪肝患者疾病严重程度比较[例(%)]

Table 1. Comparison of disease severity of patients with different TCM syndrome types of fatty liver [cases (%)]

组别	例数	轻度	中度	重度
A组	41	31(75.61)	8(19.51)	2(4.88)
B组	32	17(53.12)	12(37.50)	3(9.38)
C组	51	18(35.29)	26(50.98)	7(13.73)
D组	45	11(24.44)	24(53.33)	10(22.22)
E组	22	5(22.73)	6(27.27)	11(50.00)
注：各组疾病严重程度比较，Hc=33.708，P＜0.001。

下载: 导出CSV

表 2 不同中医证候类型脂肪肝患者与对照组彩超血流动力学参数比较(x ±s)

Table 2. Comparison of hemodynamic parameters of patients with fatty liver of different TCM syndromes and control group by color Doppler ultrasound (x ±s)

组别	例数	MPVV(cm/s)	PPVV(cm/s)	HARI
对照组	50	26.11±3.47	19.11±3.18	0.79±0.11
A组	41	22.41±3.13^a	17.34±2.35^a	0.75±0.06^a
B组	32	23.08±3.65^a	17.01±2.28^a	0.72±0.08^a
C组	51	21.33±3.09^abc	15.77±2.86^abc	0.69±0.04^abc
D组	45	19.04±2.89^abcd	14.32±2.44^abcd	0.67±0.04^abcd
E组	22	16.09±2.08^abcde	13.15±2.57^abcde	0.61±0.05^abcde
F值		41.880	24.031	28.800
P值		＜0.001	＜0.001	＜0.001
注：与对照组比较，^aP＜0.05；与A组比较，^bP＜0.05；与B组比较，^cP＜0.05；与C组比较，^dP＜0.05；与D组比较，^eP＜0.05。

下载: 导出CSV

表 3 彩超血流动力学参数判断痰瘀互结的效能

Table 3. Effectiveness of color ultrasound hemodynamic parameters in determining turbid phlegm and blood stasis

项目	cut-off值	AUC	95% CI	约登指数	灵敏度(%)	特异度(%)	P值
MPVV	≤17.16 cm/s	0.748	0.689~0.802	0.431	63.64	79.45	＜0.001
PPVV	≤12.32 cm/s	0.750	0.691~0.804	0.431	63.64	79.45	＜0.001
HARI	＜0.67	0.720	0.659~0.776	0.394	68.18	71.23	＜0.001

下载: 导出CSV

表 4 不同严重程度脂肪肝患者彩超血流动力学参数比较(x ±s)

Table 4. Comparison of hemodynamic parameters of color ultrasound in patients with fatty liver of different severity (x ±s)

组别	例数	MPVV(cm/s)	PPVV(cm/s)	HARI
轻度	82	22.89±3.09	17.19±2.94	0.73±0.06
中度	76	20.17±3.47^a	15.13±2.79^a	0.69±0.07^a
重度	33	16.55±3.15^ab	13.14±2.88^ab	0.61±0.06^ab
F值		46.338	25.654	41.307
P值		＜0.001	＜0.001	＜0.001
注：与轻度脂肪肝患者比较，^aP＜0.05；与中度脂肪肝患者比较，^bP＜0.05。

下载: 导出CSV

表 5 彩超血流动力学参数诊断重度脂肪肝的效能

Table 5. Effectiveness of color Doppler hemodynamic parameters in judging severe fatty liver

项目	cut-off值	AUC	95% CI	约登指数	灵敏度(%)	特异度(%)	P值
MPVV	≤11.40 cm/s	0.654	0.582~0.721	0.277	45.45	82.28	＜0.001
PPVV	≤13.24 cm/s	0.667	0.595~0.733	0.340	60.61	73.42	＜0.001
HARI	＜0.61	0.626	0.553~0.695	0.256	36.36	89.24	＜0.001

下载: 导出CSV

表 6 不同中医证候类型脂肪肝患者与对照组血清学指标水平比较(x ±s)

Table 6. Comparison of serological indexes between patients with different TCM syndrome types and control group (x ±s)

组别	例数	SF(ng/mL)	Hcy(μmol/L)	hs-CRP(mg/L)
对照组	50	194.81±41.64	4.11±0.56	5.18±0.89
A组	41	217.51±38.41^a	10.14±1.04^a	8.82±1.02^a
B组	32	225.73±45.17^a	10.31±1.12^a	8.75±1.17^a
C组	51	261.15±41.25^abc	11.32±2.48^abc	10.13±1.36^abc
D组	45	288.13±54.14^abcd	13.09±1.35^abcd	11.46±1.22^abcd
E组	22	301.47±59.43^abcde	16.18±1.36^abcde	13.59±2.78^abcde
F值		31.850	276.300	160.900
P值		＜0.001	＜0.001	＜0.001
注：与对照组比较，^aP＜0.05；与A组比较，^bP＜0.05；与B组比较，^cP＜0.05；与C组比较，^dP＜0.05；与D组比较，^eP＜0.05。

下载: 导出CSV

表 7 不同严重程度脂肪肝患者血清学指标水平比较(x ±s)

Table 7. Comparison of serological indexes in patients with different severity of fatty liver (x ±s)

组别	例数	SF(ng/mL)	Hcy(μmol/L)	hs-CRP(mg/L)
轻度	82	221.45±41.03	10.28±1.06	8.87±1.11
中度	76	272.19±48.56^a	12.49±1.71^a	10.67±1.09^a
重度	33	309.47±66.58^ab	14.42±1.27^ab	13.17±3.08^ab
F值		43.794	117.158	85.844
P值		＜0.001	＜0.001	＜0.001
注：与轻度脂肪肝患者比较，^aP＜0.05；与中度脂肪肝患者比较，^bP＜0.05。

下载: 导出CSV

参考文献(15)

[1]	李茜, 杨洋俊, 孙易, 等. 运动促进肝脏健康: 表观遗传视域下非酒精性脂肪肝病的转归[J]. 中国体育科技, 2024, 60(2): 28-36. LI Q, YANG Y J, SUN Y, et al. Exercise promotes liver health: outcome of nonalcoholic fatty liver disease from an epigenetic perspective[J]. Chin Sport Sci Technol, 2024, 60(2): 28-36.
[2]	KAZANKOV K, JØRGENSEN S M D, THOMSEN K L, et al. The role of macrophages in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(3): 145-159. doi: 10.1038/s41575-018-0082-x
[3]	TARGHER G, TILG H, BYRNE C D. Non-alcoholic fatty liver disease: a multisystem disease requiring a multidisciplinary and holistic approach[J]. Lancet Gastroenterol Hepatol, 2021, 6(7): 578-588. doi: 10.1016/S2468-1253(21)00020-0
[4]	贾绘, 倪薇, 包成明, 等. CT和彩色多普勒超声对急性胰腺炎合并脂肪肝的临床诊断价值[J]. 中华消化病与影像杂志(电子版), 2024, 14(3): 239-243. JIA H, NI W, BAO C M, et al. Clinical diagnostic value of CT and color Doppler ultrasound in acute pancreatitis complicated with fatty liver[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(3): 239-243.
[5]	徐祥涛, 史会连, 陈冉, 等. 基于肝脏磁共振质子密度脂肪分数研究非酒精性脂肪肝病患者中医证候分布及临床特征[J]. 中西医结合肝病杂志, 2023, 33(9): 790-794. XU X T, SHI H L, CHEN R, et al. The distribution of TCM syndromes and the clinical characteristics of nonalcoholic fatty Liver disease on the base of magnetic resonance imaging proton density fat fraction[J]. Chin J Integr Tradit West Med Liver Dis, 2023, 33(9): 790-794.
[6]	曹宇萌, 张海燕, 刘立新. 非酒精性脂肪性肝病的病理改变与血清铁蛋白和血清铁含量变化关系的meta分析[J]. 临床荟萃, 2023, 38(3): 197-207. doi: 10.3969/j.issn.1004-583X.2023.03.001 CAO Y M, ZHANG H Y, LIU L X. Correlation between pathological changes and serum ferritin and iron levels in nonalcoholic fatty liver disease: a meta-analysis[J]. Clin Focus, 2023, 38(3): 197-207. doi: 10.3969/j.issn.1004-583X.2023.03.001
[7]	李潇萌, 吴少玉, 王媛媛. 非酒精性脂肪性肝病合并2型糖尿病患者血清同型半胱氨酸、成纤维细胞生长因子21和核因子-κB水平变化及其临床意义探讨[J]. 实用肝脏病杂志, 2023, 26(2): 202-205. doi: 10.3969/j.issn.1672-5069.2023.02.013 LI X M, WU S Y, WANG Y Y. Implication of serum homocystein, fibroblast growth factor-21 and nuclear factor-κB levels in patients with non-alcoholic fatty liver diseases and T2DM[J]. J Pract Hepatol, 2023, 26(2): 202-205. doi: 10.3969/j.issn.1672-5069.2023.02.013
[8]	周国艳, 李青, 瞿子春, 等. 二甲双胍对2型糖尿病合并非酒精性脂肪肝患者血清FGF21、Hs-CRP的影响[J]. 湖南师范大学学报(医学版), 2022, 19(2): 59-63. doi: 10.3969/j.issn.1673-016X.2022.02.016 ZHOU G Y, LI Q, QU Z C, et al. Effect of metformin on serum FGF21 and Hs-CRP in patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease[J]. J Hunan Normal Univ(Med Sci), 2022, 19(2): 59-63. doi: 10.3969/j.issn.1673-016X.2022.02.016
[9]	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中西医结合诊疗共识意见(2017年)[J]. 中国中西医结合消化杂志, 2017, 25(11): 805-811. Digestive Diseases Professional Committee of Chinese Association of Integrated Traditional and Western Medicine. Consensus opinions on the diagnosis and treatment of non-alcoholic fatty liver disease with integrated chinese and western medicine (2017)[J]. Chin J Integr Tradit West Med Diges, 2017, 25(11): 805-811.
[10]	林颖鑫, 孟健, 冯蕾, 等. 声衰减成像在代谢相关脂肪性肝病分级诊断中的应用[J]. 中国医学影像学杂志, 2023, 31(10): 1080-1084, 1102. doi: 10.3969/j.issn.1005-5185.2023.10.015 LIN Y X, MENG J, FENG L, et al. Attenuation imaging in the grading diagnosis of metabolic dyfunction-associated fatty liver disease[J]. Chin J Med Imaging, 2023, 31(10): 1080-1084, 1102. doi: 10.3969/j.issn.1005-5185.2023.10.015
[11]	李新, 李瀛, 蒋春梅, 等. 非酒精性脂肪肝脂肪分数与门脉血流动力学的MRI研究[J]. 中国医学计算机成像杂志, 2022, 28(2): 142-146. doi: 10.3969/j.issn.1006-5741.2022.02.007 LI X, LI Y, JIANG C M, et al. Study on fat fraction and hemodynamics of nonalcoholic fatty liver[J]. Chin Comput Med Imaging, 2022, 28(2): 142-146. doi: 10.3969/j.issn.1006-5741.2022.02.007
[12]	陈长喜, 杜娟, 宋健, 等. 血清超敏C反应蛋白与老年人非酒精性脂肪肝的相关性[J]. 中华全科医学, 2023, 21(9): 1491-1494. doi: 10.16766/j.cnki.issn.1674-4152.003153 CHEN C X, DU J, SONG J, et al. Study on correlation between serum hypersensitive C-reactive protein and nonalcoholic fatty liver disease in the elderly[J]. Chin J Gen Pract, 2023, 21(9): 1491-1494. doi: 10.16766/j.cnki.issn.1674-4152.003153
[13]	韩艳, 张凡, 毛永华, 等. 非酒精性脂肪肝患者血清铁蛋白水平与肝脏硬度的关系[J]. 医学研究杂志, 2021, 50(7): 130-135. HAN Y, ZHANG F, MAO Y H, et al. Relationship between serum ferritin level and liver stiffness among patients with nonalcoholic fatty liver disease[J]. J Med Res, 2021, 50(7): 130-135.
[14]	张瑶, 霍迎新, 赵伟, 等. H型高血压患者血尿酸水平与非酒精性脂肪性肝病的关系[J]. 实用医学杂志, 2024, 40(18): 2561-2565. doi: 10.3969/j.issn.1006-5725.2024.18.009 ZHANG Y, HUO Y X, ZHAO W, et al. The relationship between blood uric acid levels and non-alcoholic fatty liver disease in patients with type H hypertension[J]. J Pract Med, 2024, 40(18): 2561-2565. doi: 10.3969/j.issn.1006-5725.2024.18.009
[15]	POUWELS S, SAKRAN N, GRAHAM Y, et al. Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss[J]. BMC Endocr Disord, 2022, 22(1): 63. DOI: 10.1186/s12902-022-00980-1.