【摘要】 目的:初步探讨铁代谢指标及受控衰减参数(CAP)与非酒精性脂肪性肝病(NAFLD)患者中医证型的相关性。方法:采用观察性、横断面研究方法，入组我院门诊及住院的NAFLD患者共120例，分为肝郁脾虚证、痰浊内阻证、湿热蕴结证、痰瘀互结证4种证型；比较不同证型与肝功能、血脂、血清铁蛋白(SF)、转铁蛋白(TRF)及CAP的关系；运用Logistic回归分析NAFLD患者中医证型的影响因素。结果:肝郁脾虚43例(35.8%),痰浊内阻33例(27.5%),湿热蕴结34例(28.3%),痰瘀互结10例(8.3%)。丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(γ-GT)、甘油三酯(TG)水平在各中医证型的分布差异有统计学意义(P<0.05)。TRF在各证型中差异无统计学意义(P>0.05)。SF、CAP在各中医证型分布差异具有统计学意义(P<0.001)。进一步两两比较，肝郁脾虚证的SF、CAP水平分别低于痰浊内阻证、湿热蕴结证、痰瘀互结证(P<0.05)。多分类Logistic回归提示，以肝郁脾虚证为参照，SF、CAP升高是痰浊内阻证、湿热蕴结证、痰瘀互结证的影响因素，γ-GT是痰瘀互结证的危险因素。结论:NAFLD患者不同中医证型铁代谢水平不同，且各证型肝脏脂肪变性程度不同，SF及CAP与中医证型存在相关性，肝郁脾虚可能是病程的早期阶段。更多还原

【Abstract】 Objective:To explore the identifying significance of iron metabolism index in different TCM syndromes in patients with nonalcoholic fatty liver disease.Methods:Using observational and cross-sectional research methods,a total of 120 NAFLD patients in the outpatient and inpatient departments of our hospital were enrolled.There are four types of syndromes:liver depression and spleen deficiency syndrome,phlegm-turbid internal resistance syndrome,damp-heat accumulation syndrome,phlegm and blood stasis mutual syndrome;Compare the relationship between different syndrome types and liver function,blood lipids,serum ferritin (SF),transferrin (TRF) and CAP;Logistic regression was used to analyze the influencing factors of TCM syndromes in NAFLD patients.Results:First,a total of 43 cases (35.8%) of liver depression and spleen deficiency,33 cases (27.5%) of phlegm-turbid internal resistance,34 cases (28.3%) of damp-heat accumulation,and 10 cases (8.3%) of phlegm and blood stasis mutual.Second,the levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),γ-glutamyl transpeptidase (γ-GT),and triglyceride (TG) in each of TCM syndrome type was statistically significant (P<0.05).There was no statistically significant difference in TRF among various syndrome types (P>0.05).Further pairwise comparisons showed that the levels of SF and CAP in the syndrome of liver depression and spleen deficiency were lower than those of phlegm-turbid internal resistance syndrome,damp-heat accumulation syndrome,phlegm and blood stasis mutual syndrome (P<0.05).Third,Multi-classification Logistic regression suggests:Taking liver depression and spleen deficiency syndrome as a reference.Elevated SF and CAP are the influencing factors of phlegm-turbid internal resistance syndrome,damp-heat accumulation syndrome,phlegm,and blood stasis mutual syndrome.Also,the γ-GT is a risk factor for phlegm and blood stasis syndrome.Conclusion:NAFLD patients have different levels of iron metabolism in different TCM syndrome types,and the degree of liver steatosis of each syndrome type is different.SF and CAP are related to TCM syndrome types.Liver depression and spleen deficiency may be an early stage of the disease course.更多还原