不同中医辨证分型NAFLD患者CT影像学特点分析

目的 研究不同中医辨证分型的非酒精性脂肪性肝病(NAFLD)患者电子计算机断层扫描(CT)影像学特点及临床意义。方法 2017年1月～2020年1月我院收治的NAFLD患者240例,采用中医辨证分型方法分为肝郁脾虚证组72例、痰湿内阻证组34例、湿热内蕴证组89例、痰瘀互结证组31例和肝肾不足证组14例,均接受CT检查。结果 肝郁脾虚证组CT分度为轻度所占比例为88.9%,显著高于痰湿内阻证组、湿热内蕴证组、痰瘀互结证组和肝肾不足证组的17.6%、25.8%、6.5%和0.0%(P＜0.05);肝肾不足证组重度脂肪肝比例为85.7%,痰湿内阻证组为51.6%,显著高于肝郁脾虚证组的0.0%、痰湿内阻证组的8.8%和湿热内蕴证组的15.7%(P＜0.05); 肝郁脾虚证组肝脏CT值为(42.4±4.7)HU,痰湿内阻证组为(37.0±5.6)HU,均显著高于湿热内蕴证组、痰瘀互结证组和肝肾不足证组【分别为(32.0±5.8)HU、(27.0±6.2)HU和(22.8±7.9)HU,P＜0.05】,而肝/脾CT比值分别为为(0.8±0.1)和(0.7±0.2),显著高于湿热内蕴证组、痰瘀互结证组和肝肾不足证组【分别为(0.6±0.1)、(0.5±0.1)和(0.4±0.1),P＜0.05】。结论 不同中医证型的NAFLD患者CT表现有所区别,了解这些特征可能对辨证施治有帮助。

CT imaging feature in patients with non-alcoholic fatty liver diseases with different TCM syndrome

Objective The aim of this study was to investigate the CT imaging feature in patients with non-alcoholic fatty liver diseases(NAFLD)with different traditional Chinese medicine(TCM)syndrome.Methods 240 patients with NAFLD were enrolled in our hospital between January 2017 and January 2020,and the TCM syndrome were determined.All patients underwent CT scan.Results The percentage of mild fatty liver by CT diagnosis in patients with liver depression and spleen deficiency was 88.9%,significantly higher than 17.6%,25.8%,6.5%and 0.0%(P<0.05)in patients with damp phlegm and internal resistance syndrome,damp heat and internal gathering syndrome,phlegm and blood stasis syndrome and liver and kidney deficiency syndrome;the percentage of severe fatty liver in patients with liver and kidney deficiency syndrome was 85.7%,and that in patients with phlegm and blood stasis syndrome was 51.6%,significantly higher than 0.0%in patients with liver depression and spleen deficiency,8.8%in with damp phlegm and internal resistance and 15.7%in damp heat and internal gathering syndrome(P<0.05);the CT score in patients with liver depression and spleen deficiency was(42.4±4.7)HU and the CT score in patients with damp phlegm and internal resistance was(37.0±5.6)HU,both significantly higher than(32.0±5.8)HU,(27.0±6.2)HU and(22.8±7.9)respectively,P<0.05 in patieHU,nts with damp heat and internal gathering,in with ph legm and blood stasis syndrome and in with liver and kidney deficiency syndrome,while the liver/spleen ratio were(0.8±0.1)and(0.7±0.2),significantly higher than【(0.6±0.1),(0.5±0.1)and(0.4±0.1),respectively,P<0.05】in patients with damp phlegm and internal resistance,in patients with damp heat and internal gathering and in with liver and kidney deficiency syndrome.Conclusion The CT imaging of patients with NAFLD with different TCM syndromes is characteristic,which might help the TCM doctors to deal with the entity appropriately in clinical practice.