旨肪肝中医辨证客观化与影像学诊断相关性研究

目的：通过影像学检查（B超、CT）对非酒精性脂肪性肝病（NAFLD）进行定性定量诊断分析，探讨NAFLD影像学指标与中医各证型之间的相关性。方法：选取NAFLD患者200例，辨证分为肝郁脾虚、痰湿内阻、湿热内蕴、痰瘀互结、肝肾不足5个中医证型，同时运用B超、CT两种影像学方法对脂肪肝进行分度和定量诊断，分析脂肪肝严重程度与各中医讧型之间的关系。结果：（1）NAFLD中医辨证分型以湿热内蕴最常见（37．00％），肝肾不足最少（6．00％）。2种检查方法均提示从肝郁脾虚型、痰湿内阻型、湿热内蕴型、痰瘀互结型到肝肾不足型，非酒精性脂肪肝严重程度逐渐加重，经’X^2检验，各中医证型间的脂肪肝程度差异有统计学意义（P〈0．01）。（2）与正常对照组相比，NAFLD各中医证型肝／脾CT比值均有不同程度的降低（P〈0．05），各组间比较，从肝郁脾虚型、痰湿内阻型、湿热内蕴型、痰瘀互结型到肝肾不足型，肝／脾CT比值逐渐降低，且差异具有统计学意义。结论：NAFLD各中医证型与影像学指标（B超、CT）之间存在一定的相关性，B超、CT检查可为脂肪肝的中医辨证规范化研究提供参考依据。

Association between radiological diagnosis and traditional Chinese medicine syndrome types of nonalcoholic fatty liver disease

Objective ：To qualitatively and quantitatively analyze nonalcoholic fatty liver disease （NAFLD）by imaging methods（ ultrasound and CT）and to investigate the association between the imaging indices and traditional Chinese medicine （TCM） syndrome types of NAFLD. Methods ： A total of 200 NAFLD patients were included in the study, and they were classified as having the syndromes of stagnation of liver qi and spleen deficiency, stagnation of phlegm dampness, internal retention of damp - heat, intermingled phlegm and blood stasis, and deficiency of liver and kidney. The severity of fatty liver was quantitatively evaluated by ultrasound and CT. The relationship between the severity and TCM syndrome types of fatty liver was analyzed. Results： The most common TCM syndrome of NAFLD was internal retention of damp - heat （37.00%） , while the least common one was deficiency of liver and kidney（6.00% ）. The two imaging methods showed that the severity of NAFLD increased gradually from the syn- dromes of stagnation of liver qi and spleen deficiency, stagnation of phlegm dampness, internal retention of damp - heat, and intermingled phlegm and blood stasis to the syndrome of deficiency of liver and kidney, and there were sig- nificant differences in severity of fatty liver between TCM syndrome types （ P 〈 0. 01 ）, as demonstrated by chi - square test. Compared with the normal control group, the NAFLD patients showed variable decreases in liver/spleen CT ratio （P 〈 0. 05 ） , and liver/spleen CT ratio decreased gradually from the syndromes of stagnation of liver qi and spleen deficiency, stagnation of phlegm dampness, internal retention of damp -heat, and intermingled phlegm and blood stasis to the syndrome of deficiency of liver and kidney, with significant differences between TCM syndrometypes. Conclusion：There is association between the TCM syndrome types and imaging indices （ultrasound and CT）of NAFLD,and ultrasound and CT provide reference for standardized TCM syndrome differentiation of fatty liver.