793例脂肪肝患者证候分布规律

目的：研究脂肪肝的中医证候分布规律。方法：采用以病统证,病证结合的研究模式,建立基于EPidata3.1软件和多中心、大样本临床调查的脂肪肝证候表观数据库,用SPSS13.0软件对证候数据进行二次因子分析和聚类分析。结果：肝肾不足、阴虚火旺、肝郁脾虚、脾虚、脾虚湿阻、轻证湿热内蕴、血瘀、重证湿热内蕴、痰湿内阻是脂肪肝的基本证型。脂肪肝以单个证型和2～4个基本证型组合形式多见,病机较为简单时,脾虚湿阻型最为常见,病机较复杂时,肝肾不足型最为常见。108例（13.6%）患者表现为无症状型,46例（5.8%）患者表现为证候不可分类型,其余患者被聚为脾虚痰瘀互结（91例,11.5%）、肝肾阴虚（147例,18.5%）、脾虚痰湿中阻（254例,32.0%）、脾虚湿热内蕴（81例,10.2%）和肝郁脾虚湿阻（66例,8.3%）等5种证型。结论：多元统计分析方法在一定程度上揭示了脂肪肝的证候分布规律,值得深入研究;本病病位在脾,与肝、肾关系密切;脾虚为本病基本病机,痰、湿、瘀、热、肝郁为本病主要病理要素;肝肾阴虚是本病较为特殊的一个类型。

Distribution pattern of traditional Chinese medicine syndromes in 793 patients with fatty liver disease

Objective： To study the distribution pattern of traditional Chinese medicine （TCM） syndromes in fatty liver disease.
Methods. A multicenter and large sample survey was carried out by adopting the model of ＂combining disease with syndrome＂. A TCM syndrome information database was established by EPidata 3. 1 software. The distribution pattern of TCM syndromes in fatty liver was studied by factor analysis and cluster analysis methods with SPSS 13.0 software.
Results： The basic syndromes of fatty liver included insufficiency of liver and kidney, flaring fire due to yin deficiency, liver-qi stagnation and spleen deficiency, spleen deficiency, spleen deficiency and dampness stagnation, mild syndrome of internal accumulation of damp-heat, blood stasis, severe syndrome of internal accumulation of damp-heat, and internal stagnation of phlegm-dampness. Single syndrome and combination of two to four basic syndromes were common in fatty liver disease. The syndrome of spleen deficiency and dampness stagnation was the most frequent one when its pathogenesis was simple, while the syndrome of insufficiency of liver and kidney was most frequent one when the pathogenesis was complicated. A total of 108 patients （13.6%） had no obvious symptoms, 46 patients （5.8%） were classified into the pattern of noncategorization, and the other patients were classified into five syndromes including phlegm accumulating with stagnation due to spleen deficiency （11.5%, 91/793）, yin deficiency of liver and kidney （18.5%, 147/ 793）, retention of phlegmatic dampness due to spleen deficiency （32.0%, 254/793）, internal accumulation of damp-heat due to spleen deficiency （10.2%, 81/793）, and damp obstruction due to liver-qi stagnation and spleen deficiency （8.3%, 66/793）. Conclusion： Multi-element analysis reveals the distribution pattern of TCM syndromes in fatty liver disease, which is worthy of further study. The basic pathogenesis is spleen deficiency, and has a close correlation with the liver and kidney. The main pathogenesis factors are phlegm, dampness, blood stasis, heat and liver-qi stagnation. Yin deficiency of liver and kidney isa typical syndrome in fatty liver disease.