世界中医药

作者	单位
李敏谦1,2,3,4，林育1,4，项磊1,4，朴胜华1,2,3,4，郭姣1,2,3,4	1 广东省代谢病中西医结合研究中心，广州，510006； 2 国家中医药管理局高脂血症调肝降脂国家中医药重点研究室，广州，510006； 3 国家中医药管理局脂代谢国家中医药三级实验室，广州，510006； 4 广东省代谢性疾病中医药防治重点实验室，广州，510006

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中文摘要:

目的：基于临床文献研究非酒精性脂肪性肝病（NAFLD）的证型、证素及舌脉分布特征，深入分析其病因病机，为NAFLD的中医药辨证施治提供循证支持。方法：检索3大中文数据平台（CNKI、WANGFANG DATA、VIP）2006—2017年（共12年）发表的NAFLD中医药临床研究文献共2 297篇，严格遵循纳入/排除标准筛选，得到符合要求的77篇文献，并对其从发表时间、地域、文献质量、证型、病性和病位证素多维度进行评价。结果：1）近年来NAFLD证候相关发文数量呈上升趋势，以沿海地区发文数最多；NAFLD中医证候类文献类型以描述性研究（57.14%）和病例对照研究（31.16%）为主，随机对照（9.10%）和队列研究（2.60%）较少，文献质量参差不齐；2）剔除低质量文献（9篇），对中高质量文献（68篇）进行统计分析，NAFLD主要证型为：肝郁脾虚证（22.37%）、湿热蕴结证（21.96%）、痰瘀互结证（12.73%）、痰湿内阻（8.85%）、湿浊内停（7.87%）和肝肾不足（5.80%）；3）主要的病性证素依次为湿（24.32%）、气滞（15.38%）、气虚（14.81%）和痰（14.22%）；主要病位证素依次为肝（48.12%）、脾（39.03%）、肾（12.43%）、胆（0.32%）和胃（0.10%）；舌脉以淡红舌、白腻苔、脉弦为主。结论：1）NAFLD证型随疾病的进展变化阶段呈现不同，初期以实证为主，中期呈虚实夹杂，后期以虚证为多见，虚实间常相互转化。病变脏腑主责之肝，与脾、肾等有一定相关性。湿、气滞、气虚、痰是NAFLD关键病性证素。2）NAFLD高水平和高质量研究不足，需开展多区域、多中心、大样本中医临床随机对照研究或队列研究，以期为NAFLD中医辨证论治提供循证依据。

English Summary:

To summarize the distribution characteristics of TCM syndromes type，syndrome elements，tongue and pulse of non-alcoholic fatty liver disease (NAFLD) based on the clinical researches of traditional Chinese medicine (TCM) of NAFLD. Methods:A total of 77 cases，which were related to TCM syndromes of NAFLD and published on Chinese National Knowledge Infrastructure (CNKI)，Wanfang data，VIP from 2006 to 2017，were evaluated from time，region，the quality of literatures，syndrome type，syndrome elements of disease nature and location，and analyzed with association rule and frequency analysis. Results:1)In recent years，the number of publications related to NAFLD syndrome has been on rising，with the largest number of publications in coastal areas. Cross-sectional studies (57.14%) and case-control studies (31.16%) were the two main types of TCM syndrome literature of NAFLD. Randomized controlled trials (9.10%) and cohort studies (2.60%) were less，and the quality of these were uneven. 2)For analyzing 68 medium and high quality literatures，the main type of NAFLD was syndrome of stagnation of liver qi and spleen deficiency (22.37%)，in turn to syndrome of accumulated dampness-heat (21.96%)，syndrome of phlegm and blood stasis (12.73%)，syndrome of stagnation and blockade of phlegm-damp(8.85%)，syndrome of wet turbidity stop (7.87%) and syndrome of deficiency of liver and kidney (5.80%). 3)The main syndrome elements of disease nature were wet (24.32%)，in turn to qi stagnation (15.38%)，qi deficiency (14.81%) and phlegm (14.22%). The main syndrome elements of disease location were liver (48.12%)，spleen (39.03%)，kidney (12.43%)，gallbladder (0.32%) and stomach (0.10%). Pink tongue，white greasy fur and stringy pulse were the common tongue manifestations and pluses in NAFLD. Conclusion:The NAFLD syndrome type is different in the progress of the disease. In the early stage，it is mainly based on excess，while in the middle stage，it is mixed with deficiency and excess. In the later period，the deficiency of the syndrome is common，and the deficiency and excess are often transformed into each other. The findings indicate that the primary location of disease syndrome factors of NAFLD is liver. Wet，qi stagnation，qi deficiency and phlegm are the key pathogenesis of NAFLD. High level and high quality of studies on NAFLD are insufficient，so it is necessary to carry out multiregional and multi-center large sample of TCM clinical randomized controlled studies or cohort studies，in order to provide evidence basis for TCM syndrome differentiation and treatment of NAFLD.

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