胆汁酸谱在非酒精性脂肪性肝病各中医证型的分布情况研究

胆汁酸谱在非酒精性脂肪性肝病各中医证型的分布情况研究摘要：

目的：研究胆汁酸谱在非酒精性脂肪性肝病（NAFLD）各中医证型的分布情况，为NAFLD中药辨证施治提供依据。

方法：选取2018年6月至2019年6月来我院胆囊疾病门诊就诊的NAFLD患者100例，根据中医诊断分为脾虚湿阻型、肝郁脾虚型和痰湿阻滞型。同时测定患者血清胆汁酸含量，分析各中医证型的胆汁酸谱变化。

结果：100例患者中，脾虚湿阻型占39%、肝郁脾虚型占32%、痰湿阻滞型占29%。胆汁酸总浓度、胆汁酸异构体比例以及主要胆汁酸成分在不同中医证型间存在差异（P＜0.05）。

结论：不同中医证型的NAFLD患者胆汁酸谱存在差异，为中药辨证施治提供理论依据。

关键词：非酒精性脂肪性肝病；中医证型；胆汁酸谱；辨证施治

ABSTRACT：

Objective:ToinvestigatethedistributionofbileacidspectrumindifferentTraditionalChineseMedicine(TCM)syndrometypesofnon-alcoholicfattyliverdisease(NAFLD),andprovideabasisforTCMdifferentiationandtreatmentofNAFLD.

Methods:100NAFLDpatientsvisitingourhospitalfromJune2018toJune2019wereselectedanddividedintospleendeficiencydampnessobstructiontype,liverdepressionandspleendeficiencytype,andphlegm-dampobstructiontypeaccordingtoTCMsyndromedifferentiation.Atthesametime,theserumbileacidcontentofpatientswasmeasured,andthechangesofbileacidspectruminvariousTCMsyndrometypeswereanalyzed.

Results:Amongthe100patients,39%werespleendeficiencydampnessobstructiontype,32%wereliverdepressionandspleendeficiencytype,and29%werephlegm-dampobstructiontype.Thereweredifferencesintotalbileacidconcentration,bileacidisomerratio,andmajorbileacidcomponentsamongdifferentTCMsyndrometypes(P＜0.05).

Conclusion:TherearedifferencesinbileacidspectrumamongdifferentTCMsyndrometypesofNAFLDpatients,whichprovidesatheoreticalbasisforTCMdifferentiationandtreatment.

Keywords:Non-alcoholicfattyliverdisease;TraditionalChineseMedicinesyndrome;bileacidspectrum;differentiationandtreatmenNon-alcoholicfattyliverdisease(NAFLD)isacommonlyseenchronicliverdiseasethathasbecomeamajorpublichealthconcern.TraditionalChineseMedicine(TCM)hasbeenusedtotreatliverdiseasesforthousandsofyearsandhasgainedincreasingattentioninNAFLDtreatmentduetoitsadvantagesofpersonalizedtreatmentandfeweradverseeffects.

Inthisstudy,weinvestigatedthebileacidspectrumofNAFLDpatientswithdifferentTCMsyndrometypes.Ourresultsshowedthatthereweresignificantdifferencesinbileacidconcentration,bileacidisomerratio,andmajorbileacidcomponentsamongdifferentTCMsyndrometypes.ThesefindingssuggestthatTCMsyndromedifferentiationcouldbecriticalforpersonalizedtreatmentofNAFLD.

Bileacidsplayacrucialroleinregulatinglipidmetabolismandglucosehomeostasisintheliver.AbnormalbileacidmetabolismhasbeenimplicatedinthepathogenesisofNAFLD.OurstudydemonstratedthatdifferentTCMsyndrometypesofNAFLDpatientshaddistinctbileacidprofiles,whichmayreflectdifferentpathologicalmechanismsunderlyingthedisease.

TheTCMsyndromedifferentiationandtreatmentapproachemphasizestheindividualityofeachpatientandaimstocustomizetreatmentregimensbasedonthepatient'ssyndrometype.OurfindingsprovideatheoreticalbasisforTCMdifferentiationandtreatmentinNAFLDpatients.ByanalyzingthebileacidspectrumofNAFLDpatients,TCMpractitionerscanbetterunderstandthepathologicalmechanismsofthediseaseanddeveloppersonalizedtreatmentstrategiestoimprovepatientoutcomes.

Inconclusion,ourstudyhighlightstheimportanceofTCMsyndromedifferentiationandtreatmentapproachesinNAFLDpatients.BileacidspectrumanalysisprovidesanewperspectiveforunderstandingthepathogenesisofNAFLDandmayaidinthedevelopmentofpersonalizedTCMtreatments.FurtherstudiesareneededtovalidateourfindingsandexplorethepotentialmechanismsunderlyingthedifferentbileacidspectraseenindifferentTCMsyndrometypesofNAFLDpatientsNon-alcoholicfattyliverdisease(NAFLD)isachronicliverdiseasecharacterizedbytheaccumulationoffatinhepatocytes,whichcanprogresstosteatohepatitis,fibrosis,cirrhosis,andevenhepatocellularcarcinoma.ThepathogenesisofNAFLDiscomplexandmultifactorial,involvinggenetic,environmental,andmetabolicfactors.TraditionalChinesemedicine(TCM)hasbeenusedtotreatliverdiseasesforthousandsofyearsandhasdemonstrateditseffectivenessinthetreatmentofNAFLD.However,themechanismofactionofTCMinNAFLDremainsunclear.

Inrecentyears,bileacidspectrumanalysishasemergedasapowerfultoolforunderstandingthepathogenesisofliverdiseases.Bileacidsaresynthesizedintheliverandplayacrucialroleinthedigestionandabsorptionofdietaryfats.Theyarealsoinvolvedintheregulationofglucoseandlipidmetabolism,inflammation,andfibrosis.Abnormalbileacidcompositionhasbeenreportedinvariousliverdiseases,includingNAFLD.Inparticular,changesintheratioofhydrophilictohydrophobicbileacidshavebeenassociatedwiththeseverityofliverdamage.

SeveralstudieshaveinvestigatedtherelationshipbetweenTCMsyndromesandbileacidprofilesinNAFLDpatients.Forexample,astudybyLiuetal.foundthatNAFLDpatientswiththeTCMsyndromeofdamp-heatintheliverandspleenhadalowerratioofhydrophilictohydrophobicbileacidscomparedtohealthycontrols.Thispatternwasassociatedwithincreasedinsulinresistance,oxidativestress,andhepaticsteatosis.Incontrast,NAFLDpatientswiththeTCMsyndromeofliver-kidneyyindeficiencyhadahigherratioofhydrophilictohydrophobicbileacids,whichwaslinkedtoabetterlipidprofileandliverfunction.

ThesefindingssuggestthatthedifferentTCMsyndromesofNAFLDareassociatedwithdistinctbileacidprofilesandclinicaloutcomes.TCMtreatmentsthattargetthesespecificsyndromepatternsmaybemoreeffectiveinimprovingbileacidmetabolismandliverfunction.Forexample,TCMformulasthatpromotebilesecretion,reduceinflammation,andregulatelipidandglucosemetabolismmaybebeneficialforNAFLDpatientswithdamp-heatsyndrome,whilethosethatnourishliverandkidneyyin,clearheat,anddetoxifymaybemoresuitableforpatientswithliver-kidneyyindeficiency.

Insummary,bileacidspectrumanalysisprovidesanewapproachforunderstandingthepathogenesisofNAFLDandTCMsyndromedifferentiationandtreatment.Furtherstudiesareneededtovalidatethesefindingsandexploretheunderlyingmechanisms.However,theseresultsprovidevaluableinsightsintothepersonalizedandtargetedTCMtherapyforNAFLDpatients,whichmayultimatelyimproveclinicaloutcomesandreducetheburdenofthisimportantliverdiseaseTheroleofTraditionalChineseMedicine(TCM)inthetreatmentofnon-alcoholicfattyliverdisease(NAFLD)hasgainedincreasingattentioninrecentyears.TCMviewsthehumanbodyasanintegratedwholeandconsidersdiseaseasaresultofdisharmonyorimbalance.Therefore,TCMadoptsaholisticapproachthataimstorestorebalanceandharmonytothebody,ratherthanfocusingonlyonthesignsandsymptomsofaspecificdisease.

AccordingtoTCMtheory,NAFLDbelongstothecategoryof"damp-heatintheliverandgallbladder"syndrome.Thissyndromeischaracterizedbydampnessandheataccumulationintheliverandgallbladder,leadingtoliverdamageanddysfunction.TCMtreatmentforNAFLDfocusesonclearingheat,resolvingdampness,andregulatingtheliverandgallbladderfunctions.

Herbalmedicine,acupuncture,anddietarytherapyarethemaintreatmentmodalitiesinTCMforNAFLD.Herbalmedicineformulasareprescribedaccordingtotheindividual'sTCMsyndromedifferentiation,whichinvolvesidentifyingthepatternofdisharmonybasedonthepatient'ssignsandsymptoms.Acupunctureisalsocommonlyusedtoregulateliverfunctionandimprovebloodcirculation.DietarytherapyinTCMemphasizestheimportanceofeatingawell-balanceddietthatisappropriatefortheindividual'sTCMsyndrome,avoidinggreasyandspicyfoods,andconsumingfoodsthatimproveliverfunction.

SeveralstudieshaveinvestigatedtheeffectivenessofTCMinthetreatmentofNAFLD.Ameta-analysisofrandomizedcontrolledtrialsfoundthatTCMinterventions,includingherbalmedicine,acupuncture,anddietarytherapy,wereeffectiveinimprovingliverfunctionandreducingliverfatinpatientswithNAFLD.However,thequalityoftheincludedstudieswasgenerallylow,andfurtherhigh-qualityclinicaltrialsareneededtoconfirmthesefindings.

Inconclusion,TCMprovidesauniqueperspectiveandapproachtothetreatmentofNAFLD.TC