Analysis Of TCM Symptoms Of Liver Fibrosis In NAFLD And Its Influence On Digestive System Related Hormones

Objective: By discussing the distribution characteristics of TCM syndromes of liver fibrosis in NAFLD,this paper provides reference for objectification of TCM syndrome differentiation in NAFLD.At the same time,the influence of NAFLD liver fibrosis progression on digestive system related hormones was discussed,so as to establish an evaluation system of digestive system function damage and provide basis for early diagnosis and treatment of various chronic diseases secondary to NAFLD liver fibrosis progression.Methods: A total of 408 NAFLD patients who were diagnosed by color Doppler ultrasound and met the inclusion criteria from April 2019 to October2020 in the Department of Hepatology,Ruikang Hospital affiliated to guangxi university of Chinese medicine were collected.After strictly following the exclusion criteria and exclusion criteria,326 subjects were finally included.The basic information of patients,symptoms and signs of TCM,TCM syndrome types,liver function and gastrointestinal hormone results were recorded.The liver stiffness measurement(LSM)of patients with NAFLD was detected by using the instantaneous elasticity imaging technique(FT),and the influence of LSM on serum Total bilirubin(TBIL),Direct bilirubin(direct bilirubin),DBIL),Indirect bilirubin(IBIL),Total protein(TP),Albumin(ALB),Globulin(GLB),Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),Alkaline phosphatase(ALP),Glutamyl transpeptidase(GGT),gastrin 17(G-17),Motilin(MTL),Cholecystokinin(CCK),D-lactic acid(D-LA),Diamine oxidase(DAO)and Lipopolysaccharide(LPS).The clinical data of NAFLD patients were statistically analyzed by SPSS21.0 and EXCEL software,and the relationship between NAFLD liver fibrosis and TCM syndrome types was summarized.The correlation between LSM value and liver function and gastrointestinal hormone index of 326 subjects was analyzed,and the effect of LSM value on gastrointestinal hormone was analyzed by univariate linear regression bivariate and multivariate correlation statistics were used to analyze the effects of LSM value on liver function and gastrointestinal hormone indexes in non-hepatic fibrosis and liver fibrosis stage,non-hepatic fibrosis,liver fibrosis and severe liver fibrosis stage respectively.The purpose of this study is to clarify the early warning value of NAFLD liver fibrosis progress on gastrointestinal dysfunction of digestive system.Results: 1.The distribution of TCM syndrome types of 326 patients is:113 cases of liver depression and spleen deficiency,accounting for 34.7%,92 cases of phlegm-dampness trapping spleen,78 cases of damp-heat middle resistance,34 cases of qi stagnation and blood stasis,accounting for 10.4%,and 9 cases of spleen-kidney yang deficiency,accounting for 2.8%.2.Compared with the liver hardness value detected by Fibrotouch and histopathological staging table,liver depression and spleen deficiency syndrome,phlegm-dampness stagnation syndrome,damp-heat middle resistance syndrome and qi stagnation and blood stasis syndrome are distributed in each stage of liver fibrosis;Liver depression and spleen deficiency syndrome are mainly distributed in the early stage of liver fibrosis,mainly F0-1 and F2;Phlegm-dampness trapping spleen syndrome,damp-heat middle resistance syndrome and qi stagnation and blood stasis syndrome are more distributed in F0-1,F2 and F2-3.The deficiency of spleen and kidney yang is mainly distributed in F3-4 and F4 stages.The LSM values of different TCM syndrome types from low to high are: liver depression and spleen deficiency syndrome,phlegm-dampness trapping spleen syndrome,damp-heat middle obstruction syndrome,qi stagnation and blood stasis syndrome,spleen and kidney yang deficiency syndrome,and there is significant difference in LSM values among TCM syndrome types(P<0.01).The differences between phlegm-dampness syndrome,damp-heat middle resistance syndrome,qi stagnation and blood stasis syndrome,spleen and kidney yang deficiency syndrome and liver depression and spleen deficiency syndrome were statistically significant(P<0.05).The differences between phlegm-dampness syndrome,damp-heat middle resistance syndrome,qi stagnation and blood stasis syndrome and spleen-kidney yang deficiency syndrome were statistically significant(P<0.05).There was no significant difference between phlegm-dampness syndrome and damp-heat syndrome and qi stagnation and blood stasis syndrome(P > 0.05).3.The distribution of TCM symptoms and tongue pulse in 326 patients is as follows: the top 10 symptoms with the highest frequency are: right flank pain,loss of appetite,mental depression,yellow urine,loose stool,listlessness,abdominal distension,obesity,chest and hypochondriac distension,fatigue and fatigue;The top three tongue pulse conditions with the highest frequency were white or greasy coating,pale tongue and thin pulse string.4.The correlation between liver function indexes and LSM values in 326 patients was analyzed.It was found that DBIL,ALT,AST,ALP and GGT were positively correlated with LSM values(r>0,P<0.05).TBIL,IBIL,GLB,TP,ALB and LSM had no statistical significance(P>0.05).By analyzing the correlation between gastrointestinal hormones and LSM,it was found that CCK was positively correlated with LSM(r>0,P<0.05).The values of DAO,D-LA,G-17,LPS,MTL and LSM were not statistically significant(P > 0.05).The linear regression analysis of gastrointestinal hormones and LSM showed that CCK,DAO,D-LA,LPS,MTL had linear regression relationship with LSM(P<0.05),and their coefficients were 8.234,-0.328,-1.157,44.827 and 48.927 respectively.The linear regression relationship between G-17 and LSM has no statistical significance(P>0.05),and its coefficient is 0.293.5.According to LSM value,they were divided into non-hepatic fibrosis group and hepatic fibrosis group.It was found that ALT,AST,GGT,CCK and LPS were significantly different among different hepatic fibrosis groups(P < 0.05),among which CCK,LPS and LSM values were significantly different(P < 0.05),and CCK and LPS index coefficients were 1.012 and0.999 respectively.According to LSM values,they were divided into non-hepatic fibrosis group,hepatic fibrosis group and severe hepatic fibrosis group,among which ALT,AST,ALP,GGT,CCK and LPS were significantly different among different hepatic fibrosis groups(P < 0.05),while CCK,LPS and LSM values had no significant difference(P > 0.05).Conclusion: 1.LSM value based on Fibro Touch detection is different among TCM syndromes of liver fibrosis in nonalcoholic fatty liver disease,among which LSM value of patients with spleen and kidney yang deficiency syndrome is the highest,and LSM value of patients with liver depression and spleen deficiency syndrome is the lowest,which may be helpful to TCM syndrome differentiation of NAFLD liver fibrosis.2.The liver fibrosis progression of NAFLD affects the changes of liver function indexes ALT,AST,GGT and gastrointestinal hormone indexes CCK and LPS,which indicates that the liver fibrosis progression of NAFLD is related to gallbladder contractile function and gastrointestinal function.By observing the influence of LSM value on CCK and LPS,it has an early warning effect on evaluating the progress of NAFLD liver fibrosis and gastrointestinal dysfunction of digestive system.