Meta-analysis Of The Relationship Between TCM Constitution And Nonalcoholic Fatty Liver Disease

Objective:As a global health problem,non-alcoholic fatty liver disease has an increasing prevalence in recent years,and it has become one of the major chronic liver diseases in our country.Non-alcoholic fatty liver disease is a metabolic disease of the liver in which triglyceride-based lipids accumulate in liver cells as pathological changes.The spectrum includes non-alcoholic simple liver steatosis and non-alcoholic steatohepatitis（NASH）,Liver cirrhosis and Hepatocellular carcinoma（HCC）.The 2020 International Fatty Liver Group expert consensus changed the name of nonalcoholic fatty liver disease to metabolically associated fatty liver disease（MAFLD）.This article systematically assesses the relationship between the constitution of traditional Chinese medicine and non-alcoholic fatty liver through a meta-analysis of existing evidence.Methods:Search databases,including Pub Med,Embase,Cochrane,China Knowledge Network（CNKI）,Chongqing VIP（VIP）,Wanfang,China Biomedical Database（CBM）.Retrieve the relevant literature on TCM physique and non-alcoholic fatty liver disease,the retrieval time is from 2009 to August 2021,regardless of language,race,etc.The literature was screened according to the inclusion and exclusion criteria.The literature information extraction and quality evaluation were individually evaluated by two researchers.The cross-sectional study was evaluated using the American Institute for Health Care Quality Research（AHRQ）standards,and the case-control study and cohort study were evaluated using the Newcastle-Ottawa Scale（NOS）.The combined effect size of RStudio1.4 and Rev Man5.3 was used for statistical analysis.Combine the individual rate and the odds ratio（OR）of each study.And conducted a subgroup analysis to further discuss.Use the funnel chart to detect whether there is publication bias.Results:1.A total of 23 documents were finally eligible for the included study,and a total of 18642 participants were included.The scores of 16cross-sectional studies were 4-8 points.There were 2 high-quality documents,and the rest were medium-quality documents.Seven case-control studies scored 4-7 points,and one high-quality literature.No cohort study.2.Non-alcoholic fatty liver disease has the highest proportion of patients with Phlegm-Dampness constitution,and the other constitutions from high to low are Qi-Deficiency,dampness-heat,balanced,Yin-deficiency,Qi stagnation,Yang-deficiency,blood stasis and inherit special.3.The proportion of phlegm-damp constitution in patients with non-alcoholic fatty liver disease was significantly higher than that of the control group,the combined effect size OR=2.58,95%CI[1.71,3.89];the proportion of dampness-heat was higher than that of the control group,OR=1.83,95%CI [1.51,2.21];while the proportion of Qi-deficiency constitution was not statistically different from that of the control group,OR=1.12,95%CI[0.90,1.41];The proportion of balanced constitution was significantly smaller than that of the healthy population,OR=0.36,95%CI[0.22,0.57].4.The combined statistical heterogeneity is relatively high,and the common physique is analyzed by gender and age subgroups.Gender: In patients with Qi-deficiency,the combined effect size OR is 0.54 and 95%CI is[0.31,0.94] when comparing males with females;Comparing males with females,the combined effect size OR is 1.91 and 95%CI is [1.45,2.54] in patients with damp-heat constitution;Among patients with phlegm-dampness,the combined effect size OR was 1.40 and the 95% CI was[0.89,2.20] when Comparing males with females.Age: When younger than 40 years old,phlegm-dampness constitution accounted for 21%,95% CI was[18%-24%],damp-heat constitution accounted for 24%,95% CI was[5%-42%],Qi-deficiency constitution accounted for 8%,95%CI is [6%-10%];between 40-60 years old,phlegm-dampness constitution accounts for 27%,95% CI is [17%-38%],damp-heat constitution accounts for 15%,95% The CI is [11%-20%],the constitution of Qi-deficiency accounts for 11%,and the95% CI is [6%-17%];when older than 60 years old,the phlegm-dampness constitution accounts for 21%,and the 95% CI is [14%-29%],damp-heat constitution accounted for 9%,95% CI was [3%-15%],Qi-deficiency constitution accounted for 13%,and 95% CI was [7%-19%].5.The distribution of the funnel chart is obviously uneven,and there is publication bias.Conclusion:1.Phlegm-dampness,damp-heat and qi-deficiency are the main biased constitutions of NAFLD patients.Phlegm-dampness and damp-heat may be risk factors for NAFLD,and balanced constitution may be protective factors for NAFLD.2.There are gender differences in the TCM physique distribution of NAFLD patients.Male patients are mostly damp-heat physique,while female patients are mostly qi-deficiency physique.There is no significant difference between sexes in the distribution of phlegm-dampness constitution.3.There are age differences in the TCM physique distribution of NAFLD patients.There is no significant difference in the distribution of phlegm-dampness in different age groups,suggesting that phlegm-dampness can occur at different ages.Damp-heat and Qi-deficiency are more common in NAFLD patients under 40 and 60 years old,respectively.4.There are regional differences in the distribution of TCM constitution in NAFLD patients.Phlegm-dampness is mainly distributed in East China,damp-heat is mainly distributed in South China,and Qi-deficiency is more evenly distributed in East China,North China and South China.5.This study provides a new idea for screening the risk factors of NAFLD.But the included statistics are highly heterogeneous,and there may be certain deviations.Moreover,the relationship between phlegm-dampness,damp-heat and the pathogenesis of NAFLD is not yet clear,and more research is needed to further clarify.