Study On TCM Constitution And Related Factors Of Patients With Fatty Liver In Yunnan Province

Objective:To understand the TCM constitution distribution and other relevant influencing factors of fatty liver in yunnan(Kunming,Lijiang and Binchuan),to further explore the relationnship between the risk factors of fatty liver and TCM constitution,and to provide scientific basis for the prevention and treatment of fatty liver.Methods:The survey was conducted by using a uniform questionnaire,cross-sectional survey and casecontrol study.From October 2016 to October 2018,the physical examination population was randomly selected from five hospitals(yunnan hospital of traditional Chinese medicine,kunming hospital of traditional Chinese medicine,the first affiliated hospital of yunnan university of traditional Chinese medicine,dianchi physical examination center,binchuan county hospital of traditional Chinese medicine,and lijiang people’s hospital)in yunnan province,a total of 15 40 subjects met the inclusion criteria,the survey data included basic information(gender,age,nationality,education background,occupation),life behavior(smoking,drinking,diet,exercise,sleep),anthropological indicators(height,weight,systolic blood pressure,diastolic blood pressure,heart rate,BMI),laboratory indicators(TBIL,DBIL,IBIL,TP,ALB,GLB,ALT,AST,ALP,GGT).TC,TG,HDL,LDL;FPG.BUN,SCr,UA;RBC,HGB,PLT,WBC),physical identification and abdominal B-ultrasound diagnosis were classified for statistical analysis.A total of 148 subjects(104 cases in the fatty liver case group and 44 cases in the normal control group)were randomly selected from the 1540 subjects for the analysis of three gene polymorphisms(PNPLA 3,TM6SF2,PPARa).Results: 1.Basic information: among the 1540 subjects,the average age was 54.6±14.4 years,with 814 males(52.9%)and 726 females(47.1%).2.Indicators with statistical difference between the fatty liver group and the normal group include age,ethnicity,occupation,smoking status,exercise and sleep;Body weight,SBP,DBP,HR,BMI;TBIL,DBIL,TP,ALB,GLB,ALT,AST,ALP,GGT,TG,HDL,FPG,RBC,HGB,PLT;Phlegmy wet mass quality,dampness-heat quality,the mild deficiency quality,Yang deficiency quality(The Phlegmy wet mass and dampness-heat quality of fatty liver group were more than that of control group,and the mild and Yang deficiency quality were less than that of control group).3.Distribution of TCM constitution of fatty liver in yunnan:(1)phlegm-dampness-heat substance(27.7%)>dampness-heat substance(18.6%)> gentle quality(15.4%)> qi-deficiency substance(13.9%)> yin-deficiency substance(8.4%),> qi-stagnation substance(6.2%),> yangdeficiency substance(6%),> blood-stasis substance(2.6%),> specific substance(1.3%).The degree of fatty liver mainly includes moderate to severe phlegm-dampness fatty liver.(2)the patients with fatty liver in kunming were mainly mild fatty liver with specific nature and Yin deficiency,and the rest were mostly mild and Yang deficiency;In lijiang,the moderate and severe fatty liver in phlegm-dampness was higher than that in kunming,and qi deficiency was the most in other constituteions.The most patients with fatty liver in binchuan were phlegm-dampness and dampness-heat.4.There were statistical differences in the indicators of fatty liver patients with different TCM constitutions in yunnan,three regions and nine regions,including age,nationality,occupation,smoking status,exercise and sleep;Body weight,SBP,DBP,HR,BMI;ALT,HDL,FPG,HGB.5.Between the fatty liver group and the normal control group and between the fatty liver patients with nine different TCM constitution there was no statistical difference in the genotype,allele and genetic model of the polymorphic loci of the three genes(PNPLA3,TM6SF2,PPARa)(P >0.05).6.Binary Logistic regression analysis of fatty liver related factors:(1)risk factors for fatty liver disease and OR(95%CI)include: Moderate intensity exercise 5.737(3.747 ~ 8.783),less exercise 75.388(10.277-552.995),BMI1.209(1.088-1.342),DBP1.042(1.014-1.070),DBIL1.466(1.198-1.794),ALP1.048(1.029-1.066),GGT1.047(1.022-1.072),TG1.716(1.255-2.345),FPG6.175(3.663-10.407);Protective factors and OR(95%CI)were smoking 0.505(0.274-0.930)and ALB 0.707(0.643-0.778).(2)influencing factors of four main fatty liver patients with different TCM constitutions.Risk factors and OR(95%CI)were BMI1.351(1.069-1.708),DBP1.077(1.013-1.1 44),and FPG17.981(4.641-69.668).Protective factors and OR(95%CI)were ALB0.558(0.425-0.732).The risk factors and OR(95%CI)of patients with fatty liver in hot and humid temperament were: ALP1.103(1.020-1.192)and FPG18.868(2.827-125.928).Protective factors and OR(95% CI)were ALB0.821(0.707-0.954).Risk factors and OR(95%CI)of fatty liver in patients with Yang deficiency were: male 15.623(1.342-181.889),BMI1.696(1.044-2.754),GGT1.106(1.023-1.196),FPG12.305(2.775-54.561).Protective factors and OR(95%CI)were ALB0.509(0.340-0.762).Risk factors and OR(95%CI)were: SBP1.059(1.016-1.104),ALT1.113(1.034-1.198),ALP1.074(1.030-1.119),GGT1.099(1.029-1.173),and FPG6.385(1.782-22.882).Protective factors and OR(95%CI)were smoking 0.264(0.070-0.995)and ALB0.553(0.423-0.723).Conclusion: 1.Fatty liver in yunnan is closely related to exercise amount,BMI,blood pressure,blood lipid and blood glucose,etc.The main risk factors for fatty liver are as follows: less exercise,and high BMI,DBP,DBIL,ALP,GGT,TG and FPG.2.The phlegm-dampness and damp-heat quality are the most common TCM constitutions of fatty liver patients in yunnan.The risk factors of fatty liver in phlegm and dampness were: BMI,DBP,FPG.The risk factors of fatty liver in heat and damp were ALP and FPG.TCM constitution can be used as an important index to determine fatty liver disease.3.The results of this study suggest that the polymorphism of PNPLA3 gene(P=0.056)may be related to fatty liver predisposition,but it needs to be further studied by expanding the sample size.