Research On Biochemistry, Serum Metabolomics And TCM Syndrome Types In Patients With Non-alcoholic Fatty Liver Disease

BackgroundNon-alcoholic fatty liver disease(NAFLD)is a clinicopathological syndrome characterized by diffuse bullous steatosis of hepatocytes,except for alcohol and other definite liver damage factors.With the prevalence of obesity and metabolic syndrome,non-alcoholic fatty liver has become the leading cause of abnormal liver biochemical indicators in chronic liver diseases and health check-ups in China.Simple fatty liver can further develop into non-alcoholic steatohepatitis.There is a lot of evidence in clinic that it is related to liver fibrosis and cirrhosis.It may also be one of the main causes of cryptogenic cirrhosis until it develops into hepatocellular carcinoma.At present,the leading cause of death in patients with non-alcoholic fatty liver disease is still cardiovascular disease.Nevertheless,the proportion of patients who die from liver disease has gradually increased,and we still need to pay enough attention to it.As for the diagnosis of nonalcoholic fatty liver,abdominal color Doppler ultrasound is still the main method in clinic at present,but color Doppler ultrasound itself has the characteristics of low sensitivity and large error,so the diagnosis is often inaccurate.The more accurate diagnostic method is the proton density fat content determination technology of MRI,but it is difficult to popularize because of its high price.The gold standard for diagnosis and classification of non-alcoholic fatty liver is liver biopsy,but as an invasive technique,it can not be accepted by all patients,and there are also possibilities of false positive results caused by sample puncture deviation and sampling error.Therefore,a scientific,convenient and relatively moderate diagnostic technology needs to be excavated urgently.In addition,dietary intervention is one of the important means of early NAFLD treatment,but the current clinical investigation on diet and living habits of NAFLD patients is relatively lacking,and there is a lack of comprehensive and scientific dietary guidance program,which can not fundamentally eliminate the risk factors of disease.ObjectiveTo investigate the general situation and dietary habits of NAFLD patients,determine their biochemical indicators and specific serum metabolic components,and preliminarily explore the distribution of TCM syndromes in NAFLD patients.MethodFrom October 2018 to February 2019,the North District Health Examination Center of S ino-Japanese Friendship Hospital recruited both NAFLD patients and healthy control groups.Through questionnaire survey,the basic information of patients was filled in,including general information(gender,age,occupation,body mass index,waist circumference,hip circumference,etc.),dietary habits,clinical symptoms(symptoms,signs,tongue and pulse).(2)Examine the blood routine,liver and kidney function,blood lipids and other serological indicators,and take serological samples to determine their specific serum markers;(3)Establish a database and use statistical methods for statistical analysis of various indicators.Result1.General situation:101 effective questionnaires and serum biochemical indicators were collected,including 66 cases in NAFLD group and 35 cases in health group.There were 43 males(65.2%)and 23 females(34.8%)in NAFLD group.The ratio of males to females was 1.87:1.In the healthy group,there were 13 males(37.1%)and 22 females(62.9%).The ratio of males to females was 0.59:1.The youngest age in NAFLD group was 25 years old and the oldest age was 65 years old,with an average age of 37.5(31.75,47).In age structure,the most age group in NAFLD group was 30-39 years old,accounting for 37.9%.Among them,men aged 39-39 accounted for 46.5%of male patients,while women aged 40-49 accounted for 34.8%of female patients.The youngest age in the healthy group was 24 years old and the oldest age was 58 years old,with an average of 34(31,36)years old.There were significant differences in sex and age between NAFLD group and healthy group(P=0.007).2.Body mass index:BMI in NAFLD group was in normal range in 7 cases,accounting for 11.3%,BMI was higher than normal range in 55 cases(4 groups of NAFLD data were not statistics),accounting for 88.7%.Among them,32 cases belonged to overweight range and 23 cases belonged to obesity range.In the healthy group,17 cases(53.1%)had normal BMI,15 cases(46.9%)had higher BMI than normal BMI(3 groups of data were not counted),including 10 cases of overweight and 5 cases of obesity.Statistical analysis showed that there was significant difference in BMI between NAFLD group and healthy group(P<0.001),and BMI of NAFLD group was significantly higher than that of healthy group.3.Biochemical indicators:There were significant differences in triglyceride(TG),low density lipoprotein(DDLC),uric acid(UA),ALT,AST and blood sugar(GLU)between NAFLD group and healthy group(P<0.05),and the above biochemical indicators in NAFLD group were higher than those in healthy group,while the biochemical indicators in high density lipoprotein(HDLC)in NAFLD group were lo wer than those in healthy group(P=0.008).4.Serum metabonomics:Compared with the control group,the distribution of metabolites in the patient group changed significantly.Two potential biomarkers were identified by screening the variables with significant differences between the patient gro up and the healthy group.The molecular formula of the biomarker 1 m/z 429.2407 could be preliminarily deduced as C25H28N60 or C21H36N205S.The biomarker 2 m/z 524.3698 currently uses data such as ChemSpider.There is no exact matching data in database retrieval,and the exact structure confirmation of both needs further analysis and identification.5.Distribution of TCM Syndrome Types:A total of 66 valid questionnaires for disease group were collected.According to the diagnostic criteria of TCM,there were 9 cases of liver depression and spleen deficiency syndrome,accounting for 0.14%;6 cases of phlegm turbidity and internal obstruction syndrome,accounting for 0.09%;41 cases of damp-heat accumulation syndrome,accounting for 0.62%;4 cases of phlegm and blood stasis syndrome,accounting for 0.06%;6 cases of Spleen-Kidney Deficiency syndrome,accounting for 0.09%.Conclusion1.Men are more likely to develop NAFLD than women,and most NAFLD patients are obese or overweight.2.The le vels of blood lipid and uric acid in patients with NAFLD increased,and most of them had abnormal liver function.3.The distribution of serum metabolism in NAFLD group was significantly different from that in healthy group,but the specific structure of NAFLD group needs to be further explored.4.The most frequently occurring syndromes are damp-heat accumulation syndrome,followed by liver depression and spleen deficiency,phlegm turbidity internal obstruction,spleen and kidney deficiency and phlegm and blood stasis syndrome.