Characteristics Of Tongue Coating And Intestinal Flora In Patients With Non-alcoholic Fatty Liver Disease With Phlegm Dampness

Objectives:To study the characteristics and correlation of tongue coat ing and intestinal flora in patients with phlegm-wet NAFLD,and to investigate the correlation between microbial information a nd biochemical indexes,TCM constitution,tongue image informat ion and body composition,so as to provide a new idea for the c lassification and prevention of patients with NAFLD.Methods:29 patients with NAFLD were selected from the Classic ward of traditional Chinese medicine and obesity specialist of Hube i Traditional Chinese Medicine Hospital(Guanggu Hospital)from August 2020 to December 2020.The detection of body compositio n,biochemical information,TCM constitution investigation and tongue image information were collected to investigate the meta bolic risk factors of NAFLD patients.Illumina Miseq,a highly variable region of 16 S r RNA gene,was sequenced and bioinformat ics analyzed to explore the correlation between intestinal flor a and bacterial flora on the tongue and feces.Results:(1)The main constitution of NAFLD patients was phlegm and dampness(37.93%).Male patients were more than female patients(62.07% VS 37.93%),and most of the patients were young people(27.96±10.28).(2)The indexes of lean body weight,protein,fat-free body weight and skeletal muscle weight of patients wit h phlegm-dampness constitution were higher than those with ping ping constitution.The total body fat and visceral fat area wer e lower than those of the patients with mild constitution,but there was no statistically significant difference(P>0.05).(3)Most patients were associated with obesity(86.21%),hyperlipi demia(79.31%),and hyperuricemia(65.52%),with abnormal gluco se and lipid metabolism indicators such as UA,HOMA-IR,HDL-C,and TG.The biochemical indexes of patients were significantly correlated with body composition(P<0.01),TG,HDL-C,Apo-B,U A and CREA were significantly correlated with body composition(P<0.01),UA was significantly correlated with protein,minera l,total body fat,lean body weight,fat-free body weight and s keletal muscle weight(P<0.01).(4)The main tongue manifestat ions were red tongue(65.52%),fat tongue(41.38%)and white to ngue(75.86%,65.52%).In patients with phlegm-dampness constit ution,lichen was also observed,while in patients with mild co nstitution,cracked tongue was also observed.(5)In the analys is of flora abundance,the dominant flora of tongue coating flo ra and intestinal flora were Bacteroidetes,Firmicute,Proteoba cteria,fusobacteria and actinobacteria.Spirochaetes and Candi datus saccharibacteria were only found in tongue coating flora;Lentisphaerae,synergistetes and verrucomicrobia were only found in the intestinal flora.At the genus level,the flora of to ngue coating and intestinal tract were Prevotella,Fusobacteriu m and Eubacterium.(6)In the correlation analysis of tongue coa ting and intestinal flora,the intestinal flora of patients wit h Veillonella,Streptococcus and tongue coating Haemophilus wer e positively correlated(P=0.037/0.008);Intestinal alloprevote lla and Haemophilus were positively correlated with Prevotella(P=0.001/0.05).(7)In the analysis of the characteristic flora of patients with phlegm dampness constitution,it was found tha t the abundance of intestinal sutterella flora of patients with phlegm dampness constitution was higher than that of patients with mild constitution;There was a significant negative correl ation between intestinal Streptococcus and Prevotella in patien ts with phlegm dampness constitution(P = 0.013).Conclusions:The main TCM Constitution of NAFLD patients is phlegm damp ness,and the accumulation of phlegm dampness plays a major rol e in the etiology and pathogenesis.With the increase of metabo lic risk factors in patients with NAFLD,metabolic disorders ma y exist in common pathogenesis and interact with each other.Mo st patients with phlegm dampness constitution have dyslipidemia,which can be screened by body composition such as neck circumf erence,abdominal circumference and timely intervention.Due to phlegm dampness,the patient often has red and fat tongue with white thick fur,and other tongue features can be seen with di fferent constitution.The dominant flora of tongue coating and intestinal flora in patients with NAFLD is consistent,so it ca n be considered to cooperate with treatment to achieve the internal relative balance.Patients with phlegm dampness constituti on have characteristic associated flora with inflammatory facto r release and glucose and lipid metabolism disorder.