Study On The Correlation Between TCM Syndrome Type And Thyroid Hormone Level In Nonalcoholic Fatty Liver Disease

Objective:By observing the association between TCM syndrome type and thyroid hormone level in patients with non-alcoholic fatty liver disease(NAFLD),we can understand the distribution difference of TH level in different TCM syndrome types of NAFLD.To explore the correlation between TH level and the severity of NAFLD,in order to improve the accuracy of TCM syndrome differentiation and enrich the objectified indexes of TCM syndrome differentiation and classification of NAFLD.Methods:From December 2019 to January 2022,150 NAFLD patients(observation group)who met the inclusion criteria in the outpatient clinic or inpatient treatment of the Liver Disease Center of Xiamen Traditional Chinese Medicine Hospital were selected.During the same period,30 healthy people(control group)who underwent physical examination in the physical examination center of Xiamen Traditional Chinese Medicine Hospital were selected.A total of 150 NAFLD patients were divided into TCM syndrome differentiation based on symptoms,tongue and pulse,etc.General data such as gender,age,height,weight,body mass index(BMI),serological indicators,imaging indicators and other related data were collected,and a database was established.SPSS 20.0 was used to analyze the distribution difference of TH level in NAFLD patients with different TCM syndroms,and the correlation between TH and BMI,controlled attenuation parameter,(CAP),liver Stiffness measurement(LSM),liver severity,liver function and metabolic correlation indexes.Results:1.A total of 150 NAFLD patients were collected in this study,including 65 cases of liver stagnation and spleen deficiency(43.3%)> 48 cases of dampness-heat accumulation syndrome(32.0%)> 25 cases of dampness-turbidity internal arrest syndrome(16.7%)> 12 cases of phlegm-stasis syndrome(8.0%),and no spleen-kidney deficiency syndrome was collected.2.FT3 and FT4 levels in NAFLD patients with normal thyroid function(observation group)were lower than those in healthy subjects(control group),and TSH levels were higher than those in control group,with statistical significance(P<0.05).3.There were no statistically significant differences in the distribution of gender and age among different TCM syndromes of NAFLD patients(P>0.05).There were statistically significant differences in the distribution of BMI,CAP,LSM and the severity of abdominal fatty liver disease among different TCM syndromes(P<0.01).The value of liver depression and spleen deficiency syndrome was the lowest.In abdominal ultrasonography,liver depression and spleen deficiency were mainly mild fatty liver(64.6%),dampness and heat accumulation syndrome and dampness and turbidity internal arrest syndrome were mostly moderate fatty liver(62.5%,52.0%),and phlegm and blood stasis syndrome were mostly severe fatty liver(66.7%).4.There were statistical differences in the distribution of FT3,FT4 and TSH levels among TCM syndromes(P<0.05).The values of FT3 and FT4 were the lowest in the syndrome of mutual accumulation of phlegm and blood stasis,which were significantly different from those in the syndrome of liver depression and spleen deficiency(P<0.01).The distribution of TSH in TCM syndrome showed the trend of phlegm and stasis syndrome >dampness and turbidity internal arrest syndrome > dampness and heat accumulation syndrome > liver depression and spleen deficiency syndrome.Pair-to-pair-comparison showed that there were significant differences(P<0.01),except that there was no significant difference between dampness-turbidity internal arrest syndrome,dampness-heat accumulation syndrome and phlegm-stasis syndrome(P>0.05).5.Studies on the correlation between TH level and serological indicators suggested that ALT and GGT increased when FT3 level decreased,presenting a negative correlation(r=-0.212,-0.174,P=0.009,0.033).UA value decreased with FT3 decrease,presenting a positive correlation(r=0.170,P=0.038).The lower FT4 level,the higher TG,showing a negative correlation(r=-0.177,P=0.030).The higher the TSH level was,the higher the ALT,TC,TG and UA were,showing a positive correlation(r=0.264,0.228,0.197,0.179,P=0.001,0.005,0.016,0.029),while the HDL-C was negatively correlated(r=-0.193,P=0.018).6.In the study on the correlation between TH level and BMI and imaging indicators,it was found that the lower FT4 level was,the higher BMI and LSM were,showing a negative correlation(r=-0.196,-0.164,P=0.016,0.045).The higher the TSH level was,the higher the BMI and LSM values were,the positive correlation was(r=0.352,0.297,P=0.000,0.000).TSH showed statistically significant difference in the grading of abdominal fatty liver(Z=10.434,P=0.005),and TSH was the highest in severe fatty liver,and the difference was significant compared with mild fatty liver(P=0.004).Conclusion:1.The levels of FT3,FT4 and TSH in NAFLD patients with normal thyroid function were different from those in healthy subjects.FT3 and FT4 in NAFLD group were lower than those in healthy controls and at a low normal level,while TSH was higher than those in healthy controls and at a high normal level.2.There were differences in the distribution of FT3,FT4 and TSH levels among different TCM syndromes of NAFLD patients.FT3 and FT4 were the lowest and TSH was the highest in the syndrome of phlegm-stasis interaction,while the distribution of TH level was opposite in the syndrome of liver stagnation and spleen deficiency.The distribution of TH level can provide reference for the differentiation of TCM syndromes of NAFLD to a certain extent.3.The more severe the liver injury,the lower FT3 level and the higher TSH level;The higher TG was,the lower FT4 level and the higher TSH level were.The more severe the fatty liver and fibrosis,the higher the TSH level.The levels of FT3,FT4 and TSH are correlated with the severity of NAFLD to a certain extent.In the diagnosis and treatment of NAFLD,in addition to monitoring related indicators of liver function and metabolism,the fluctuation of FT3,FT4 and TSH should also be closely monitored for timely intervention.