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| 題 名 | 脂肪肝臨床表現與中醫證型關係研究=The Relationship between the Clinical Manifestation of the Fatty Liver and the TCM Pattern Diagnosis |
|---|---|
| 作 者 | 張宏州; | 書刊名 | 中醫藥年報 |
| 卷 期 | 光碟版1:1 2012.10[民101.10] |
| 頁 次 | 頁169-191 |
| 專 輯 | 中醫診斷基準及臨床照顧相關研究 |
| 分類號 | 413.34 |
| 關鍵詞 | 脂肪肝; 中醫辨證分型; 舌象檢查; Fatty liver; TCM pattern presentation; Tongue examination; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 研究目的:透過望、聞、問、切四診、腹部超音波以及血液檢查,深入探討脂肪肝病患之臨床表現與中醫證型之關係,以建立脂肪肝之中醫診斷方法標準化,增加中醫診斷敏感度及精確度,以提供中藥臨床療效評估基礎。 研究方法:於本院中西醫整合門診收集實際脂肪肝患者 100名,經主持人之說明並取得病患之知情同意書後,進行腹部超音波檢查、血液檢查、完整之個人病史、家族史、用藥史詢問及中醫四診檢查,搭配電腦化舌象診察系統,擷取病患舌診影像,加以數位化分析,進一步研究腹部超音波診斷嚴重度分析與脂肪肝病患生化指標之關係以及與中醫辨證分型之關係。 結果與討論:本研究篩選脂肪肝受試者 100名,其中 92名符合脂肪肝診斷,經中醫辨證分型,無明顯證型共 51名占 55.4%最多、痰濕內阻型 16名占 17.4%次之、肝膽濕熱型 14名占 15.2%、肝鬱氣滯型 5名占 5.4%、肝腎陰虛型 3名占 3.3%、脾腎虧虛型 2名占 2.2%、瘀血阻絡型 1名僅占 1.1%。其中痰濕內阻型、肝膽濕熱型相較於無明顯證型者可以顯著反應脂肪肝指數的升高,而肝膽濕熱證型可以有效偵測患者 GPT異常上升、高三酸甘油脂症、以及高密度脂蛋白降低,成為脂肪肝是否需要介入治療的重要臨床鑑別指標,其餘肝鬱氣滯、瘀血阻絡、肝腎陰虛、脾腎虧虛等四種證型對於脂肪肝相關指標則無明顯鑑別能力。因此本研究建議脂肪肝之中醫診治標準,應以肝膽濕熱、痰濕內阻二型為主要臨床診治證型,以提高臨床診斷之敏感度以及辨識率,將有助於未來中醫藥防治脂肪性肝炎之發展。 |
| 英文摘要 | AIM: The aim of the study is to explore the relationship between the severity of the fatty liver and the TCM pattern presentation by the four kinds of examination-inspection, smell, ask question and palpation. This is the basis to establish the TCM diagnosis standard for fatty liver, and to increase the sensitivity and accuracy. METHOD: We design to recruit 100 participants with fatty liver via integrated medicine outpatients. After the the explaintation of insent-concent form and signature, every participant will receive abdominal sonography, blood serum biochemistry examination, medical history taking, and TCM four kinds pattern diagnosis examination. Besides, we will take the their tongue images for digital analysis. RESULTS & DISCUSSION: The study screened 100 participates, 92 persons were diagnosed fatty liver by abdominal sonography. These participants were evaluated by TCM pattern differentiation, no obvious pattern presentation accounts for 55.4%(51/92) mostly, the phlegm damp internal stasis pattern accounts for 17.4%(16/92), Damp heat pattern accounts for 15.2%(14/92), and other 4 pattern totally accounts for 12%(11/92). Comparison with the participants with no obvious pattern presentation, the phlegm damp internal stasis pattern and the damp heat pattern can reflect the elevation of fatty liver score significantly. Besides, the damp heat pattern can detect the elevation of GPT and TG of the serum and the decrease of HDL-C of the serum. These parameters are the markers for the decision for the treatment of the fatty liver disease. Based on the study result, we suggest the phlegm damp internal stasis pattern and the damp heat pattern are the main TCM differentiation pattern for the treatment of the fatty liver disease. The 2 patterns can reflect the severity of steatohepatitis and help the clinician clinical practice more sensitive and more specific for the treatment of the fatty liver disease. To establish the TCM differentiation pattern standard is helpful to develop good TCM treatment for the fatty liver disease in the future. |
本系統中英文摘要資訊取自各篇刊載內容。