Correlation between liver fibrosis and tongue features in patients with non-alcoholic fatty liver disease
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摘要: 目的 探讨非酒精性脂肪性肝病(NAFLD)患者肝纤维化评分(NFS)与舌象特征的关系。方法 从中日友好医院体检中心随机招募确诊为NAFLD的受试者，收集受试者的人口学资料、测量学指标、实验室指标等，按标准化流程采集受试者的舌象照片并进行校正与标注，比较不同舌象特征的受试者间NFS评分的差异。结果 NAFLD患者舌色上以暗红舌为主，苔色上以淡黄苔为主。暗红舌、紫舌、黄苔及舌质瘀点和瘀斑的NAFLD患者的NFS评分显著高于淡红舌、白苔、无瘀点和瘀斑的患者；紫舌患者中NFS>0.676的比例显著高于淡红舌、红舌和暗红舌的患者(P＜0.05)；舌质瘀点和瘀斑的患者中NFS>0.676的比例亦显著高于舌质无瘀点和瘀斑的患者(P＜0.05)。结论 暗红舌、紫舌、黄苔、舌质瘀点和瘀斑对NAFLD患者肝纤维化有重要的提示作用。Abstract: Objective To investigate the correlation between the non-alcoholic fatty liver disease(NAFLD) fibrosis score(NFS) and tongue features in patients with NAFLD.Methods Subjects diagnosed as NAFLD were randomly recruited from the Medical Examination Center of China-Japan Friendship Hospital and their demographic data, measurement indexes, and laboratory indexes were collected. The subjects' tongue pictures were collected and corrected. Comparing the differences in NFS among subjects with different tongue features.Results Dark red tongue, light yellow coating were predominant in NAFLD patients' tongue images. NFS was significantly higher in NAFLD patients with dark red tongue, purple tongue, yellow coating and stasis tongue than in patients with light red tongue, white coating. The proportion of NFS>0.676 in patients with purple tongue was significantly higher than in patients with light red tongue, red tongue and dark red tongue(P < 0.05). The proportion of NFS>0.676 in patients with stasis tongue was also significantly higher than in other patients(P < 0.05).Conclusion Dark red tongue, purple tongue, yellow coating, stasis tongue are important indicators of liver fibrosis in NAFLD patients.
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表 1 NAFLD患者NFS评分与舌质颜色的关系
M(P25，P75)，例(%) 项目 淡红舌(n=51) 红舌(n=63) 暗红舌(n=247) 紫舌(n=12) H/χ2 P NFS评分 -1.455(-1.797，-0.859) -1.162(-1.740，-0.774) -0.939(-1.552，-0.544)2) -0.550(-1.446，0.275)1) 16.900 0.001 NFS＞0.676 2(3.9) 0 16(6.5) 4(33.3)1)3)4) 20.731 ＜0.001 NFS＜-1.455 25(49.0) 22(34.9) 72(29.1)2) 3(25.0) 8.050 0.045 与淡红舌比较，1)P＜0.05，2)P＜0.01；与红舌比较，3)P＜0.01；与暗红舌比较，4)P＜0.01。 
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表 2 NAFLD患者NFS评分与舌苔颜色的关系
M(P25，P75)，例(%) 项目 白苔(n=113) 淡黄苔(n=201) 深黄苔(n=59) H/χ2 P NFS评分 -1.390(-1.789，-0.795) -0.976(-1.602，-0.596)1) -0.774(-1.115，-0.326)1)2) 24.454 ＜0.001 NFS＞0.676 3(2.7) 16(8.0) 3(5.1) 3.752 0.153 NFS＜-1.455 55(48.7) 57(28.4)1) 10(16.9)1) 21.470 ＜0.001 与白苔比较，1)P＜0.01；与淡黄苔比较，2)P＜0.05。
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表 3 NAFLD患者NFS评分与舌质瘀点的关系
M(P25，P75)，例(%) 项目 舌质无瘀点(n=298) 舌质瘀点(n=75) Z/χ2 P NFS评分 -1.076(-1.743，-0.660) -0.841(-1.269，-0.410) -3.083 0.002 NFS＞0.676 11(3.7) 11(14.7) 13.005 ＜0.001 NFS＜-1.455 106(35.6) 16(21.3) 5.518 0.019
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表 4 NAFLD患者NFS评分与舌质瘀斑的关系
M(P25，P75)，例(%) 项目 舌质无瘀斑(n=315) 舌质瘀斑(n=58) Z/χ2 P NFS评分 -1.076(-1.743，-0.675) -0.718(-1.104，-0.298) -4.272 ＜0.001 NFS＞0.676 11(3.5) 11(19.0) 21.130 ＜0.001 NFS＜-1.455 114(36.2) 8(13.8) 11.164 0.001
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表 5 NAFLD患者不同中医证型与舌象特征的关系
例(%) 舌象特征 肝郁脾虚证(n=57) 痰浊内阻证(n=63) 湿热蕴结证(n=185) 痰瘀互结证(n=68) χ2 P 舌质颜色 淡红舌 15(26.3) 20(31.7) 12(6.5)2)4) 4(5.9)2)4) 36.744 ＜0.001 红舌 8(14.0) 10(15.9) 40(21.6) 5(7.4)6) 7.734 0.052 暗红舌 32(56.1) 32(50.8) 130(70.3)1)4) 53(77.9)2)4) 14.824 0.002 紫舌 2(3.5) 1(1.6) 3(1.6) 6(8.8)5) 8.930 0.030 舌苔颜色 白苔 37(64.9) 36(57.1) 22(11.9)2)4) 18(26.5)2)4)6) 83.992 ＜0.001 淡黄苔 20(35.1) 27(42.9) 111(60.0)2)3) 43(63.2)2)3) 16.365 0.001 深黄苔 0 0 52(28.1)2)4) 7(10.3)1)4)6) 45.092 ＜0.001 舌质瘀点 1(1.8) 7(11.1) 26(14.1)1) 41(60.3)2)4)6) 87.708 ＜0.001 舌质瘀斑 1(1.8) 3(4.8) 17(9.2) 37(54.4)2)4)6) 97.749 ＜0.001 与肝郁脾虚证比较，1)P＜0.05，2)P＜0.01；与痰浊内阻证比较，3)P＜0.05，4)P＜0.01；与湿热蕴结证比较，5)P＜0.05，6)P＜0.01。
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[1] Huang TD, Behary J, Zekry A. Non-alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management[J]. Intern Med J, 2020, 50: 1038-1047. doi: 10.1111/imj.14709
[2] Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64: 73-84. doi: 10.1002/hep.28431
[3] Zhou J, Zhou F, Wang W, et al. Epidemiological Features of NAFLD From 1999 to 2018 in China[J]. Hepatology, 2020, 71: 1851-1864. doi: 10.1002/hep.31150
[4] 童聪, 李亚年, 顾达, 等. 扬州市老年体检人群非酒精性脂肪肝患病情况及相关危险因素[J]. 江苏预防医学, 2022, 33(2): 143-145. doi: 10.13668/j.issn.1006-9070.2022.02.007
[5] Parola M, Pinzani M. Liver fibrosis: Pathophysiology, pathogenetic targets and clinical issues[J]. Mol Aspects Med, 2019, 65: 37-55. doi: 10.1016/j.mam.2018.09.002
[6] 徐列明, 刘平, 沈锡中, 等. 肝纤维化中西医结合诊疗指南(2019年版)[J]. 中国中西医结合杂志, 2019, 39(11): 1286-1295. doi: 10.7661/j.cjim.20190916.314
[7] Wong VW, Chu WC, Wong GL, et al. Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in Hong Kong Chinese: a population study using proton-magnetic resonance spectroscopy and transient elastography[J]. Gut, 2012, 61: 409-415. doi: 10.1136/gutjnl-2011-300342
[8] Nah EH, Cho S, Kim S, et al. Prevalence of liver fibrosis and associated risk factors in the Korean general population: a retrospective cross-sectional study[J]. BMJ Open, 2021, 11: e046529. doi: 10.1136/bmjopen-2020-046529
[9] Vilar-Gomez E, Calzadilla-Bertot L, Wai-Sun Wong V, et al. Fibrosis Severity as a Determinant of Cause-Specific Mortality in Patients With Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Study[J]. Gastroenterology, 2018, 155: 443-457. doi: 10.1053/j.gastro.2018.04.034
[10] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957. doi: 10.3969/j.issn.1001-5256.2018.05.007
[11] Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD[J]. Hepatology, 2007, 45: 846-854. doi: 10.1002/hep.21496
[12] 陈家旭, 邹小娟, 季绍良, 等. 中医诊断学[M]. 北京: 人民卫生出版社, 2012: 35-38.
[13] 李军祥, 陈誩, 王允亮. 非酒精性脂肪性肝病中西医结合诊疗共识意见(2017年)[J]. 中国中西医结合消化杂志, 2017, 25(11): 805-811. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=045b3eff-56be-493c-887d-c436098b9b58
[14] 樊威, 李潇潇, 丁江涛, 等. 人工智能在中医舌诊中的应用探讨[J]. 光明中医, 2019, 34(1): 37-40. doi: 10.3969/j.issn.1003-8914.2019.01.016
[15] 王洋, 李书楠, 王昌恩, 等. 中医疗效评价中舌象研究重要性探析[J]. 中华中医药杂志, 2017, 32(10): 4347-4349. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201710003.htm
[16] 魏翔宇, 詹松华, 周华, 等. 中医舌诊新技术研究进展[J]. 中国中医基础医学杂志, 2021, 27(9): 1519-1521. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC202109042.htm
[17] Vilar-Gomez E, Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers[J]. J Hepatol, 2018, 68: 305-315. doi: 10.1016/j.jhep.2017.11.013
[18] Jaruvongvanich V, Wijarnpreecha K, Ungprasert P. The utility of NAFLD fibrosis score for prediction of mortality among patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis of cohort study[J]. Clin Res Hepatol Gastroenterol, 2017, 41: 629-634. doi: 10.1016/j.clinre.2017.03.010
[19] Lee J, Vali Y, Boursier J, et al. Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events: A systematic review[J]. Liver Int, 2021, 41: 261-270.
[20] 段绍杰, 陈佳良, 程钰, 等. 慢性肝病患者舌象特征研究进展[J]. 中西医结合肝病杂志, 2019, 29(6): 567-569. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201906032.htm
[21] 张治国, 杨杰, 张智, 等. 舌象与肝病关系临床研究集析[J]. 时珍国医国药, 2010, 21(4): 981-983. https://www.cnki.com.cn/Article/CJFDTOTAL-SZGY201004104.htm
[22] 朱熠文, 林晖明, 周军, 等. 老年肥胖型及非肥胖型脂肪肝患者中医体质特点分析[J]. 中国中西医结合消化杂志, 2021, 29(7): 464-467. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=6126dd7b-1b85-4043-ba7e-713b77204040
[23] 李文政. 肝硬化腹水患者舌象与转归关系及辨证施治[J]. 新疆中医药, 2007(4): 115. https://www.cnki.com.cn/Article/CJFDTOTAL-XJZY200704073.htm
[24] 陈燕. 舌诊在慢性乙型肝炎中的应用[D]. 武汉: 湖北中医学院, 2009.
[25] 周文伟, 王邦才, 王培劼, 等. 酒精性肝病患者瘀血舌象与肝功能指标的相关性研究[J]. 中国中医药科技, 2020, 27(5): 673-675, 718. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYY202005001.htm
[26] 刘文兰, 张炎, 于玫, 等. 慢性乙型肝炎苔色与舌象其他特点关系的研究[J]. 贵阳中医学院学报, 2005(2): 17-19. https://www.cnki.com.cn/Article/CJFDTOTAL-GYZX200502009.htm
[27] 武哲丽, 陈群, 徐志伟, 等. 肝病瘀血舌象患者与血瘀证各组ET/NO的临床实验研究[J]. 四川中医, 2008(5): 4-5. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY200805004.htm
[28] 赵鸣芳. 辨病辨证并治与辨证论治的比较研究[J]. 南京中医药大学学报, 2022, 38(8): 655-665. https://www.cnki.com.cn/Article/CJFDTOTAL-NJZY202208002.htm
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