Study On Ultrasonic Hemodynamics In Medical Checkup Crowd With Nonalcoholic Fatty Liver Disease Of Different Syndrome Types

ObjectiveTo study ultrasonic hemodynamics in medical checkup crowd with nonalcoholic fatty liver disease(NAFLD) of different syndrome types, and try to discuss TCM pathogenesis evolution of NAFLD in medical checkup crowd.MethodsObjects were from the medical checkup crowd in First Affiliated Hospital to Guangzhou University of Chinese Medicine. Those who met NAFLD diagnostic standard and have spleen hypofunction and damp retention syndrome(A), liver depression and Qi stagnation syndrome(B), combination of phlegm and blood-stasis syndrome(C), as well as the health (control group) each 30 cases (male and female in half) were enrolled in the study. Each group had no significant difference in age and height, so they were comparable. Observe liver and heart hemodynamics in each group with Doppler ultrasonic diagnostic instrument, collect their fatty liver ultrasonic grade, right hepatic lobe oblique diameter(RHLOD), portal vein inside diameter(PVID), portal vein flow velocity(PVFV), hepatic venous spectrum pattern(HVSP), left ventricular ejection fraction(LVEF), left ventricular E/A ratio(E/A), and then make a comprehensive comparison integrated with duration of disease, blood pressure (BP), body mass index (BMI), fasting blood sugar (FBG),blood uric acid (UA),C-reactive protein (CRP),hepatic function, alpha-fetoprotein (AFP), blood lipids, atherogenic index of plasma [AIP=lg(TG/HDLC)], etc.Results1. Comparison of fatty liver duration and severityGroup C had longer duration (P<0.05) and higher grade (P<0.05), compared with the other two syndrome types. 2. Comparison of liver Doppler ultrasonic index and relative lab indexRHLOD in control group, group A, B, and C were 123.30±9.72mm,130.30±9.09mm,137.17±13.19mm,150.03±11.68mm, respectively, and they were significantly larger one by one(P<0.01, P<0.05). PVID in group B and C were significantly larger than in control group and group A (P<0.05). PVFV in group C was significantly lower than in group A and B (P<0.05). HVSP abnormal rate in control group, group A, B, and C were 6.67%(2/30),20.00%(6/30),46.67% (14/30),73.33%(22/30).respectively. Group A and control group had no difference in HVSP abnormal rate, but among the three syndrome types, HVSP abnormal rate was significantly higher one by one (P<0.05, P<0.01).γ-glutamyl transferase(GGT) in group B and group C were higher in group A(P<0.05). AFP in three syndrome types were within normal range, but AFP in group C was significantly higher than in control group (P<0.05).3. Comparison of heart Doppler ultrasonic index and metabolic syndrome (MS) relative indexThere was no difference in LVEF among all groups. E/A in control group, group A, B, and C were 1.548±0.368,1.287±0.307,1.105±0.329,0.890±0.363, respectively, and they were significantly lower one by one(P<0.01, P<0.05); and besides, incidence of cardiac diastolic dysfunction were 3.33%(1/30),23.33%(7/30),50.00%(15/30),76.67%(23/30), respectively, they were significantly higher one by one(P<0.01, P<0.05). BP in group C was significantly higher than in group A (P<0.05). BMI in group C was significantly larger than in group B (P<0.05). UA in group C was significantly higher than in group A (P<0.05). Only in group C among the three syndrome types, CRP was significantly higher than in control group(P<0.05). AIP in group C was significantly higher than in group A (P<0.05).Conclusion1.The change of liver and heart ultrasonic hemodynamics are related to TCM syndrome differentiation in NAFLD, and can be one of the objective indicators in the syndrome differentiation of NAFLD.2. Among the three syndrome types in NAFLD, type B and C have change in liver hemodynamics, and have worse hepatic function than type A, and also, hepatic tumor maker in type C, although within normal range, is higher than in the healthy.3. The three syndrome types of A, B and C in NAFLD have normal cardiac systolic function, but have declining cardiac diastolic function, moreover, type C has higher BP, BMI, UA, CRP and AIP, which may be the relative factors of the declining cardiac diastolic function.4. Based on the duration, severity, ultrasonic hemodynamics and relative indexes in NAFLD of the three syndrome types, the TCM pathogenesis evolution of NAFLD can be inferred:①type A and B tend to develop into type C;②NAFLD, located in the liver(belonging to wood in the five elements), tend to affect the heart(belonging to fire in the five elements), which coincides with TCM theory "mother organ's disorder affecting its child-organ"...