Clinical Study On Relationship Between Carotid Atherosclerosis And Nonalcoholic Fatty Liver Diease, TCM Syndrome Types Of Carotid Atherosclerosis Accompanied By Nonalcoholic Fatty Liver Diease And Related Indexes

Objective:1.To control-observe on related indexes of abdominal obesity,insulin resistance(IR),dyslipidaemia,abnormal adiponetin(APN) and inflammation response of patients with carotid atherosclerosis(CAS) accompanied by nonalcoholic fatty liver diease(NAFLD),exploring relationship between carotid atherosclerosis and nonalcoholic fatty liver diease,and related mechanisms linking carotid atherosclerosis and nonalcoholic fatty liver diease.2.To study the relationship between related indexes of abdominal obesity,IR, dyslipidaemia,abnormal APN,inflammation response and TCM syndrome types of patients with CAS accompanied by NAFLD,trying to find some peculiar indexes to provide reliable basis for the syndrome differentiation and treatment of patients with CAS accompanied by NAFLD.Methods:74 patients of CAS accompanied by NAFLD and 25 patients only with CAS in control group were selected and divided into 4 types,collecting their test results of Body mass index(BMI),Waist circumference(WC),Homostasis model assessment-IR(HOMA-IR), Cholesterol(CHOL),Triglyceride(TG),Low density lipoprotein-cholesterol(LDL-C),APN, High sensitivity c-reactive protein(hs-CRP) and Tumor necrosis factor(TNF-a),and compared with those in control group,further making bivariate correlation analysis between these test indexes in case group of CAS accompanied by NAFLD.These indexes were compared in different TCM syndrome types of patients with CAS accompanied by NAFLD, and proposing the peculiar indexes which lead to the syndrome differentiation and treatment of patients.Results:1.The levels of BMI,WC,HOMA-IR,CHOL,TG,APN,hs-CRP and TNF-ain patients with CAS accompanied by NAFLD were different from those in control group,and all differences had statistical significance(P＜0.01).Whereas the level of LDL-C was different from that in control group,and the difference also had statistical significance(P＜0.05). 2.The values between BMI and HOMA-IR,WC and HOMA-IR,TG and hs-CRP in patients with CAS accompanied by NAFLD respectively were in significant positive linear correlation, whereas APN and HOMA-IR was in significant negative correlation. 3.Donstituent ratio of TCM syndrome types of CAS accompanied by NAFLD:Syndrome of spleen hypofunction and dampness accumulation＞Syndrome of deficiency of damp-heat brewing internally＞Syndrome of phlegm and blood stasis＞Syndrome of yin deficiency of liver and kidney.4.The level of related indexes of abdominal obesity of CAS accompanied by NAFLD:①BMI:Syndrome of spleen hypofunction and dampness accumulation(29.59±2.77 kg/m~2)＞Syndrome of phlegm and blood stasis(26.05±1.66 kg/m~2)＞Syndrome of deficiency of damp-heat brewing internally(24.88±1.97 kg/m~2).The level of BMI in Syndrome of spleen hypofunction and dampness accumulation was significantly higher than that in Syndrome of deficiency of damp-heat brewing intemally and Syndrome of phlegm and blood stasis (P＜0.01).②WC:Syndrome of spleen hypofunction and dampness accumulation (102.32±6.44 cm)＞Syndrome of phlegm and blood stasis(92.42±2.78 cm)＞Syndrome of deficiency of damp-heat brewing internally(89.29±4.20 cm).The level of WC in Syndrome of spleen hypofunction and dampness accumulation was significantly higher than that in Syndrome of deficiency of damp-heat brewing internally and Syndrome of phlegm and blood stasis(P＜0.01).5.The level of HOMA-IR of CAS accompanied by NAFLD:Syndrome of spleen hypofunction and dampness accumulation(4.02±1.13)＞Syndrome of phlegm and blood stasis(2.97±0.59)＞Syndrome of deficiency of damp-heat brewing internally(2.62±0.77).The level of HOMA-IR in Syndrome of spleen hypofunction and dampness accumulation was significantly higher than that in Syndrome of deficiency of damp-heat brewing internally and Syndrome of phlegm and blood stasis(P＜0.01).6.The level of related indexes of dyslipidaemia of CAS accompanied by NAFLD:①CHOL: Syndrome of phlegm and blood stasis(6.81±1.04 mmol/l)＞Syndrome of deficiency of damp-heat brewing internally(5.74±0.35 mmol/l)＞Syndrome of spleen hypofunction and dampness accumulation(5.39±0.51 mmol/l).The level of CHOL in Syndrome of phlegm and blood stasis was significantly higher than that in Syndrome of spleen hypofunction and dampness accumulation and Syndrome of deficiency of damp-heat brewing internally (P＜0.01).②TG:Syndrome of phlegm and blood stasis(3.55±1.64 mmol/l)＞Syndrome of deficiency of damp-heat brewing internally(2.88±1.06 mmol/l)＞Syndrome of spleen hypofunction and dampness accumulation(2.06±0.66 mmol/l).The level of TG in Syndrome of spleen hypofunction and dampness accumulation was significantly lower than that in Syndrome of deficiency of damp-heat brewing internally and Syndrome of phlegm and blood stasis(P＜0.01).③LDL-C:Syndrome of phlegm and blood stasis(3.46±0.89 mmol/l)＞Syndrome of spleen hypofunction and dampness accumulation(3.45±0.85 mmol/l)＞Syndrome of deficiency of damp-heat brewing internally(3.10±0.85 mmol/l).7.The level of related indexes of inflammation response of CAS accompanied by NAFLD: ①hs-CRP:Syndrome of phlegm and blood stasis(3.98±1.67 mg/l)＞Syndrome of spleen hypofunction and dampness accumulation(3.06±0.91 mg/l)＞Syndrome of deficicncy of damp-heat brewing internally(3.04±1.54 mg/l).The level of hs-CRP in Syndrome of phlegm and blood stasis was higher than that in Syndrome of spleen hypofunction and dampness accumulation and Syndrome of deficiency of damp-heat brewing internally(P＜0.05).②TNF-a:Syndrome of deficiency of damp-heat brewing internally(87.22±11.12 pg/ml)＞Syndrome of spleen hypofunction and dampness accumulation(81.79±7.68 pg/ml)＞Syndrome of phlegm and blood stasis(72.81±12.03 pg/ml).The level of TNF-ain Syndrome of deficiency of damp-heat brewing internally was significantly higher than that in Syndrome of phlegm and blood stasis(P＜0.01),whereas that in Syndrome of spleen hypofunction and dampness accumulation was higher than that in Syndrome of phlegm and blood stasis (P＜0.05).8.The level of APN of CAS accompanied by NAFLD:Syndrome of phlegm and blood stasis (6.81±2.06 mg/l)＞Syndrome of deficiency of damp-heat brewing internally(6.54±2.35 mg/l)＞Syndrome of spleen hypofunction and dampness accumulation(4.11±1.29 mg/l).The level of APN in Syndrome of spleen hypofunction and dampness accumulation was significantly lower than that in Syndrome of deficiency of damp-heat brewing internally and Syndrome of phlegm and blood stasis(P＜0.01).Conclusion:1.There was a close relationship between nonalcoholic fatty liver diease and carotid atherosclerosis,and mechanisms linking them were related to abdominal obesity,IR, dyslipidaemia,abnormal APN and inflammation response.NAFLD also was proposed as a new risk factor of atherosclerosis.2.The levels of BMI,WC,HOMA-IR,TG and APN in patients with CAS accompanied by NAFLD could be regarded as the reference indexes leading to the syndrome differentiation and treatment of patients in Syndrome of spleen hypofunction and dampness accumulation,whereas CHOL as the reference index leading to the syndrome differentiation and treatment of patients in Syndrome of phlegm and blood stasis.