Characteristics Of Syndrome Elements Of Syndrome Drift In Syndrome Of Liver Depression And Spleen Deficiency In Non-alcoholic Fatty Liver Disease

Objective:To recognize the syndrome drift in syndrome of liver depression and spleen deficiency in non-alcoholic fatty liver disease(NAFLD),to enrich the theory of dynamics in traditional Chinese medicine,and to learn the rules of syndrome changes in the course of the disease process by analyzing the characteristics of syndrome element during syndrome drift in NAFLD with liver stagnation and spleen deficiency syndrome,to provide basis for improvement of treatment based on syndrome differentiation.Methods:Syndrome drift was defined as that new symptoms or signs were emerging but another syndrome pattern else more than the original syndrome pattern can not be recognized as yet due to the new symptoms or signs were inadequate neither in amount nor in severity.The emerging of new syndrome(s)beyond neither change the original syndrome pattern nor form any other syndrome pattern.In this study,91 cases of NAFLD patients with liver stagnation and spleen deficiency syndrome were recruited who were treated in outpatient or inpatient department from September 2016 to December 2017 in Xiamen Hospital of Traditional Chinese Medicine.Patients were followed up for up to three months.The follow-up was ended if syndrome drift occurred during the scheduled 3-month follow-up period.The patient’s information on TCM four consultations was recorded in detail every 2 weeks,and the occurrence of symptom drift was assessed.By using the Traditional Chinese Medicine Health Identification System provided by Fujian University of Traditional Chinese Medicine Syndrome Study Base,the disease location and nature syndrome elements of patients in the syndrome drift group were obtained and the syndrome elements characteristics were analyzed and summarized.Results:1.The syndrome drift occurred in 49(53.8%)of the 91 patients included in this study.2.Baseline data:In the aspect of baseline gender,age,TBil,GOT,TG,TC,LDL-c,FPG,hepatic tissue inflammatory necrosis stage G,hepatic tissue fibrosis stage S in the syndrome drift group and the group without syndrome drift,there was no significant difference in the distribution between the two groups;In aspect of the baseline BMI(Z=-2.214,P=0.027),ALT(F=0.314,P=0.004),AST(Z=-3.413,P=0.001),NAS scores(Z=-4.469,P<0.001)of two groups,there was significant difference in the distribution between the two groups.The baseline BMI,ALT,AST,and NAS scores of the syndrome drift group were higher,and the illness of patients in the syndrome drift group were more serious.3.In making statistics of syndrome elements with syndrome elements integral ≥70 in syndrome drift group,liver,spleen and gall bladder were the disease location syndrome elements existing both at baseline and syndrome drift occurrence;the new disease location syndrome elements in syndrome drift occurrence were stomach and semi-exterior-interior.Disease nature syndrome elements both at baseline and syndrome drift occurrence include qi deficiency,humidity,yang deficiency,qi stagnation and sputum while the new disease nature syndrome elements in the occurrence of syndrome drift were heat and yin deficiency.4.In making statistics of all the syndrome elements with integral in the syndrome drift group,disease location syndrome elements occurring both at baseline and syndrome drift occurrence were liver,spleen,gall bladder and small intestine while the new disease location syndrome elements in the occurrence of syndrome drift were stomach,large intestine and semi-exterior-interior.The disease nature syndrome elements emerging both at baseline and syndrome drift occurrence were sputum,yang deficiency,qi deficiency,qi stagnation,humidity,heat,qi collapse,blood stasis and fluid retention,while new nature syndrome elements in syndrome drift were heat,yin deficiency and ingestion.Conclusion:1.Syndrome drift is common in syndrome of liver depression and spleen deficiency in NAFLD and about half of cases(53.8%)emerged syndrome drift.2.Patients with high BMI,high levels of ALT,AST and high NAS scores are liable to have syndrome drift and most of the patients with syndrome drift has more serious illness.3.In the syndrome of liver stagnation and spleen deficiency in NAFLD,the disease location syndrome elements liver,spleen,gall bladder and small intestine were throughout.When syndrome drift occurs,the new disease location syndrome elements were mostly stomach,large intestine and semi-exterior-interior.The nature of disease syndrome elements sputum,yang deficiency,deficiency of qi,qi stagnation,humidity,heat,qi collapse,blood stasis and fluid retention were throughout and the new syndrome elements for nature of disease in syndrome drift were mostly heat,yin deficiency and indigestion.