Clinical Observation On The Influence Of Renal Function And The Distribution Of TCM Syndromes In NAFLD Liver Fibrosis

Objective:In this study,the indexes of liver and renal functions and the distribution of traditional Chinese medicine（TCM）syndromes in patients with non-alcoholic fatty liver disease（NAFLD）at different stages of liver fibrosis were compared to analyze the influence of liver fibrosis in NAFLD on liver and renal functions and the pathogenesis changes in TCM.It is expected to provide early warning for renal function impairment in NAFLD patients and basis for early diagnosis and treatment of chronic kidney disease（CKD）,so as to curb the occurrence and development of CKD,and thus provide important help for the realization of"Healthy China".Methods:In this study,patients diagnosed as NAFLD by ultrasound were collected from outpatients and inpatients in the Department of Hepatology,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine between April 2019 and October 2020.These patients were assayed by Fibro Touch,and then the stage of fibrosis was segmented by the Liver Stiffness Measurement（LSM）.Then collect the general data of the NAFLD patients,such as age,sex,TCM symptoms,tongue and pulse information,the syndromes of TCM were determined according to the above information.At the same time,the relevant indexes of liver and kidney functions were collected.Such as Total Bilirubin（TBIL）,Indirect Bilirubin（IBIL）,Direct Bilirubin（DBIL）,Total Protein（TP）,Albumin（ALB）,Globulin（GLO）,Alanine aminotransferase（ALT）,Aspartate aminotransferase（AST）,Alkaline phosphatase（ALP）,Uric Acid（UA）etc.In addition,C-reactive protein（CRP）,Glutamic Acid Decarboxylase（GAD）and pulmonary Surfactant Protein D（SP-D）were also collected in this study.Statistical analysis was performed on the above indexes to determine the influence of NAFLD liver fibrosis progression on the above system damage.Results:1.The degree of liver fibrosis in NAFLD patients was not related to gender,age,serum levels of TBIL,IBIL,TP,ALB,GLO,UREA,CREA,CRP,GAD,urineβ2-MG and e GFR_MDRD（P>0.05）.And it was closely related to serum levels of DBIL,ALT,AST,ALP,GGT and CCR（P<0.05）.2.There are significant differences in serum UA levels among B,C and D groups and in serum SP-D levels among groups A,B and C（P<0.05）.3.There was significant difference between the distribution of five TCM syndromes and different degrees of NAFLD liver fibrosis（P<0.05）.In each stage of liver fibrosis,the Liver-stagnation and Spleen-deficiency syndrome is the main part,while the Damp-heat stagnation syndrome and the Phlegm-dampness trapping spleen syndrome occupy an important part in each stage of liver fibrosis.With the progress of liver fibrosis,the proportion of Spleen-kidney yang deficiency syndrome gradually increases,and becomes the main syndrome type in severe liver fibrosis.Conclusion:1.For patients with NAFLD with more severe liver fibrosis,the damage to liver and renal function will be more serious.2.After the liver fibrosis of NAFLD progresses to the stage of mild liver fibrosis,further aggravation of liver fibrosis degree will reduce the serum UA level.3.Before NAFLD liver fibrosis progresses to severe liver fibrosis,the more severe the liver fibrosis is,the worse the lung function is.4.The Liver-stagnation and Spleen-deficiency syndrome is the main pathogenesis of NAFLD in TCM.The Damp-heat stagnation syndrome and the Phlegm-dampness trapping spleen syndrome also occupy an important part in each stage of NAFLD liver fibrosis.With the development of liver fibrosis,NAFLD patients gradually appeared the syndrome of spleen and kidney yang deficiency.