脂肪肝臨床表現與中醫證型關係研究

張宏州
中山醫學大學
在先進國家脂肪肝是除了病毒性肝炎以外另一個造成慢性肝炎的重要原因。由於脂肪肝與肥胖、第二型糖尿病、高血脂及胰島素抗性等代謝症候群特徵有極高之關聯性，被認為是代謝症候群的典型肝臟表現。最新研究指出，有10-20%的脂肪肝患者會演變成慢性脂肪性肝炎，而長期發炎未獲得適當的治療，日後會有導致肝硬化、肝衰竭的可能，因而脂肪性肝炎的治療，逐漸獲得醫界的重視。
本研究之目的在於透過望、聞、問、切四診及腹部超音波檢查，深入探討脂肪肝病患之臨床表現與中醫證型之關係，以建立脂肪肝之中醫診斷方法標準化，增加中醫診斷敏感度及精確度，以提供中藥臨床療效評估基礎。
本研究將從文獻中匯整中醫辨證論治診斷分型之資料，以選定主要證型及其診斷之可能指標後，於本院中西醫整合門診收集實際脂肪肝患者100名，經主持人之說明並取得病患之知情同意書後，進行腹部超音波檢查、血液檢查、完整之個人病史、家族史、用藥史詢問及中醫四診檢查，搭配新一代電腦化舌象診察系統，擷取病患舌診影像，加以數位化分析，進一步研究腹部超音波診斷嚴重度分析與脂肪肝病患生化指標之關係以及與中醫辨證分型之關係，建立客觀臨床分型指標，以作為未來中西醫結合臨床試驗之基礎。
關鍵字：脂肪肝、中醫證型、舌診

The relationship between the clinical manifestation of the fatty liver and the TCM pattern diagnosis

Hung-Chou Chang
Chung Shan medical university
Fatty liver is a another important cause of chronic hepatitis in advanced country except viral hepatitis. Due to fatty liver has highly relationship with obesity, type 2 DM, hyperlipidemia and insulin resistance, it was think as the manifestation of metabolic syndrome. There are so many reports alarm us fatty liver may progress to steatohepatitis, hepative fibrosis, cirrhosis and even hepatic failure or hepatocellular carcinoma. So there are many studies aim at the treatment for fatty liver.
The aim of the study is to explore the relationship between the severity of the fatty liver and the TCM pattern presentation by the four kinds of examination-inspection, smell, ask question and palpation. This is the basis to establish the TCM diagnosis standard for fatty liver, and to increase the sensitivity and accuracy.
We will summary the documents (including conventional machine and traditional Chinese medicine) initially. Then we design recruit 100 participants with fatty liver via integrated medicine outpatients. After the explaintation of insent-concent form and signature, every participant will receive abdominal sonography, blood serum biochemistry examination, medical history taking, and TCM four kinds pattern diagnosis examination. Besides, we will take the their tongue images for digital analysis. We hope we can explore the relationship between the severity of the fatty liver and the TCM pattern presentation and to establish the TCM diagnosis standard for fatty liver.
關鍵字：Fatty liver, TCM pattern presentation, tongue examination