【目的】 探讨不同中医证型酒精性肝病患者的临床特点。【方法】 回顾性收集2018～2022年在佛山市中医院就诊的符合 纳入、排除标准的129例酒精性肝病患者的一般资料、中医证型以及就诊时的肝肾功能、血脂、肝脏瞬时弹性成像等临床数 据，分析酒精性肝病患者的中医证型分布，探讨不同中医证型酒精性肝病患者的临床特点。【结果】（1）一般资料方面，129例患 者中，男性128例（99.22%），女性1例（0.78%）；平均年龄为（48.71 ± 11.50）岁；平均体质量指数（BMI）为（23.82 ± 3.98）kg·m-2。 （2）中医证型分布方面，以湿热蕴结证最常见，共70例（54.26%），其余分别为肝郁脾虚证24例（18.60%）、痰湿内阻证22例 （17.05%）、肝肾不足证 7例（5.43%）、痰瘀互结证 3例（2.33%）、瘀血内结证 3例（2.33%）。（3）临床特点方面，经非参数秩和 检验分析，不同中医证型酒精性肝病患者的 BMI、饮酒量、天冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）、总胆红素 （TBIL）、碱性磷酸酶（ALP）、甘油三酯（TG）、肝脏硬度测量值（LSM）以及反映肝脏脂肪含量的受控衰减参数值（CAP）比较， 差异均有统计学意义（P＜0.05或 P＜0.01）。其中较为突出的特征是，仅有肝郁脾虚证、痰湿内阻证、痰瘀互结证及瘀血内 结证等 4型患者的 BMI超标（＞24 kg·m-2），而样本量占比高达 54.26% 的湿热蕴结证和肝肾不足证患者的 BMI均在正常范围 （分别为 23.03 kg·m-2和 21.42 kg·m-2），且此两种证型的 BMI与痰湿内阻证（26.44 kg·m-2）均存在显著性差异（P＜0.01），提示 酒精性肝病有超过一半以上患者不会出现超重现象；另外，BMI 最高的痰湿内阻证患者在血清 TG（2.69 mmol/L）、CAP （292 db/m）等指标中也同样呈现出最高数值，提示痰湿内阻证患者的肥胖及肝脏脂肪浸润程度相对于其他证型严重；而代表 肝脏慢性炎症损伤的 AST和胆管细胞损伤的 GGT，在湿热蕴结证和肝肾不足证中均有显著性升高，且此两型患者的 LSM值 也是所有证型分组里最高的，差异均有统计学意义（P＜0.05或 P＜0.01）。【结论】 湿热蕴结证是酒精性肝病的主要中医临床 证型；酒精性肝病的肝脏脂肪浸润程度和体质量超标与病情严重程度并不呈一致性关系；不同中医证型酒精性肝病患者的 临床异常指标存在一定差异，临床辨证时可将中医四诊资料与临床指标相互参照，这将有助于提高中医临床诊断的准确性。

Objective To explore the clinical characteristics of patients with alcoholic liver disease（ALD）of various traditional Chinese medicine（TCM）syndrome types. Methods A retrospective analysis was conducted in 129 patients with alcoholic liver disease who met the inclusion and exclusion criteria in Foshan Hospital of Traditional Chinese Medicine from 2018 to 2022. The general data of the patients as well as their TCM syndrome types and clinical information of liver and kidney function，blood lipid，liver transient elastography during the hospital visit were collected. The distribution of TCM syndrome types in ALD patients was analyzed， and the clinical characteristics of the ALD patients with various TCM syndrome types were explored. Results（1）Of the 129 patients，128（99.22%）were male and only one（0.78%）was female，the average age was（48.71 ± 11.50） years old，and the average body mass index（BMI）was（23.82 ± 3.98）kg·m-2.（2）Damp-heat accumulation syndrome was most common syndrome type in ALD patients，with a total of 70 cases（54.26%），and then came liver depression and spleen deficiency syndrome（24 cases， 18.60%）， internal obstruction of phlegm-damp syndrome（22 cases，17.05%），liver-kidney sufficiency syndrome（7 cases，5.43%），phlegm interweaved with blood stasis syndrome（3 cases，2.33%），and internal accumulation of blood stasis syndrome（3 cases，2.33%）. （3）The analysis of clinical characteristics by non-parametric rank sum test showed that there were no statistically significant differences in BMI， alcohol consumption， aspartate aminotransferase （AST） ， gammaglutamyltransferase（GGT）， total bilirubin（TBIL）， alkaline phosphatase（ALP）， triglyceride（TG）， liver stiffness measurement（LSM），and controlled attenuation parameter（CAP）which reflects the fat content of liver in ALD patients with various TCM syndrome types （P＜0.05 or P＜0.01）. The prominent features were as follows： patients with the 4 types of liver depression and spleen deficiency，internal obstruction of phlegm-damp， phlegm interweaved with blood stasis，and internal accumulation of blood stasis had a BMI exceeding the standard （＞24 kg·m-2），whereas patients with damp-heat accumulation syndrome and liver-kidney deficiency syndrome， which accounted for 54.26% of the sample size，had a BMI within the normal range（23.03 kg·m-2 and 21.42 kg·m-2， respectively）， and the BMI of these two types differed from that（26.44 kg·m-2）of the internal obstruction of phlegm-damp syndrome（P＜0.01）， suggesting that more than half of the ALD patients had the normal BMI; moreover，the patients with internal obstruction of phlegm-damp also had the highest values of serum TG（2.69 mmol/L） and CAP（292 db/m）except for the highest BMI，indicating that patients with internal obstruction of phlegm-damp syndrome had a more serious degree of obesity and hepatic fat infiltration than those with other syndrome types; the levels of AST and GGT，which separately reflect the chronic inflammatory injury of liver and bile duct cell injury， were significantly increased in the patients with damp-heat accumulation syndrome and liver-kidney deficiency syndrome，and the LSM value of these two types of patients was also the highest in all of the syndrome types，the differences being all statistically significant（P＜0.05 or P＜0.01）. Conclusion Damp-heat accumulation syndrome is the main TCM syndrome type of ALD patients，the degree of fatty infiltration of the liver and overweight of ALD patients are not corresponded to the severity of illness，and there are some differences in the clinical indicators of ALD patients with various TCM syndrome types. However，with cross reference to the data of the four diagnostic examinations of TCM and the clinical indicators， the accuracy of the TCM diagnosis of ALD is expected to be increased.

R259.75

广东省佛山市“十四五”重点专科建设项目（编号：粤卫函 【2021】 107号）；佛山市高水平医院建设“登峰计划”项目（编号： 佛府办[2019]1号）