[1]林诗佳,孙金蕊,侯金易,等.糖尿病肾脏病Ⅳ-Ⅴ期合并代谢相关脂肪性肝病患者NFS评分、AAR与湿热证的相关性研究[J].陕西中医,2026,(4):472-476,482.[doi:DOI:10.3969/j.issn.1000-7369.2026.04.007]
　LIN Shijia,SUN Jinrui,HOU Jinyi,et al.Correlation study between NFS and AAR scores and damp-heat syndrome in patients with stage Ⅳ-Ⅴ diabetic kidney disease complicated by metabolic dysfunction-associated fatty liver disease[J].,2026,(4):472-476,482.[doi:DOI:10.3969/j.issn.1000-7369.2026.04.007]
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糖尿病肾脏病Ⅳ-Ⅴ期合并代谢相关脂肪性肝病患者NFS评分、AAR与湿热证的相关性研究

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2026年4期
页码:
472-476,482
栏目:
临床研究
出版日期:
2026-04-05

文章信息/Info

Title:
Correlation study between NFS and AAR scores and damp-heat syndrome in patients with stage Ⅳ-Ⅴ diabetic kidney disease complicated by metabolic dysfunction-associated fatty liver disease
作者:
林诗佳1; 2; 孙金蕊1; 2; 侯金易1; 2; 李垚锬1; 2; 陈慧1; 2; 曹博宁1; 2; 刘耀珊1; 2; 张佳坤1; 2; 王珍1; MASSELI Christine3（德国）
（1.北京中医药大学东直门医院，北京 100700；2.北京中医药大学，北京 100029；3.北京善生缘中医门诊部有限公司，北京 100027）
Author(s):
LIN Shijia1; 2; SUN Jinrui1; 2; HOU Jinyi1; 2; LI Yaotan1; 2; CHEN Hui1; 2; CAO Boning1; 2; LIU Yaoshan1; 2; ZHANG Jiakun1; 2; WANG Zhen1; MASSELI Christine3
（1.Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700，China;2.Beijing University of Chinese Medicine,Beijing 100029，China;3.Beijing Shanshengyuan Traditional Chinese Medicine Clinic Co.,Ltd.,Beijing 100027，China）
关键词:
糖尿病肾脏病; 代谢相关脂肪性肝病; 湿热证; 共病管理; 内热致癥; 纤维化
Keywords:
Diabetic kidney disease; Metabolic dysfunction-associated fatty liver disease; Damp-heat syndrome; Comorbidity management; Internal heat leading to Zheng; Fibrosis
分类号:
R 587.2
DOI:
DOI:10.3969/j.issn.1000-7369.2026.04.007
文献标志码:
A
摘要:
目的：探讨非酒精性脂肪性肝病纤维化评分（NFS）和天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值（AAR）与糖尿病肾脏病（DKD）Ⅳ-Ⅴ期合并代谢相关脂肪性肝病（MAFLD）患者湿热证之间的相关性。方法：共纳入101例DKD Ⅳ-Ⅴ期合并MAFLD患者，非湿热证35例，湿热证66例；对患者NFS评分、AAR与肾功能指标进行相关性分析；对患者湿热证积分与NFS评分、AAR及肾功能指标进行相关性分析；对非湿热证与湿热证患者进行NFS评分、AAR及肾功能指标比较。结果：NFS评分与血尿素氮（BUN）、血肌酐（Scr）、24 h尿蛋白定量（24 h-UTP）具有显著中等正相关性；与eGFR具有显著中等负相关性（均P＜0.05）。AAR与BUN、Scr具有显著低正相关性；与肾小球滤过率（eGFR）具有显著低负相关性（均P＜0.05）。湿热证积分与NFS评分、AAR具有显著中等正相关性；与BUN、Scr、24 h-UTP具有显著低正相关性；与eGFR具有显著中等负相关性（均P＜0.05）。与非湿热证组患者比较，湿热证组患者eGFR显著降低，NFS评分、AAR、BUN、Scr、24 h-UTP显著升高（均P＜0.05）。结论：肝纤维化与肾功能障碍之间存在密切联系。湿热证是导致DKDⅣ-Ⅴ期合并MAFLD患者肝纤维化及肾脏损害加重的关键中医证素。DKD Ⅳ-Ⅴ期合并MAFLD患者肝脏纤维化相关评分越高，肾功能损伤越严重，提示肝肾脂质代谢与纤维化可能是DKD疾病进展的关键影响因素。
Abstract:
Objective:To explore the correlation between the Non-alcoholic Fatty Liver Disease Fibrosis Score (NFS),the ratio of aspartate aminotransferase to alanine aminotransferase (AAR),and the damp-heat syndrome in patients with stages Ⅳ-Ⅴ diabetic kidney disease (DKD) complicated by metabolic dysfunction-associated fatty liver disease (MAFLD).Methods:A total of 101 patients with stage Ⅳ-Ⅴ DKD complicated with MAFLD were included,among which 35 cases were non-damp-heat syndrome and 66 cases were damp-heat syndrome.Correlation analysis was performed on the NFS score,AAR and renal function indicators of the patients.Correlation analysis was also carried out between the damp-heat syndrome score of the patients and the NFS score,AAR and renal function indicators.Comparison of NFS score,AAR and renal function indicators was made between patients with non-damp-heat syndrome and those with damp-heat syndrome.Results:The NFS score was significantly and moderately positively correlated with blood urea nitrogen (BUN),serum creatinine (Scr),and 24-hour urine protein quantification (24 h-UTP)，and was significantly and moderately negatively correlated with eGFR (all P<0.05).AAR was significantly and weakly positively correlated with BUN and Scr，and was significantly and weakly negatively correlated with estimated glomerular filtration rate (eGFR) (all P<0.05).The damp-heat syndrome score was significantly and moderately positively correlated with the NFS score and AAR，and was significantly and weakly positively correlated with BUN,Scr,and 24 h-UTP，and was significantly and moderately negatively correlated with eGFR (all P<0.05).Compared with patients in the non-damp-heat syndrome group,patients in the damp-heat syndrome group had significantly decreased eGFR and significantly increased NFS score,AAR, BUN,Scr,and 24 h-UTP (all P<0.05).Conclusion:There is a close relationship between liver fibrosis and renal dysfunction.The damp-heat syndrome is the key traditional Chinese medicine syndrome element leading to the aggravation of liver fibrosis and kidney damage in patients with stage Ⅳ-Ⅴ diabetic kidney disease (DKD) complicated by metabolic-associated fatty liver disease (MAFLD).In patients with stage Ⅳ-Ⅴ DKD complicated by MAFLD,the higher the score related to liver fibrosis,the more severe the renal function impairment,suggesting that liver-kidney lipid metabolism and fibrosis may be the key influencing factors for the progression of DKD.

参考文献/References:

[1]GHANI N A,HASSAN S N F S,ABIDIN R Z,et al.Measuring the prevalence of chronic kidney disease among type 2 diabetes mellitus patient in hospital jitra:A population-based cohort study[J].J Pharm,2025,5(1):83-94.
[2]杨敏,李瑾.中医药治疗糖尿病肾病研究进展[J].中国中医药现代远程教育,2023,21(23):86-89.
[3]ESLAM M,NEWSOME P N,SARIN S K,et al.A new definition for metabolic dysfunction-associated fatty liver disease:An international expert consensus statement[J].J Hepatol，2020，73(1):202-209.
[4]KHAN M A B,HASHIM M J,KING J K,et al.Epidemiology of type 2 diabetes-global burden of disease and forecasted trends[J].J Epidemiol Glob Health,2020,10(1):107-111.
[5]EN L C E,ANG C Z,QUEK J,et al.Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus:An updated systematic review and meta-analysis[J].Gut，2023，72(11):2138-2148.
[6]RONG J,ZHANG Z,PWNG X,et al.Mechanisms of hepatic and renal injury in lipid metabolism disorders in metabolic syndrome[J].Int J Biol Sci,2024,20(12):4783-4798.
[7]黄桢奇,周艳林,柯婷,等.中药治疗2型糖尿病合并非酒精性脂肪性肝病作用机制进展[J].陕西中医,2025,46(10):1437-1441.
[8]中华中医药学会,北京中医药大学东直门医院,北京中医药大学.糖尿病肾脏疾病中西医结合诊疗指南[J].北京中医药大学学报,2024,47(4):580-592.
[9]CUSI K,ISAACS S,BARB D,et al.American association of clinical endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings:Co-sponsored by the american association for the study of liver diseases (AASLD)[J].Endocr Pract，2022，28(5):528-562.
[10]EASL，EASD，EASO，et al.EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)[J].J Hepatol，2024，81(3):492-542.
[11]范建高,徐小元,南月敏,等.代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J].实用肝脏病杂志,2024，27(4)：494-510.
[12]邓铁涛.实用中医诊断学[M].上海：上海科学技术出版社，1988：312-313.
[13]《慢性肾脏病3～5期非透析中西医结合诊疗专家共识》编写组.慢性肾脏病3～5期非透析中西医结合诊疗专家共识[J].中国中西医结合杂志,2022,42(7):791-801.
[14]王梦迪,赵文景,刘梦超,等.糖尿病肾脏病患者血清sTNFR1、sTNFR2表达及其与内热证的相关性分析[J].中国中西医结合肾病杂志,2021,22(5):388-392.
[15]王珍,刘玉宁,王梦迪,等.糖尿病肾脏病内热证分布规律及与肾脏功能相关性研究[J].中国中西医结合肾病杂志,2017,18(6):505-508.
[16]MOGENSEN C E.Microalbuminuria，blood pressure and diabetic renal disease:Origin and development of ideas[J].Diabetologia，1999，42（3）:263-285.
[17]KIDNEY DISEASE:IMPROVING GLOBAL OUTCOMES(KDIGO)CKD WORK GROUP.KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease[J].Kidney Int，2024，105(4):117-314.
[18]ANGULO P,HUI J M,MARCHESINI G,et al.The NAFLD fibrosis score:A noninvasive system that identifies liver fibrosis in patients with NAFLD[J].Hepatology，2007，45(4):846-854.
[19]JANGJOO S,EMAMI N,SAHRANAVARD M,et al.Diagnostic value of non-invasive liver function tests in liver fibrosis and changes in these parameters post-metabolic surgery[J].Obes Surg，2023，33(2):548-554.
[20]杨彦平.基于超声弹性成像构建的糖尿病脂肪肝患者肝纤维化风险的预测模型[J].中国医疗器械信息,2024,30(24):8-10，77.
[21]盛凌黎,曹子怡,郭小平,等.加味陈氏糖肾方治疗糖尿病肾脏病G3-4A1-3期合并脂代谢紊乱临床研究[J].陕西中医,2025,46(2):192-196.
[22]杨帆,魏小果,李娟,等.清肝降脂汤对体外诱导非酒精性脂肪肝细胞模型脂代谢和过氧化物酶体增殖物激活受体-α的调节作用研究[J].陕西中医,2024,45(10):1326-1329，1335.
[23]何风英.2型糖尿病合并MAFLD人群中NFS、FIB-4与糖尿病微血管病变的相关性研究[D].兰州：兰州大学,2023.
[24]李雪,高菁,郑时静,等.肾络癥瘕辨证方法及其临床应用[J].北京中医药大学学报,2024,47(8):1049-1054.
[25]王珍,王梦迪,刘笑慈,等.王耀献教授从热邪论治糖尿病肾病经验[J].中国中西医结合肾病杂志,2014,15(5):379-380.
[26]李军祥,白宇宁,王允亮,等.非酒精性脂肪性肝病中西医结合诊疗专家共识(2025年)[J].中国中西医结合消化杂志,2025,33(4):339-350.

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备注/Memo

备注/Memo:
国家自然科学基金资助面上项目（82574992）；北京中医药大学揭榜挂帅青年项目(2023-JYB-JBQN-016)
更新日期/Last Update: 2026-04-05