Case Analysis of General Practice Diagnosis and Treatment in a "Three High" Patient with Coexistence and Fatty Liver Disease

doi:10.12114/j.issn.1007-9572.2025.0129

Chinese General Practice ›› 2026, Vol. 29 ›› Issue (06): 810-816.DOI: 10.12114/j.issn.1007-9572.2025.0129

• Consulting Room of General Practitioner • Previous Articles

Case Analysis of General Practice Diagnosis and Treatment in a "Three High" Patient with Coexistence and Fatty Liver Disease

1. Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
2. Baizhifang Community Health Service Center, Xicheng District, Beijing 100054, China
3. Unit Three, Center of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
4. Department of General Practice, the First Hospital of Tsinghua University, Beijing 100016, China

Received:2025-05-21 Revised:2025-07-01 Published:2026-02-20 Online:2026-01-05
Contact: CAO Li, JIANG Yue
About author:
LI Jie and YANG Xinhui are co-first authors

一例"三高"合并脂肪性肝病患者的全科诊疗案例分析

1．100050　北京市，首都医科大学附属北京友谊医院
2．100054　北京市西城区白纸坊社区卫生服务中心
3．100069　北京市，首都医科大学附属北京佑安医院肝病中心三科
4．100016　北京市，清华大学第一附属医院全科医学科

通讯作者: 曹黎, 姜岳
作者简介:
李杰和杨昕晖为共同第一作者
作者贡献：
李杰提出文章思路，设计案例展示，提出治疗惰性等观点，负责论文起草；杨昕晖补充文章思路，设计案例展示，提出综合管理方案和路径，负责论文起草；曹黎负责患者病例资料收集和整理；张晶负责患者检验结果、检查结果和病理结果等收集；姜岳负责最终版本修订，对论文负责。
基金资助:
首都卫生发展科研专项项目(首发2023-2S-003); 北京慢性病防治与健康教育研究会2024年"青苗行动"基层专项课题(MBZX0102024006)

Abstract

Abstract:

Background

Hypertension, diabetes, and dyslipidemia (abbreviated as "Three High") frequently coexist with metabolic dysfunction-associated fatty liver disease (FLD). These diseases interact synergistically, significantly elevating the risk of adverse cardiovascular and hepatic outcomes. The standardized diagnosis and treatment pathway for these patients by general practitioners in primary care is still being explored.

Objective

Through a typical case report, this paper intends to explore the general practice thinking and practice process of general practitioners in the general practice of patients with "Three High" and FLD.

Methods

Reporting the general practice process of screening, identification, risk assessment, two-way referral and comprehensive management of a patient with "Three High" and FLD, this article showed the individualized comprehensive management plan and general practice diagnosis and treatment pathway.

Results

After 8 months of full-course and comprehensive management by general practitioners, the patient's blood pressure and blood glucose reached the target, low-density lipoprotein cholesterol was reduced, the weight loss, waist circumference was reduced, the degree of liver steatosis and fibrosis was significantly improved, and the medication compliance and self-management ability were significantly improved.

Conclusion

The general practitioner-based comprehensive management of patients with "Three High" and FLD can significantly improve the metabolic indicators and liver status of patients, reflecting the central role of general practice in the management of multiple chronic diseases, and providing practical reference for optimizing the standardized management path of such patients at primary level.

Key words: Three high, Fatty liver, Hypertension, Diabetes mellitus, Dyslipidemias, General practice, Case report

摘要：

背景

高血压、糖尿病、血脂异常（"三高"）常与代谢相关脂肪性肝病（FLD）共存，相互影响并显著增加了心血管及肝脏不良结局风险。目前基层全科医生对这类共病患者的规范化诊疗路径尚在探索。

目的

通过典型病例报告，探索基层全科医生对"三高"合并FLD患者的全科诊疗思路与实践流程。

方法

报道1例"三高"合并FLD患者的筛查、识别、风险评估、双向转诊及综合管理的全科诊疗过程，展示个体化综合管理方案和全科诊疗路径。

结果

经过8个月以全科医生为主的全程、全方位综合管理，患者血压、血糖达标，低密度脂蛋白胆固醇降低，体质量减轻，腰围缩小，肝脏脂肪变及纤维化程度显著改善，用药依从性及自我管理能力明显提高。

结论

通过对"三高"合并FLD患者进行以全科医生为主的综合管理，能够显著改善患者代谢指标及肝脏状况，体现了全科医疗在慢性病共病管理中的核心作用，为优化此类患者的基层规范化管理路径提供了实践参考。

关键词: 三高, 脂肪肝, 高血压, 糖尿病, 血脂异常, 全科医学, 案例分析

CLC Number:

R-05

LI Jie,YANG Xinhui,CAO Li, et al. Case Analysis of General Practice Diagnosis and Treatment in a "Three High" Patient with Coexistence and Fatty Liver Disease[J]. Chinese General Practice, 2026, 29(06): 810-816. DOI: 10.12114/j.issn.1007-9572.2025.0129.
李杰,杨昕晖,曹黎等. 一例"三高"合并脂肪性肝病患者的全科诊疗案例分析[J]. 中国全科医学, 2026, 29(06): 810-816. DOI: 10.12114/j.issn.1007-9572.2025.0129.

Figures/Tables 6

References 27

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实验室检查项目	时间
实验室检查项目	2022-04-13	2023-04-13	2023-06-13	2024-04-11
BMI（kg/m²）	27.1	26.7	26.8	26.3
诊室血压（mmHg）	140/83	138/79	126/88	141/92
空腹血糖（mmol/L）	5.98	5.39	5.93	6.03
糖化血红蛋白（%）	5.39	—	5.10	5.20
三酰甘油（mmol/L）	2.04	2.50	1.61	2.52
总胆固醇（mmol/L）	7.53	7.51	5.57	7.10
低密度脂蛋白胆固醇（mmol/L）	4.77	5.20	3.61	5.08
高密度脂蛋白胆固醇（mmol/L）	1.52	1.49	1.53	1.50
血尿酸（μmol/L）	537.8	587.6	489.7	492.3
丙氨酸氨基转移酶（U/L）	36	86	42	50
天冬氨酸氨基转移酶（U/L）	54	150	57	82
谷氨酰转肽酶（U/L）	58.0	—	123.1	—
血小板计数（×10⁹/L）	112.3	138.1	113.8	108.2

实验室检查项目	时间
实验室检查项目	2022-04-13	2023-04-13	2023-06-13	2024-04-11
BMI（kg/m²）	27.1	26.7	26.8	26.3
诊室血压（mmHg）	140/83	138/79	126/88	141/92
空腹血糖（mmol/L）	5.98	5.39	5.93	6.03
糖化血红蛋白（%）	5.39	—	5.10	5.20
三酰甘油（mmol/L）	2.04	2.50	1.61	2.52
总胆固醇（mmol/L）	7.53	7.51	5.57	7.10
低密度脂蛋白胆固醇（mmol/L）	4.77	5.20	3.61	5.08
高密度脂蛋白胆固醇（mmol/L）	1.52	1.49	1.53	1.50
血尿酸（μmol/L）	537.8	587.6	489.7	492.3
丙氨酸氨基转移酶（U/L）	36	86	42	50
天冬氨酸氨基转移酶（U/L）	54	150	57	82
谷氨酰转肽酶（U/L）	58.0	—	123.1	—
血小板计数（×10⁹/L）	112.3	138.1	113.8	108.2

餐次	食谱	能量	油脂/盐
早餐	蒸南瓜：150 g 纯牛奶：250 mL 皮蛋豆腐：皮蛋50 g，豆腐50 g	400 kcal
午餐	荞麦面条：80 g 蘑菇炒肉：香菇50 g，油菜50 g，牛肉25 g 小葱拌豆腐：豆腐50 g，小葱20 g 韭菜炒鸡蛋：韭菜50 g，鸡蛋50 g	500 kcal	15 g/3 g
加餐	蓝莓100 g	150 kcal
晚餐	煮玉米：200 g 白菜肉丝汤：小白菜50 g，里脊肉20 g清炒蒲公英：蒲公英15 g 土豆炖肉：土豆40 g，牛肉30 g	300 kcal	10 g/2 g

餐次	食谱	能量	油脂/盐
早餐	蒸南瓜：150 g 纯牛奶：250 mL 皮蛋豆腐：皮蛋50 g，豆腐50 g	400 kcal
午餐	荞麦面条：80 g 蘑菇炒肉：香菇50 g，油菜50 g，牛肉25 g 小葱拌豆腐：豆腐50 g，小葱20 g 韭菜炒鸡蛋：韭菜50 g，鸡蛋50 g	500 kcal	15 g/3 g
加餐	蓝莓100 g	150 kcal
晚餐	煮玉米：200 g 白菜肉丝汤：小白菜50 g，里脊肉20 g清炒蒲公英：蒲公英15 g 土豆炖肉：土豆40 g，牛肉30 g	300 kcal	10 g/2 g

要点	有氧运动	抗阻运动
运动频率	1次/d	3次/周
运动强度	运动中有效心率控制在90~110次/min（运动时有些费力，可以说话但不能唱歌）	阻力负荷<40% 1 RM，10~15次×1组，每次练习2组
运动时间	运动时间开始20~30 min，以后可逐渐延长至1 h。准备活动时间5~10 min，项目包括各种简单的徒手运动或肢体活动；整理运动时间5~10 min，项目包括各种关节肌肉的放松运动。运动后心率恢复时间不超过15 min	运动时间2~5 min。准备活动时间5~10 min，项目包括各种简单的徒手运动或肢体活动；整理运动时间5~10 min，项目包括各种关节肌肉的放松运动
运动方式	步行	哑铃作为负荷器械
运动总量	每周至少累计进行150~300 min中等强度的有氧运动	每周至少60 min
运动进阶	采取"低起点，缓慢加"策略，先调节运动频率和每天的运动时间，最后调整运动强度	缓慢增加强度

Case Analysis of General Practice Diagnosis and Treatment in a "Three High" Patient with Coexistence and Fatty Liver Disease

一例"三高"合并脂肪性肝病患者的全科诊疗案例分析

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惰性层面	惰性原因	应对策略
医生层面	对疾病循证指南的认知不足^[22]；高估治疗效果：过度相信生活方式改善治疗效果，但无法提供有效的生活方式干预方案^[23]； "软理由"：评估不全面和综合管理能力不足^[24]	加强对基层医生相关指南和共识的培训和推广应用；明确综合管理的实际复杂性和具体方式，提供包括用药方案、生活方式管理和合并症管理等在内的具体方案培训和指导
患者层面	症状隐匿、认知不足和依从性差^[25]	通过健康教育提高患者认知，改善依从性，建立有效沟通渠道，通过医患共同决策制订明确可行的治疗目标，并且提高患者的自我管理能力^[27]
医疗系统层面	就诊时间限制和工作量压力过大^[26]	探索和建立以全科医生为主体的脂肪性肝病慢性病管理模式，发挥多学科协作和分级诊疗的优势

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