多烯磷脂酰胆碱治疗中重度非酒精性脂肪性肝病患者疗效初步研究*

doi:10.3969/j.issn.1672-5069.2018.05.020

摘要/Abstract

摘要： 目的探讨应用多烯磷脂酰胆碱(PPC)治疗中重度非酒精性脂肪性肝病(NAFLD)患者的疗效,并探讨其护肝机制。方法 2013年1月~2016年12月我科诊治的中重度NAFLD患者90例,采用随机数字表法将其分为3组,每组30例。对照组接受常规治疗,观察一组在常规治疗基础上加予PPC胶囊口服,观察二组加予PPC注射液静脉滴注,连续治疗8周。结果在观察结束时,观察一组和观察二组肝脏B超评分分别为（3.2±0.7）分和（3.3±0.6）分,显著低于对照组的（4.5±0.6）分,肝/脾CT比值分别为（0.9±0.2）和（0.9±0.1）,显著高于对照组的【（0.7±0.2）,P<0.05】;观察一组总胆固醇（TC）、甘油三酯（TG）和低密度脂蛋白（LDL-C）分别为（4.8±0.6） mmol/L、（2.0±0.2）mmol/L和（3.0±0.2） mmol/L,观察二组分别为（4.7±0.6） mmol/L、（1.9±0.3） mmol/L和（2.9±0.3） mmol/L,均显著低于对照组的（5.1±0.5） mmol/L 、（2.2±0.2） mmol/L 和（3.3±0.3） mmol/L,而高密度脂蛋白（HDL-C）分别为（1.4±0.4） mmol/L和（1.4±0.3） mmol/L,显著高于对照组的（1.3±0.3） mmol/L（P<0.05）;观察一组血清肿瘤坏死因子-α（TNF-α）、单核细胞趋化蛋白-1（MCP-1）和核转录因子-κB（NF-κB）水平分别为（10.3±2.6） ng/ml、（4.6±0.7）ng/ml和（9.4±1.1） ng/ml,观察二组分别为（9.8±2.3）ng/ml、（4.4±0.6） ng/ml和（9.6±1.4） ng/ml,均显著低于对照组的（22.5±3.6） ng/ml、（9.3±1.1） ng/ml 和（16.3±2.5） ng/ml,而血红素加氧酶-1（HO-1）、谷胱甘肽过氧化物酶（GSH-Px）和超氧化物歧化酶（SOD）水平均显著高于对照组（P<0.05）。结论口服或静脉给予PPC治疗NAFLD患者近期有效,可促进中重度NAFLD患者血脂代谢,其机制可能与抑制炎症和氧化应激反应有关。

关键词: 非酒精性脂肪性肝病, 多烯磷脂酰胆碱, 炎性因子, 氧化应激, 治疗

Abstract: Objective To investigate the efficacy of polyene phosphatidylcholine（PPC） in patients with moderate -to-severe nonalcoholic fatty liver disease （NAFLD）. Methods A total of 90 patients with moderate -to-severe NAFLD were recruited in our hospital between January 2013 and December 2016,and were randomly divided into three groups by computer-generated randomized numbers. The patients in control received routine treatment, and those in observation group one received PPC orally,and in observation group two received PPC intravenously for eight weeks. Results At the end of the observation,the ultrasound scores in observation group one and two were （3.2±0.7） and（3.3±0.6）,much lower than （4.5±0.6） in the control,and the liver/spleen CT ratios were（0.9±0.2） and （0.9±0.1）,much higher than （0.7±0.2） in the control （P<0.05）;serum levels of total cholesterol （TC）,triglyceride（TG） and low density lipoprotein （LDL-C） in observation group one were（4.8±0.6）mmol/L,（2.0±0.2）mmol/L and（3.0±0.2）mmol/L,and in observation group two were （4.7±0.6）mmol/L,（1.9±0.3）mmol/L and （2.9±0.3）mmol/L,much lower than（5.1±0.5）mmol/L,（2.2±0.2）mmol/L and（3.3±0.3） mmol/L,while high density lipoprotein （HDL-C） were （1.4±0.4）mmol/L and （1.4±0.3）mmol/L,respectively,much higher than （1.3±0.3）mmol/L in the control（P<0.05）;serum tumor necrosis factor-α（TNF-α）,monocyte chemotactic protein-1（MCP-1） and nuclear factor-κB （NF-κB） levels in observation group one were （10.3±2.6）ng/ml,（4.6±0.7） ng/mL and （9.4±1.1）ng/ml,and in group two were （9.8±2.3）ng/mL,（4.4±0.6）ng/ml and （9.6±1.4）ng/ml,much lower than（22.5±3.6）ng/ml,（9.3±1.1）ng/ml and（16.3±2.5）ng/ml in the control,while serum heme oxygenase-1 （HO-1）,glutathione peroxidase （GSH-Px） and superoxide dismutase （SOD） levels were much higher than those in the control（P<0.05）. Conclusion There is no significant difference in the efficacy and safety of PPC orally and intravenously in the treatment of patients with NAFLD. The therapy might promote blood lipid metabolism, and the possible mechanism might be related to the inhibition of inflammatory reaction and oxidative stress response.

Key words: Non-alcoholic fatty liver, Polyene phosphatidylcholine, Inflammatory cytokines, Oxidative stress, Therapy

周志菁, 黄永东. 多烯磷脂酰胆碱治疗中重度非酒精性脂肪性肝病患者疗效初步研究^*[J]. 实用肝脏病杂志, 2018, 21(5): 733-736.

Zhou Zhiqing, Huang Yongdong. Efficacy of polyene phosphatidylcholine in patients with moderate -to-severe nonalcoholic fatty liver disease[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(5): 733-736.

参考文献

[1] 范建高,重视非酒精性脂肪性肝病的规范化诊疗和推广.中国医学前沿杂志(电子版),2012,4(7):1-3.
[2] 徐京杭,多烯磷脂酰胆碱在肝病临床应用的专家共识.中华实验和临床感染病杂志(电子版),2017,11(4):313-319.
[3] Djordjevic DB,Zdravkovic M,Nagorni A,et al.A critical approach of guideline therapeutic recommendationsfor NAFLD.Curr Vasc Pharmacol,2017,20(6):1130-1136.
[4] World Gastroenterology Organisation.World Gastroenterology Organisation Global Guidelines:Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. J Clin Gastroenterol,2014,48(6):467-473.
[5] 陈九如,肝脏疾病影像学诊断与鉴别诊断(Ⅲ)肝脏病变的影像学诊断与鉴别诊断. 国际医学放射学杂志,2010,33(3):253-265.
[6] Shouhed D,Steggerda J,Burch M,et al.The role of bariatric surgery in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Expert Rev Gastroenterol Hepatol,2017,11(9):797-811.
[7] Younossi ZM,Loomba R,Anstee QM,et al.Diagnostic modalities for non-alcoholic fatty liver disease(NAFLD),non-alcoholic steatohepatitis (NASH) and associated fibrosis.Hepatology,2017,29(12):106-112.
[8] Rana H,Yadav SS,Reddy HD,et al.Comparative effect of insulin sensitizers and statin on metabolic profile and ultrasonographical score in non alcoholic fatty liver disease. J Clin Diagn Res,2016,10(8):19-23.
[9] Balasubramanian P,Boopathy V,Govindasamy E,et al.Assessment of portal venous and hepatic artery haemodynamic variation in non-alcoholic fatty liver disease(NAFLD) patients.J Clin Diagn Res,2016,10(8):7-10.
[10] Shigefuku R,Takahashi H,Nakano H,et al.Correlations of hepatic hemodynamics,liver function,and fibrosis markers in nonalcoholic fatty liver disease:comparison with chronic hepatitis related to hepatitis C virus. Int J Mol Sci,2016,17(9):224-230.
[11] 廖文秋,刘小叶,张琍. 多烯磷脂酰胆碱联合水飞蓟宾治疗非酒精性脂肪肝疗效观察. 实用肝脏病杂志,2014,17(2):196-197.
[12] Kim MS,Kim B,Park H,et al.Long-term fermented soybean paste improves metabolic parameters associated with non-alcoholic fatty liver disease and insulin resistance in high-fat diet-induced obese mice.Biochem Biophys Res Commun,2018,495(2):1744-1751.
[13] Ferrandino G,Kaspari RR,Spadaro O,et al.Pathogenesis of hypothyroidism-induced NAFLD is driven by intra- and extrahepatic mechanisms.Proc Natl Acad Sci U S A,2017,114(43):172-180.
[14] Woods CP,Hazlehurst JM,Tomlinson JW.Glucocorticoids and non-alcoholic fatty liver disease. J Steroid Biochem Mol Biol,2015,154(5):94-103.
[15] Pisonero VS,González GJ,Sánchez CS,et al.Flavonoids and related compounds in non-alcoholic fatty liver disease therapy.Curr Med Chem,2015;22(25):2991-3012.
[16] Fedelesova M,Kupcova V,Luha J,et al.Paraoxonase activity in sera of patients with non-alcoholic fatty liver disease. Bratisl Lek Listy,2017,118(12):719-720.
[17] Banaszczak M,Stachowska E.NAFLD pathogenesis in the light of recent research. Postepy Biochem,2017,63(3):190-197.
[18] Ragucci E,Nguyen D,Lamerson M,et al.Effects of mifepristone on nonalcoholic fatty liver disease in a patient with a cortisol-secreting adrenal adenoma.Case Rep Endocrinol,2017,39(12):616-622.

多烯磷脂酰胆碱治疗中重度非酒精性脂肪性肝病患者疗效初步研究^*

Efficacy of polyene phosphatidylcholine in patients with moderate -to-severe nonalcoholic fatty liver disease

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