阿托伐他汀联合硫普罗宁治疗非酒精性脂肪性肝病患者疗效初步研究

doi:10.3969/j.issn.1672-5069.2021.01.013

摘要/Abstract

摘要： 目的应用阿托伐他汀联合硫普罗宁治疗非酒精性脂肪性肝病(NAFLD)患者,以初步观察疗效及其血清核转录因子κB(NF-κB)、转化生长因子-β(TGF-β)、胰岛素抵抗(IR)和血脂代谢的变化。方法 2016年12月~2019年9月我院收治的NAFLD患者104例,被随机分为对照组52例和观察组52例,分别给予硫普罗宁肠溶片和硫普罗宁肠溶片联合阿托伐他汀钙片治疗,连续观察8周。常规检测血生化指标,计算稳态模型胰岛素抵抗(HOMA-IR)指数,采用ELISA法检测血清NF-κB、TGF-β和脂联素水平,采用放射免疫法检测血清胰岛素样生长因子-1(IGF-1)水平。结果在治疗结束时,观察组血清丙氨酸氨基转移酶(ALT)水平为(27.8±2.5)U/L,显著低于对照组【(43.6±3.0)U/L,P<0.05】,血清天门冬氨酸氨基转移酶(AST)水平为(22.1±6.3)U/L,显著低于对照组【(46.4±6.9)U/L,P<0.05】,血清谷氨酰转肽酶(GGT)水平为(55.6±9.8)U/L,显著低于对照组【(71.3±10.3)U/L,P<0.05】;血清甘油三酯(TG)水平为(2.4±0.5)mmol/L,显著低于对照组【(3.0±0.4)mmol/L,P<0.05】,血清总胆固醇(TC)水平为(3.6±0.7)mmol/L,显著低于对照组【(4.9±0.5)mmol/L,P<0.05】,低密度脂蛋白胆固醇(LDL-C)水平为(2.6±0.7)mmol/L,显著低于对照组【(3.1±0.6)mmol/L,P<0.05】,而血清高密度脂蛋白胆固醇(HDL-C)水平为(1.3±0.2)mmol/L,显著高于对照组【(1.1±0.3)mmol/L,P<0.05】;血清NF-κB水平为(1.2±0.1)pg/mL,显著低于对照组【(2.6±0.2)pg/mL, P<0.05】,血清TGF-β水平为(3.3±1.2)pg/mL,显著低于对照组【(5.7±1.0)pg/mL, P<0.05】,HOMA-IR水平为(2.2±0.4),显著低于对照组【(2.7±0.5),P<0.05】,而血清IGF-1水平为(0.4±0.2)μg/L,显著高于对照组【(0.3±0.1)μg/L,P<0.05】,血清脂联素水平为(11.9±2.1)mg/L,显著高于对照组【(10.7±1.8)mg/L, P<0.05】;治疗期间,观察组不良反应发生率为13.5%,与对照组的9.6%比较无统计学差异(P>0.05)。结论应用阿托伐他汀联合硫普罗宁治疗NAFLD 患者可短期恢复肝功能指标,降低血清NF-κB和TGF-β水平,改善IR和血脂代谢紊乱,其长期疗效还有待于进一步观察。

关键词: 非酒精性脂肪性肝病, 阿托伐他汀, 硫普罗宁, 核转录因子κB, 转化生长因子-β, 胰岛素抵抗, 治疗

Abstract: Objective The purpose of this study was to investigate the efficacy of atorvastatin and tiopronin combination in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 104 patients with NAFLD were admitted to our hospital between December 2016 and September 2019, and were randomly divided into observation (n=52 and control group (n=52). The patients with NAFLD in control group received routine exercise and diet intervention plus tiopronin enteric-coated tablets and those in the observation group received atorvastatin and tiopronin orally for 8 weeks. Serum nuclear factor kappa B (NF-κ B), transforming growth factor -β(TGF-β),insulin-like growth factor -1(IGF-1, insulin resistance (IR) and serum alanineaminotransferase (ALT), aspartic acid transaminase (AST), glutamyl transpeptidase ( GGT), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were detected. Results At the end of treatment, serum ALT level in the observation group was (27.8±2.5)U/L, significantly lower than 【(43.6±3.0)U/L, P<0.05】, serum AST level was (22.1±6.3)U/L, significantly lower than 【(46.4±6.9)U/L, P<0.05】, serum GGT level was (55.6±9.8)U/L, significantly lower than 【(71.3±10.3)U/L, P<0.05】, and blodd TG level was (2.4±0.5)mmol/L, much lower than 【(3.0±0.4)mmol/L, P<0.05】, blood TC level was (3.6±0.7)mmol/L, significantly lower than 【(4.9±0.5)mmol/L, P<0.05】, blood LDL-C level was (2.6±0.7)mmol/L, significantly lower than 【(3.1±0.6)mmol/L, P<0.05】, while blood HDL-C level was (1.3±0.2)mmol/L, much higher than 【(1.1±0.3)mmol/L, P<0.05】 in the control group; serum NF-κB level was (1.2±0.1)pg/mL, significantly lower than 【(2.6±0.2)pg/mL, P<0.05】, serum TGF-β level was (3.3±1.2)pg/mL, significantly lower than 【(5.7±1.0)pg/mL, P<0.05】, the HOMA-IR was (2.2±0.4), significantly lower than 【(2.7±0.5), P<0.05】, while serum IGF-1 level was (0.4±0.2)μg/L, significantly higher than 【(0.3±0.1)μg/L, P<0.05】, and serum adiponectin level was (11.9±2.1)mg/L, much higher than 【(10.7±1.8)mg/L, P<0.05】 in the control; the incidences of side effects in the two group during the treatment was not significantly different (13.5% vs. 9.6%, P>0.05). Conclusion The regimen with atorvastatin and tiopronin combination in dealing with patients with NAFLD could protect liver functions, which might be related to the reduction of serum levels of NF-κB and TGF-β, and inhibition of inflammatory reactions.

Key words: Nonalcoholic fatty liver disease, Atorvastatin, Tiopronin, Nuclear transcription factor kappa b, Transforming growth factor-β, Insulin resistance, Therapy

魏秀琴, 闫晓霞, 石国荣, 赵宏伟, 李基寿. 阿托伐他汀联合硫普罗宁治疗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, 2021, 24(1): 47-50.

Wei Xiuqin, Yan Xiaoxia, Shi Guorong, et al. Short-termefficacy of atorvastatin and tiopronin combination in the treatment of patients with nonalcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2021, 24(1): 47-50.

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