化浊通淤汤治疗非酒精性脂肪性肝病患者短期疗效研究

doi:10.3969/j.issn.1672-5069.2021.05.024

摘要/Abstract

摘要： 目的探讨应用化浊通淤汤治疗非酒精性脂肪性肝病(NAFLD)患者血脂、胰岛素抵抗和血清瘦素水平的变化。方法 2018年1月～2020年1月我科诊治的NAFLD患者100例,被随机分为对照组50例和观察组50例,分别给予水飞蓟宾胶囊治疗或化浊通淤汤治疗3个月。使用全自动生化分析仪检测血清低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、甘油三酯(TG)和总胆固醇(TC),采用双抗体夹心法检测血清瘦素水平,使用彩色多普勒超声诊断仪评估脂肪肝严重程度评分。结果在治疗结束时,观察组血清TG、TC和LDL水平分别为(1.8±0.1)mmol/L、(5.1±0.3)mmol/L和(2.0±0.2)mmol/L,显著低于对照组【分别为(2.6±0.1)mmol/L、(6.7±0.4)mmol/L和(3.1±0.2)mmol/L,P<0.05】;HOMA-IR和血清瘦素水平分别为(2.0±0.2)和(1.0±0.1)ng/mL,显著低于对照组【分别为(3.0±0.3)和(1.7±0.2)ng/mL,P<0.05】,而两组空腹血糖和HOMA-B无显著性差异【分别为(4.2±0.3)mmol/l和(67.3±7.0)%对(4.3±0.3)mmol/l和(68.1±7.1)%,P>0.05】;血清AST、ALT、GGT和超声评分分别为(41.5±4.2)U/L、(35.9±3.2)U/L、(63.6±4.0)U/L和(4.6±1.0),均显著低于对照组【分别为(51.4±5.1)U/L、(41.3±4.1)U/L、(87.5±5.7)U/L和(6.5±0.7),P<0.05】。结论应用中药化浊通淤汤治疗NAFLD患者可有效调节血脂水平,降低胰岛素抵抗和血清瘦素水平,对短期改善肝功能指标有积极的意义。

关键词: 非酒精性脂肪性肝病, 化浊通淤汤, 血脂, 胰岛素抵抗, 瘦素, 治疗

Abstract: Objective The aim of this study was to investigate the short-term efficacy of Huazhuo Tongyu decoction in the treatment of patients with non-alcoholic fatty liver diseases(NAFLD). Methods 100 patients with NAFLD were recruited in this clinical trial between January 2018 and January 2020, and were randomly divided into control group (n=50) and observation group (n=50), receiving silibinin capsules orally or Huazhuo Tongyu decoction, a decoction of herbal medicine, for three months. Blood biochemical parameters were measured by AU5800 automatic biochemical analyzer, fasting blood insulin was detected by Abbott Optium glucometer, serum leptin level was detected by double-antibodies ELISA, and the severity of fatty liver was assessed by ultrasonography (US). Results At the end of treatment, blood triglycerides (TG), total cholesterol (TC) and low density lipoprotein (LDL) in the observation group were(1.8±0.1)mmol/L, (5.1±0.3)mmol/L and (2.0±0.2)mmol/L, significantly lower than in the control group; the HOMA-IR and serum leptin level were (2.0±0.2) and (1.0±0.1)ng/mL, significantly lower than in the control, while there were no significant differences as respect to fasting plasma glucose level and HOMA-B between the two groups ; serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT) and the US score were(41.5±4.2)U/L, (35.9±3.2)U/L, (63.6±4.0)U/L and (4.6±1.0), all significantly lower than in the control. Conclusion The administration of Huazhuo Tongyu decoction could effectively regulate blood lipids, alleviate insulin resistance and decrease serum leptin levels in patients with NAFLD, which needs further investigation.

Key words: Non-alcoholic fatty liver diseases, Huazhuo Tongyu decoction, herbal medicine, Blood lipids, Insulin resistance, Leptin, Therapy

徐祥涛, 乔飞, 车军勇, 陆玮婷. 化浊通淤汤治疗非酒精性脂肪性肝病患者短期疗效研究[J]. 实用肝脏病杂志, 2021, 24(5): 701-704.

Xu Xiangtao, Qiao Fei, Che Junyong, et al. Short-term efficacy of Huazhuo Tongyu decoction in the treatment of patients with non-alcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2021, 24(5): 701-704.

参考文献

[1]Elena P, Gaetano V, Antonio M, et al. Metabolic aspects in NAFLD, NASH and hepatocellular carcinoma: the role of PGC1 coactivators. Nat Rev Gastroenterol Hepatol, 2019,16(3):160-174.
[2]施军平, 徐佳丽. 非酒精性脂肪性肝病的非药物治疗. 中华消化杂志, 2020, 40(9):587-590.
[3]Emanuel E C, Ruth C R M, Koen V, et al. Gut microbial metabolites in obesity, NAFLD and T2DM. Nat Rev Endocrinol, 2019,15(5):261-273.
[4]Giovanni M, Francesca S, Maurizio C, et al. Angiotensin II type 1 receptor rs5186 gene variant predicts incident NAFLD and associated hypertension: role of dietary fat-induced pro-inflammatory cell activation. Am J Gastroenterol,2019, 114(4):607-619.
[5]叶俊钊, 钟碧慧. 非酒精性脂肪性肝病合并代谢并发症患者规范治疗与管理. 实用肝脏病杂志, 2020,23(5):615-618.
[6]郭静, 叶琳琳, 郭玉琴,等. 从"浊阴凝痞"视角探讨非酒精性脂肪肝病辨治思路. 中华中医药杂志, 2020, 35(4):271-273.
[7]中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会, 范建高,等. 非酒精性脂肪性肝病防治指南(2018年更新版). 实用肝脏病杂志, 2018, 21(2):30-39.
[8]陆伦根, 曲颖. 非酒精性脂肪性肝病的诊断与评估. 中华消化杂志, 2020, 40(9):584-587.
[9]Chipperfield A J, Thanaj M, Scorletti E,et al. Multi-domain analysis of microvascular flow motion dynamics in NAFLD. Microcirculation, 2019, 26(5):e12538.
[10] Rodrigo M P,Kellen C,Marcella R S, et al. Short-term strength training reduces gluconeogenesis and NAFLD in obese mice.J Endocrinol, 2019, 241(1):59-70.
[11] 雷婷, 李良平. 非酒精性脂肪性肝病患者早期肾脏损伤横断面研究. 中华消化杂志, 2019, 39(5):322-326.
[12] Shimada T, Shindo A, Matsuyama H, et al. Chronic cerebral hypoperfusion upregulates leptin receptor expression in astrocytes and tau phosphorylation in tau transgenic mice. Neurosci Lett, 2019, 704(35):133-140.
[13] Huang XL, Xu M, Chen Y, et al. Validation of the fatty liver index for nonalcoholic fatty liver disease in middle-aged and elderly Chinese. Medicine,2015,94(40):1682.
[14] Zhen C, Lei W, Zhao W, et al. Clinical observation on Huoxue Huazhuo Jiangzhi decoction on blood stasis and dampness type of hyperlipidemia. World Chin Med, 2015, 14(31):21-23.
[15] Feng TT, Yang XY, Hao SS, et al. TLR-2-mediated metabolic reprogramming participates in polyene phosphatidylcholine-mediated inhibition of M1 macrophage polarization. Immunol Res, 2020, 2020,68(1):28-38.
[16] Zhang Y, R Liu, Wang J, et al. To assess the effective and safety of compound glutamine entersoluble capsules in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 2021, 100(10):e25098.
[17] Liu M T, Zhao J, Li S P. Application of smartphone in detection of thin-layer chromatography: Case of salvia miltiorrhiza. J Chr A, 2020, 1637(34):461-465.
[18] Wang HY.The evaluation of embryotoxicity of ligusticum chuanxiong on mice and embryonic stem cells. J Ethnopharmacol,2019,15(239):111-115.
[19] 李琤, 王彦淇, 李广明, 等. 自拟疏肝健脾化浊汤联合常规疗法治疗青少年肝郁脾虚型非酒精性脂肪性肝病的回顾性研究. 上海中医药杂志, 2020, 54(11):49-53.
[20] 孙建光, 高继龙. 补肾化浊方对非酒精性脂肪肝大鼠血清瘦素与胰岛素抵抗的影响. 中国实验方剂学杂志, 2012, 18(24):288-291.