消脂清肝汤对NAFLD（痰阻血瘀型）的临床疗效及相关机制的探索性研究

发布时间：2018-06-01 02:58

本文选题：非酒精性脂肪性肝病 + 消脂清肝汤　；参考：《中国中医科学院》2017年硕士论文

【摘要】：背景:非酒精性脂肪性肝病(NAFLD)是一种与胰岛素抵抗(IR)和遗传易感性相关的代谢应激性肝损伤,已成为发达国家慢性肝病的首要病因,也是我国临床常见病和多发病。除直接或通过促进并存的其他肝病的进展,导致肝衰竭和肝细胞癌(HCC)外,NAFLD还参与2型糖尿病和动脉硬化等疾病的发病。积极治疗此病可减少肝纤维化、肝硬化的发生,并减少代谢综合征及心、脑血管事件的发生。中医药治疗本病积累了丰富的临床经验,疗效显著。临床上普遍认为,本病病理因素以痰浊、瘀血为著,临床上本病亦多以痰阻血瘀证型多见。消脂清肝汤(炒白术,泽泻,绵萆參,丹参,生山楂,制首乌,茵陈,荷叶,决明子,鸡骨草,虎杖,红曲等)是中国中医科学院西苑医院肝病科治疗NAFLD的临床有效方剂,本方针对痰阻血瘀的病理基础组方,经过前期的基础研究(药效学、急性毒理)和临床观察已证实其疗效确切,是临床治疗NAFLD的有效方剂。目的:依据中医学理论和临床实践,结合现代医学,观察中药效方消脂清肝汤对于非酒精性脂肪性肝病患者的临床疗效:生化学改善率(肝功能、血脂)、中医症状改善率、体征消失率、影像学改变率(B超);并通过相关指标检测探索其可能的作用机制:抗炎(TNF-α)、降脂(TC、TG、FFA)、抗氧化(MDA、SOD)、对抗胰岛素抵抗(HOMA-IR、脂联素)。方法:本临床研究来源于北京市中医药科技发展资金项目(2014-JJ42),由西苑医院肝病科确诊为NAFLD痰阻血瘀型患者60例进行临床研究,采用随机分配原则,将60例合格对象分为治疗组30例,对照组30例。治疗组予消脂清肝汤,1次1袋(100ml),1日2次,治疗16周;对照组予多烯磷脂酰胆碱胶囊,1次2粒(456mg),1日3次,治疗16周。观察指标包括体重、腰围、中医证侯、腹部超声、血脂、肝功能、空腹血糖、胰岛素、肿瘤坏死因子、血清超氧化物歧化酶、血清丙二醛、游离脂肪酸、脂联素等。观察两组的治疗差异。结果:1.治疗组的总有效率86.7%,对照组的总有效率76.7%,治疗8周后、治疗16周后未见明显不良反应。治疗组与对照组的总体疗效相对比,治疗组明显优于对照组(P0.05)。2.治疗后两组症状体征相互比较:治疗组的疗效在胁肋胀闷或痛、脘腹胀满、食欲不振、恶心暖气、形体肥胖等症状体征上,治疗组显著优于对照组(P0.05);便溏不爽、倦怠乏力等症状体征与对照组疗效差异不显著,无从比较(P0.05)。3.治疗后两组肝功能相互比较:治疗组疗效在AST、GGT上,显著优于对照组(P0.05);在ALT、TBiL上差异不显著,无从比较(P0.05)。治疗组用药后肝功能改善效果优于对照组。4.治疗后两组血脂相互比较:治疗组疗效在TC、TG上,显著优于对照组(P0.05);在HDL-C、LDL-C上治疗组与对照组疗效差异不显著,无从比较(P0.05)。5.治疗后两组炎症坏死及血脂相关指标比较:治疗组治疗后,患者胰岛素、TNF-α、SOD、MDA、FFA、IR指数均有非常明显改善(P0.01),空腹血糖、ADP均有明显改善(P0.05);对照组治疗后,患者MDA、IR指数均有非常明显改善(P0.01),空腹血糖、胰岛素、TNF-α、SOD、FFA、ADP均有明显改善(P0.05)。两组治疗后互相比较,治疗组疗效在MDA、ADP上,非常显著优于对照组(P0.01);在SOD、FFA疗效上治疗组显著优于对照组(P0.05);在空腹血糖、胰岛素、TNF-α、IR指数上治疗组与对照组差异不显著,无从比较(P0.05)。结论:1.治疗组使用消脂清肝汤治疗非酒精性脂肪性肝病(痰阻血瘀型)患者的临床疗效显著优于使用多烯磷脂酰胆碱胶囊治疗的对照组。2.本方治疗非酒精性脂肪性肝病的作用,可能与抗炎(TNF-α)、降脂(TC、TG、FFA)、抗氧化(MDA、SOD)、对抗胰岛素抵抗(HOMA-IR、脂联素)有关。
[Abstract]:Background: nonalcoholic fatty liver disease (NAFLD) is a metabolic stress liver injury associated with insulin resistance (IR) and genetic susceptibility. It has become the primary cause of chronic liver disease in developed countries. It is also a common and frequently occurring disease in our country. HCC), in addition, NAFLD is also involved in the pathogenesis of type 2 diabetes and arteriosclerosis. The active treatment of this disease can reduce liver fibrosis, liver cirrhosis, and reduce the occurrence of metabolic syndrome and heart and cerebrovascular events. It is a clinical effective prescription for the treatment of NAFLD in the Xiyuan Hospital of Chinese Academy of science of traditional Chinese medicine (Chinese Academy of Chinese Medicine), which aims at the pathological basis of phlegm obstructing blood stasis. The basic research (pharmacodynamics, acute toxicology) and clinical observation has proved its effective curative effect, and it is an effective prescription for clinical treatment of NAFLD. Objective: To observe the clinical efficacy of the decoction of Xiao Zhi Qinggan Decoction on non-alcoholic fatty liver disease according to the theory of traditional Chinese medicine and clinical practice and modern medicine: the clinical efficacy of the decoction of Chinese medicine Xiao Zhi Qinggan Decoction The improvement rate (liver function, blood lipid), the improvement rate of TCM symptoms, the rate of signs disappearance, and the rate of imaging change (B ultrasonic); and explore the possible mechanism of action by the related indexes: anti inflammatory (TNF- alpha), lipid lowering (TC, TG, FFA), anti oxidation (MDA, SOD), anti Isle resistance (HOMA-IR, adiponectin). Methods: This clinical study originated from the science and technology of traditional Chinese medicine in Beijing. The development fund project (2014-JJ42), 60 cases of NAFLD phlegm stasis type patients diagnosed by the liver disease department of Xiyuan Hospital, were divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was treated with fat clearing liver soup, 1 times 1 bags (100ml), 2 times 1 days for 16 weeks, and the control group was given Polyene Phosphatidylcholine Capsules, 1 times 2 tablets (456mg), 3 times 1 days, treatment for 16 weeks. The observation indexes included body weight, waist circumference, TCM syndrome, abdominal ultrasound, blood lipid, liver function, fasting blood glucose, insulin, tumor necrosis factor, serum superoxide dismutase, serum malondialdehyde, free fatty acid, adiponectin, and so on. Observe the treatment difference between the two groups. Results: the total effective rate of the 1. treatment group was 86.7%, to the 1. treatment group. The total effective rate of the group was 76.7%. After the treatment for 8 weeks, there was no obvious adverse reaction after 16 weeks of treatment. The treatment group was compared with the control group. The treatment group was obviously better than the control group (P0.05) and the two groups of symptoms and signs were compared with the control group. The curative effect of the treatment group was in the ribs distension or pain, abdominal distention, loss of appetite, nausea and heat, and body obesity. On the symptoms and signs, the treatment group was significantly better than the control group (P0.05). The symptoms of loose stools and fatigue were not significantly different from those in the control group. The two groups of liver functions were compared in the treatment group after P0.05.3. treatment: the treatment group was significantly better than the control group (P0.05) on the effect of AST and GGT; there was no significant difference on ALT, TBiL, and no comparison (P0.05). The effect of liver function improvement in the treatment group was better than that of the control group after.4. treatment. The curative effect of the treatment group was significantly better than the control group (P0.05) in the treatment group on TC and TG; in HDL-C, the treatment group was not significantly different from the control group, and the two groups of inflammatory necrosis and blood lipid related indexes after P0.05.5. treatment were compared: the treatment group was treated with the treatment group. After that, the patients' insulin, TNF- alpha, SOD, MDA, FFA, IR index were significantly improved (P0.01), the fasting blood glucose and ADP were significantly improved (P0.05), and the MDA, IR index of the patients in the control group were significantly improved (P0.01). The two groups were compared with each other after treatment. The treatment group was treated with each other after treatment. The effect on MDA and ADP was significantly better than that of the control group (P0.01); in SOD, the curative effect of FFA was significantly better than that of the control group (P0.05), and there was no significant difference between the treatment group and the control group on the fasting blood glucose, insulin, TNF- alpha and IR index. Conclusion: the 1. treatment group was treated with the treatment of non-alcoholic fatty liver disease (phlegm stasis and blood stasis type) by using the decoction of clearing fat and clearing liver. The clinical efficacy of the patient is significantly better than that of the control group.2. treated with Polyene Phosphatidylcholine Capsules. The effect of the prescription on nonalcoholic fatty liver disease may be related to anti inflammatory (TNF- alpha), lipid lowering (TC, TG, FFA), antioxidant (MDA, SOD), and against insulin resistance (HOMA-IR, adiponectin).
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】