化痰祛湿活血方对NASH患者内毒素、胆汁酸、肝肠循环的影响
发布时间：2018-08-01 11:57
【摘要】：目的:经对比观察非酒精性脂肪性肝炎(NASH)患者试验组与对照组用药前后血清中内毒素(ET)、胆汁酸(TBA)和患者大便杆球比的检测数值变化情况,以研究化痰祛湿活血方对NASH患者内毒素、胆汁酸、肝肠循环的影响,从而探究化痰祛湿活血方治疗NASH的作用机制。经比较NASH患者用药前后及研究过程中谷丙转氨酶(ALT)、谷草转氨酶(AST)、游离脂肪酸(FFA)、甘油三酯(TG)、胆固醇(TC)等血清生化指标变化,并对比用药前后受试患者血浆粘度、红细胞压积、肝脾CT比值、体重指数(BMI)、腰臀围比(WHR)以及中医症候积分等临床疗效指标的数值变化以综合评价化痰祛湿活血方对NASH的临床疗效。方法:收取60例符合NASH诊断和纳入要求的患者为研究对象,按其就诊先后顺序随机分为试验组(30例)和对照组(30例)。两组均在科学调理饮食,增强适当有氧运动和健康宣教的基础上给予药物治疗。试验组药用加减化痰祛湿活血方颗粒,每天1剂,早晚冲服;对照组药用多烯磷脂酰胆碱(易善复)胶囊,1次456mg,每天3次,疗程均为3个月。对初诊首日及用药第90天前后的入组患者测体重、身高以计算出体重指数(BMI),测腰围、臀围以计算出腰臀围比(WHR);抽取患者清晨空腹8小时以上肘静脉血非抗凝血5ml,离心留取血清,用酶联免疫吸附(ELISA)法测定并观察两组患者用药前后血清ET及TBA数值变化;记录患者用药前后肝脾CT比值、大便杆球比值、血浆粘度、红细胞压积的数值变化;以及患者在用药前后及期间ALT、AST、FFA、TG、TC等生化指标数值的变化情况。结果:1、两组患者血清内毒素检测值用药后均较用药前下降(P0.05),试验组与对照组相比下降较为显著,两组患者用药后内毒素检测值比较有显然差异(P0.05)。两组患者血清总胆汁酸检测值用药后均较用药前下降(P0.05),试验组与对照组相比下降明显,两组患者用药后胆汁酸检测值比较有显然差异(P0.05)。两组患者大便杆球比值较用药前均升高,试验组差异明显(P0.01),但对照组无明显差异(P0.05),两组患者用药后大便杆球比值相比有显著差异(P0.01)。2、两组患者用药后肝功(ALT、AST)检测值较用药前均有显著下降(P0.05),而两组患者用药后ALT、AST水平相比无明显差异(P0.05)。两组患者用药后血脂(TG、TC、FFA)检测值对比差异显著(P0.01),试验组用药后血脂(TG、TC、FFA)检测值较用药前均有显著下降(P0.01),而对照组患者用药后血脂(TG、TC、FFA)检测值较用药前无明显差别(P0.05)。3、两组患者肝脾CT比值用药后较用药前均有所升高(P0.05),且试验组相比对照组升高更显著,两组患者用药后肝脾CT比值对比有显著差异(P0.05)。4、两组体重指数及腰臀围比值用药后均较用药前下降(P0.05),试验组相比对照组降低明显,两组用药后体重指数、腰臀围比值相比有显著差异(P0.05)。5、两组血浆粘度及红细胞压积用药后均较用药前下降(P0.05),试验组相比对照组降低明显,两组用药后血浆粘度、红细胞压积相比有显然差异(P0.05)。6、两组患者症候积分计算值用药后均较用药前下降(P0.05),且试验组相比对照组下降更显著,两组患者用药后症候积分计算值相比有显著差异(P0.01)。两组患者治疗效果比较,试验组相比对照组疗效更为显著,差异明显(P0.01)。结论:1、化痰祛湿活血方可降低NASH患者血清ET、TBA检测值,升高NASH患者的大便杆球比值,表明化痰祛湿活血方可能通过调节NASH患者肠道菌群,降低LPS、TBA水平,达到治疗NASH的效果。2、化痰祛湿活血方可降低NASH患者血ALT、AST、FFA、TG、TC检测值,表明化痰祛湿活血方能抑制肝脏炎症,改善脂质代谢。3、化痰祛湿活血方可提高NASH患者肝脾CT比值,表明化痰祛湿活血方可改善NASH患者肝脏脂肪变的程度。4、化痰祛湿活血方可降低NASH患者的BMI、WHR,表明化痰祛湿活血方可通过减轻体重,缩小腰围达到减轻肝脏脂肪变的程度。5、化痰祛湿活血方可使血浆粘度、红细胞压积检测值下降,表明化痰祛湿活血方能降低NASH患者的血液粘稠度。6、化痰祛湿活血方可显著降低NASH患者的中医症候积分,表明化痰祛湿活血方能显著改善NASH患者的临床症状,提高NASH的治疗效果。
[Abstract]:Objective: To observe the changes of serum endotoxin (ET), bile acid (TBA) and stool ball ratio in patients with non-alcoholic steatohepatitis (NASH) before and after treatment, in order to study the effect of eliminating phlegm and eliminating dampness and activating blood on endotoxin, bile acid and hepatic intestinal circulation in NASH patients, thus exploring phlegm and eliminating dampness and activating blood circulation. The mechanism of the treatment of NASH was made by comparing the serum biochemical indexes of NASH patients before and after the treatment and the study process, such as ALT, AST, FFA, triglyceride (TG), and cholesterol (TC), and compared the plasma viscosity, the hematocrit, the CT ratio of the liver and spleen, the body mass index (BMI), and the waist of the subjects before and after the drug use. The clinical curative effect of the hip circumference ratio (WHR) and the TCM syndrome score in order to evaluate the clinical effect of the decoction of eliminating phlegm and eliminating dampness and activating blood on NASH. Methods: 60 cases of patients who were in accordance with the NASH diagnosis and the requirements were collected and divided into the test group (30 cases) and the control group (30 cases). The two groups were all in science. On the basis of conditioning diet and strengthening proper aerobic exercise and health education, the experimental group was treated with 1 doses of medicine and reduction of eliminating phlegm, eliminating dampness and activating blood circulation, taking 1 doses a day, and taking the medicine of polyene phosphatidylcholine (Yi Shanfu) capsules, 1 times a day, 3 times a day for 3 months. The first day of first visit and ninetieth days before and after medication were taken into group. The patient measured body weight and height to calculate body mass index (BMI), waist circumference, hip circumference ratio (WHR), non anticoagulant 5ml in the elbow vein blood of more than 8 hours in the early morning of the patient, centrifugation and serum, and the changes of ET and TBA in the serum of two groups before and after the use of enzyme linked immunosorbent assay (ELISA). The changes in the CT ratio of liver and spleen, the ratio of stool ball, plasma viscosity, and hematocrit, and the changes of ALT, AST, FFA, TG, TC in patients before and after the drug use. Results: 1, the serum endotoxin test values of the two groups were lower than before the medication (P0.05), and the decrease of the test group was more significant than that of the control group. There was obvious difference between the two groups of patients with endotoxin test (P0.05). The total bile acid detection value in the two groups was lower than before the medication (P0.05), the test group was significantly lower than the control group. The two groups of patients had significant difference in the bile acid detection value after the medication (P0.05). The ratio of the bowels ball in the two groups was more than before the drug use. The difference of the test group was significant (P0.01), but there was no significant difference (P0.05) in the control group (P0.05). The ratio of the stool ball in the two groups was significantly different (P0.01).2. The test values of liver function (ALT, AST) after drug use were significantly lower than before the medication (P0.05), but there was no significant difference in the level of ALT and AST (P0.05) between the two groups after medication (P0.05). The blood lipid (TG, TC, FFA) in the test group had a significant difference (P0.01). The serum lipid (TG, TC, FFA) test values of the experimental group were significantly lower than that before the medication (P0.01), while the blood lipid (TG, TC, FFA) in the control group had no significant difference (P0.05) after the drug use (P0.05), and the two groups were higher than before. High (P0.05), and the test group increased significantly compared with the control group, two groups of patients after the liver and spleen CT ratio was significantly different (P0.05).4, two groups of body mass index and waist hip ratio after medication decreased compared with before the medication (P0.05), compared with the control group decreased significantly, the two groups after the use of body mass index, waist hip circumference ratio is significantly different (P0. 05).5, the plasma viscosity and hematocrit in the two groups were lower than that before the medication (P0.05), and the test group was significantly lower than the control group. The plasma viscosity of the two groups was obviously different (P0.05).6 compared with the red blood cell pressure, and the value of the syndrome score in the two group was lower than that before the medication (P0.05), and the test group decreased more than the control group. There was significant difference between the two groups of patients after medication (P0.01). Compared with the control group, the effect of the two groups was more significant than the control group, the difference was obvious (P0.01). Conclusion: 1, phlegm dispelling dampness and activating blood can reduce the serum ET, TBA test value of the patients with NASH, increase the ratio of the stool rod ball in the NASH patients, and show the phlegm and dispelling dampness. The Huoxue recipe may reduce the LPS and TBA levels by regulating the intestinal flora of NASH patients and reduce the level of LPS and TBA. The recipe for eliminating phlegm and eliminating dampness and activating blood can reduce the serum ALT, AST, FFA, TG, TC detection values of NASH patients. It shows that the recipe of eliminating phlegm and activating blood can inhibit the liver inflammation and improve the lipid metabolism.3. Eliminating phlegm, removing dampness and activating blood circulation can improve the degree of liver fat change in NASH patients.4, eliminating phlegm and eliminating dampness and activating blood can reduce the BMI and WHR of NASH patients. It shows that the prescription of eliminating phlegm and activating blood can reduce the degree of liver fat by reducing the body weight and reducing the degree of liver fat.5. The prescription of phlegm dispelling dampness and activating blood can reduce the blood viscosity of NASH patients.6, the recipe of eliminating phlegm and eliminating dampness and activating blood can significantly reduce the TCM syndrome score of the patients with NASH, which indicates that the prescription of eliminating phlegm and activating blood can improve the clinical symptoms of NASH patients and improve the therapeutic effect of NASH.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259
[Abstract]:Objective: To observe the changes of serum endotoxin (ET), bile acid (TBA) and stool ball ratio in patients with non-alcoholic steatohepatitis (NASH) before and after treatment, in order to study the effect of eliminating phlegm and eliminating dampness and activating blood on endotoxin, bile acid and hepatic intestinal circulation in NASH patients, thus exploring phlegm and eliminating dampness and activating blood circulation. The mechanism of the treatment of NASH was made by comparing the serum biochemical indexes of NASH patients before and after the treatment and the study process, such as ALT, AST, FFA, triglyceride (TG), and cholesterol (TC), and compared the plasma viscosity, the hematocrit, the CT ratio of the liver and spleen, the body mass index (BMI), and the waist of the subjects before and after the drug use. The clinical curative effect of the hip circumference ratio (WHR) and the TCM syndrome score in order to evaluate the clinical effect of the decoction of eliminating phlegm and eliminating dampness and activating blood on NASH. Methods: 60 cases of patients who were in accordance with the NASH diagnosis and the requirements were collected and divided into the test group (30 cases) and the control group (30 cases). The two groups were all in science. On the basis of conditioning diet and strengthening proper aerobic exercise and health education, the experimental group was treated with 1 doses of medicine and reduction of eliminating phlegm, eliminating dampness and activating blood circulation, taking 1 doses a day, and taking the medicine of polyene phosphatidylcholine (Yi Shanfu) capsules, 1 times a day, 3 times a day for 3 months. The first day of first visit and ninetieth days before and after medication were taken into group. The patient measured body weight and height to calculate body mass index (BMI), waist circumference, hip circumference ratio (WHR), non anticoagulant 5ml in the elbow vein blood of more than 8 hours in the early morning of the patient, centrifugation and serum, and the changes of ET and TBA in the serum of two groups before and after the use of enzyme linked immunosorbent assay (ELISA). The changes in the CT ratio of liver and spleen, the ratio of stool ball, plasma viscosity, and hematocrit, and the changes of ALT, AST, FFA, TG, TC in patients before and after the drug use. Results: 1, the serum endotoxin test values of the two groups were lower than before the medication (P0.05), and the decrease of the test group was more significant than that of the control group. There was obvious difference between the two groups of patients with endotoxin test (P0.05). The total bile acid detection value in the two groups was lower than before the medication (P0.05), the test group was significantly lower than the control group. The two groups of patients had significant difference in the bile acid detection value after the medication (P0.05). The ratio of the bowels ball in the two groups was more than before the drug use. The difference of the test group was significant (P0.01), but there was no significant difference (P0.05) in the control group (P0.05). The ratio of the stool ball in the two groups was significantly different (P0.01).2. The test values of liver function (ALT, AST) after drug use were significantly lower than before the medication (P0.05), but there was no significant difference in the level of ALT and AST (P0.05) between the two groups after medication (P0.05). The blood lipid (TG, TC, FFA) in the test group had a significant difference (P0.01). The serum lipid (TG, TC, FFA) test values of the experimental group were significantly lower than that before the medication (P0.01), while the blood lipid (TG, TC, FFA) in the control group had no significant difference (P0.05) after the drug use (P0.05), and the two groups were higher than before. High (P0.05), and the test group increased significantly compared with the control group, two groups of patients after the liver and spleen CT ratio was significantly different (P0.05).4, two groups of body mass index and waist hip ratio after medication decreased compared with before the medication (P0.05), compared with the control group decreased significantly, the two groups after the use of body mass index, waist hip circumference ratio is significantly different (P0. 05).5, the plasma viscosity and hematocrit in the two groups were lower than that before the medication (P0.05), and the test group was significantly lower than the control group. The plasma viscosity of the two groups was obviously different (P0.05).6 compared with the red blood cell pressure, and the value of the syndrome score in the two group was lower than that before the medication (P0.05), and the test group decreased more than the control group. There was significant difference between the two groups of patients after medication (P0.01). Compared with the control group, the effect of the two groups was more significant than the control group, the difference was obvious (P0.01). Conclusion: 1, phlegm dispelling dampness and activating blood can reduce the serum ET, TBA test value of the patients with NASH, increase the ratio of the stool rod ball in the NASH patients, and show the phlegm and dispelling dampness. The Huoxue recipe may reduce the LPS and TBA levels by regulating the intestinal flora of NASH patients and reduce the level of LPS and TBA. The recipe for eliminating phlegm and eliminating dampness and activating blood can reduce the serum ALT, AST, FFA, TG, TC detection values of NASH patients. It shows that the recipe of eliminating phlegm and activating blood can inhibit the liver inflammation and improve the lipid metabolism.3. Eliminating phlegm, removing dampness and activating blood circulation can improve the degree of liver fat change in NASH patients.4, eliminating phlegm and eliminating dampness and activating blood can reduce the BMI and WHR of NASH patients. It shows that the prescription of eliminating phlegm and activating blood can reduce the degree of liver fat by reducing the body weight and reducing the degree of liver fat.5. The prescription of phlegm dispelling dampness and activating blood can reduce the blood viscosity of NASH patients.6, the recipe of eliminating phlegm and eliminating dampness and activating blood can significantly reduce the TCM syndrome score of the patients with NASH, which indicates that the prescription of eliminating phlegm and activating blood can improve the clinical symptoms of NASH patients and improve the therapeutic effect of NASH.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259
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