检验医学在山丹茶治疗非酒精性脂肪性肝病随机对照临床研究中的应用
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摘要
目的利用检验医学指标观察中药山丹茶治疗非酒精性脂肪性肝病的临床疗效和安全性。方法收集200例非酒精性单纯性脂肪肝患者,随机分为治疗组和对照组各100例,治疗过程中2组各脱落5例患者,最终190例患者完成试验。2组均进行饮食控制和运动干预,治疗组在此基础上给予中药山丹茶(丹参15g、山楂15g、决明子15g、甘草6g)泡茶饮,1包/次,2次/天,两组患者均观察24周,比较2组患者受控衰减参数(CAP)、体质量指数(BMI)、肝功能、肾功能、血脂水平和氧化还原指标的变化,评价山丹茶联合饮食控制、运动干预非酒精性单纯性脂肪肝的临床疗效。结果与治疗前比较,治疗组CAP降低,差异有统计学意义(P<0.001),对照组差异有统计学意义(P<0.05),治疗组与对照组比较,差异有统计学意义(P<0.001);与治疗前比较,治疗组BMI指数降低,差异有统计学意义(P<0.01),对照组差异有统计学意义(P<0.05),治疗组与对照组比较,差异有统计学意义(P<0.05)。与治疗前比较,治疗组肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ谷氨酰转移酶(GGT)、亮氨酸氨基转肽酶(LAP)、前清蛋白(PA)、胆碱酯酶(CHE)水平降低,差异有统计学意义(P<0.05);对照组AST、LAP、PA、CHE水平有显著降低,差异有统计学意义(P<0.05),ALT、GGT、ALP水平差异无统计学意义(P>0.05);治疗组与对照组比较,ALT、GGT、LAP有显著降低,差异有统计学意义(P<0.05),AST、ALP、PA、CHE差异无统计学意义(P>0.05)。与治疗前比较,2组肾功能指标尿素氮(BUN)、尿酸(URIC)、肌酐(CREA)差异无统计学意义(P>0.05);治疗组与对照组比较,差异无统计学意义(P>0.05)。与治疗前比较,治疗组血脂指标三酰甘油(TG)、胆固醇(CHOL)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)差异无统计学意义(P>0.05),游离脂肪酸(FFA)有显著降低,差异有统计学意义(P<0.05);对照组TG、CHOL、HDL-C、LDL-C、FFA水平差异无统计学意义(P>0.05);治疗组与对照组比较TG、CHOL、HDL-C、LDL-C、FFA水平差异无统计学意义(P>0.05)。与治疗前比较,治疗组和对照组氧化还原指标超氧化物歧化酶(SOD)显著降低,差异有统计学意义(P<0.05),同型半胱氨酸(HCY)显著上升,差异有统计学意义(P<0.05);治疗组与对照组比较,SOD、HCY变化差异无统计学意义(P>0.05)。结论与治疗前比较,饮食控制、运动干预可降低非酒精性单纯性脂肪肝患者的部分肝功能指标,在此基础上加用山丹茶中药茶泡饮还可另外降低CAP和BMI以及部分肝功能、血脂指标;与对照组比较,治疗后治疗组患者的CAP和BMI以及部分肝功能指标较低,疗效优于对照组。
Objective To find the clinical efficacy of diet,exercise intervention on Non-alcoholic simple fatty liver disease,and also to observe the clinical efficacy of diet,exercise intervention combining with traditional Chinese medicine(Shandan tea)on non-alcoholic simple fatty liver disease.Methods The study collected 200 cases of NAFLD patients,which were divided into control group and treatment group randomly.Each group lost 5 patients in the process and 190 patients finished the experiment.Both of the groups were given diet management and exercise intervention.The treatment group also had Chinese medicine tea(Danshen 15 g,hawthorn 15 g,Semen Cassiae 15 g,liquorice 6 g and the control group did not have.Both of the groups were observed for 24 weeks to compare the change of fibroscan CAP fat quantitative,BMI,liver function,renal function,blood lipid level and redox index,which was used to assess the clinical efficacy and safety of Chinese medicine(Shandan tea)intervention on non-alcoholic simple fatty liver disease.Results Compared with before treatment,the CAP index of the treatment group decreased significantly(P<0.001),and the difference in the control group was statistically significant(P<0.05),and the difference between the treatment group and the control group was statistically significant(P<0.001).Compared with before treatment,the BMI index of the treatment group decreased,and the difference was statistically significant(P<0.01),and the difference in the control group was statistically significant(P<0.05).There were significant differences between the two groups(P<0.05).Compared with before treatment,the liver function indexes of the treatment group,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma glutamyltransferase(GGT),leucine aminotransferase(LAP),prealbumin(PA)and cholinesterase(CHE)decreased significantly,and the differences were statistically significant(P<0.05).The AST,LAP,PA and CHE in the control group were significantly decreased in the control group,(P<0.05),but there were no significant differences in ALT,GGT and ALP(P>0.05).Compared with the control group,ALT,GGT and LAP in the treatment group were significantly lower(P<0.05),while AST,ALP,PA and CHE had no significant difference(P >0.05).Compared with before treatment,there was no significant difference in Urea nitrogen(BUN),uric acid(URIC),creatinine(CREA)between the two groups(P>0.05),but there was no significant difference in BUN,URIC and CREA between the treatment group and the control group(P>0.05).Compared with before treatment,there was no significant difference in blood lipid indexes such as triglyceride(TG),cholesterol(CHOL),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)between the treatment group and the control group(P>0.05),while free fatty acid(FFA)decreased significantly(P<0.05).There was no significant difference in the levels of HOL,HDL-C,LDL-C and FFA between the treatment group and the control group(P>0.05);there was no significant difference in the levels of TG,CHOL,HDL-C,LDL-C and FFA between the treatment group and the control group(P>0.05).Compared with before treatment,the redox index of superoxide dismutase(SOD)in treatment group and control group decreased significantly,with significant difference(P<0.05),and homocysteine(HCY)increased significantly(P<0.05);there was no significant difference in the changes of SOD and HCY between treatment group and control group(P>0.05).Conclusion Compared with before treatment,diet management,exercise intervention can improve some levels of NAFLD patients′liver function index,diet management,exercise intervention and Chinese medicine(Shandan tea)can significantly reduce the levels of CAP,BMI,part of liver function levels and part of blood lipid levels.Compared with the control group,the treatment group′s CAP,BMI,ALT,GGT,LAP level are lower,which makes a great efficacy.
Objective To find the clinical efficacy of diet,exercise intervention on Non-alcoholic simple fatty liver disease,and also to observe the clinical efficacy of diet,exercise intervention combining with traditional Chinese medicine(Shandan tea)on non-alcoholic simple fatty liver disease.Methods The study collected 200 cases of NAFLD patients,which were divided into control group and treatment group randomly.Each group lost 5 patients in the process and 190 patients finished the experiment.Both of the groups were given diet management and exercise intervention.The treatment group also had Chinese medicine tea(Danshen 15 g,hawthorn 15 g,Semen Cassiae 15 g,liquorice 6 g and the control group did not have.Both of the groups were observed for 24 weeks to compare the change of fibroscan CAP fat quantitative,BMI,liver function,renal function,blood lipid level and redox index,which was used to assess the clinical efficacy and safety of Chinese medicine(Shandan tea)intervention on non-alcoholic simple fatty liver disease.Results Compared with before treatment,the CAP index of the treatment group decreased significantly(P<0.001),and the difference in the control group was statistically significant(P<0.05),and the difference between the treatment group and the control group was statistically significant(P<0.001).Compared with before treatment,the BMI index of the treatment group decreased,and the difference was statistically significant(P<0.01),and the difference in the control group was statistically significant(P<0.05).There were significant differences between the two groups(P<0.05).Compared with before treatment,the liver function indexes of the treatment group,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma glutamyltransferase(GGT),leucine aminotransferase(LAP),prealbumin(PA)and cholinesterase(CHE)decreased significantly,and the differences were statistically significant(P<0.05).The AST,LAP,PA and CHE in the control group were significantly decreased in the control group,(P<0.05),but there were no significant differences in ALT,GGT and ALP(P>0.05).Compared with the control group,ALT,GGT and LAP in the treatment group were significantly lower(P<0.05),while AST,ALP,PA and CHE had no significant difference(P >0.05).Compared with before treatment,there was no significant difference in Urea nitrogen(BUN),uric acid(URIC),creatinine(CREA)between the two groups(P>0.05),but there was no significant difference in BUN,URIC and CREA between the treatment group and the control group(P>0.05).Compared with before treatment,there was no significant difference in blood lipid indexes such as triglyceride(TG),cholesterol(CHOL),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)between the treatment group and the control group(P>0.05),while free fatty acid(FFA)decreased significantly(P<0.05).There was no significant difference in the levels of HOL,HDL-C,LDL-C and FFA between the treatment group and the control group(P>0.05);there was no significant difference in the levels of TG,CHOL,HDL-C,LDL-C and FFA between the treatment group and the control group(P>0.05).Compared with before treatment,the redox index of superoxide dismutase(SOD)in treatment group and control group decreased significantly,with significant difference(P<0.05),and homocysteine(HCY)increased significantly(P<0.05);there was no significant difference in the changes of SOD and HCY between treatment group and control group(P>0.05).Conclusion Compared with before treatment,diet management,exercise intervention can improve some levels of NAFLD patients′liver function index,diet management,exercise intervention and Chinese medicine(Shandan tea)can significantly reduce the levels of CAP,BMI,part of liver function levels and part of blood lipid levels.Compared with the control group,the treatment group′s CAP,BMI,ALT,GGT,LAP level are lower,which makes a great efficacy.
引文
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[10]王依屹,张珏,鲁传翠.2型糖尿病患者胰岛素抵抗与血清游离脂肪酸浓度的关系[J].检验医学,2012,27(10):806-808.
[2] PARK S H,JEON W K,KIM S H,et al.Prevalence and risk factors of nonalcoholicfattyliver disease among Korean adults[J].J Gastroenterol Hepatol,2006,21(1):138-143.
[3] FAN J G,FARRELL G C.Epidemiology of non-alcoholic fatty liver disease in China[J].J Hepatol,2009,50(1):204-210.
[4]范建高,曾民德.脂肪肝与肝纤维化[J].肝脏,1999,4(2):99-100.
[5]刘彬,张学智.中医辨证论治非酒精性脂肪肝近10年研究进展[J].中国中西医结合消化杂志,2013,21(4):218-221.
[6]王雁翔,王灵台,高月求.脂肪肝中医证型流行病学调查及其中医病因病机初探[J].中国中西医结合杂志,2005,25(2):126-130.
[7]谢晶日.脂肪肝的中医研究现状[J].现代消化及介入诊疗,2009,14(4):242-246.
[8]中华医学会肝脏病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南[J].药品评价,2007,4(2):77-79.
[9]范建高,曾民德.脂肪性肝病[M].北京:人民卫生出版社,2005:137-138.
[10]王依屹,张珏,鲁传翠.2型糖尿病患者胰岛素抵抗与血清游离脂肪酸浓度的关系[J].检验医学,2012,27(10):806-808.