茵陈蒿汤合四逆散治疗非酒精性脂肪肝伴高同型半胱氨酸血症临床观察
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摘要
目的:探讨茵陈蒿汤合四逆散对非酒精性脂肪肝(NAFLD)伴高同型半胱氨酸血症(HHcy)患者的临床疗效。方法:病例来源于北京市西城区什刹海社区卫生服务中心门诊共126例NAFLD伴HHcy患者,随机数字表法分为脂肪肝对照组(安慰剂)、西药组(多烯磷脂酰胆碱胶囊和叶酸片)、中药组(茵陈蒿汤合四逆散方),42例/组,治疗期间无脱落;连续治疗3个月。观察治疗前后临床有效率,观察肝功能[丙氨酸氨基转移酶(ALT),天门冬氨酸氨基转移酶(AST)],同型半胱氨酸(Hcy),血脂[总胆固醇(TC),总甘油三酯(TG),低密度脂蛋白(LDL),高密度脂蛋白(HDL)],氧化炎症指标[丙二醛(MDA),超氧化物酶歧化酶(SOD),超敏C反应蛋白(hs-CRP)],安全性评价指标肾功能(血肌酐(SCr),血尿素氮(BUN)]以及症状评分。结果:中药组总有效率92. 86%;西药组总有效率88. 10%;两组总有效率比较无统计学差异。各组患者治疗前各指标无差异。治疗后中药组、西药组ALT,AST,Hcy,TC,TG,MDA,hs-CRP,症状积分较本组治疗前明显降低(P <0. 05),且低于脂肪肝对照组(P <0. 05); HDL,SOD明显升高(P <0. 05),且高于脂肪肝对照组(P <0. 05);与西药组比较,中药组ALT,Hcy,TC,TG,MDA,hs-CRP,症状积分明显降低(P <0. 05),SOD明显升高(P <0. 05)。结论:茵陈蒿汤合四逆散改善NAFLD伴Hcy患者的高同型半胱氨酸血症、肝功能、血脂以及氧化、炎症状态。
Objective: To investigate the clinical efficacy of Yinchenhao Tang combined with Sinisan( YCSN) on non-alcoholic fatty liver disease( NAFLD) with hyperhomocysteinemia( HHcy). Method: Totally 126 cases of NAFLD with HHcy in Beijing Shichahai Community Health Service Center were randomly divided into NAFLD control group,traditional Chinese medicine( TCM) group,and modern medicine group,with 42 cases in each group. The TCM group was treated with YCSN orally,the modern medicine group was treated with polyene phosphatidylcholine capsules and folic acid tablets,and the NAFLD control group was treated with placebo. The course of treatment was 3 months. The clinical efficiency,liver function,Hcy,blood lipid,oxidative inflammation index and symptom score in two groups were observed before and after treatment. Result: The total effective rate of the TCM group was 92. 86%,while that of the modern medicine group was 88. 10%. There was no significant difference in the clinical efficiency between the two groups. There was no difference in the indexes of groups before treatment. After treatment, alanine aminotransferase( ALT),aspartate aminotransferase( AST),Hcy,total cholesterol( TC),total triglyceride( TG),low-density lipoprotein( LDL),malondialdehyde( MDA),highsensitive C reactive protein( hs-CRP),serum creatinine( SCr),blood urea nitrogen( BUN),and symptom scores in the TCM group and the modern medicine group were significantly lower than those before the treatment( P <0. 05),and lower than those in the NAFLD control group( P < 0. 05); and high-density lipoprotein( HDL) and superoxidase dismutase( SOD) in the TCM group and the modern medicine group significantly increased( P <0. 05),and higher than those of NAFLD control group( P < 0. 05). Compared with the modern medicine group,ALT,Hcy,TC,TG,MDA,hs-CRP,and symptom scores in TCM group were significantly lower than those before the treatment( P < 0. 05),while SOD in the TCM group was significantly increased( P < 0. 05). Conclusion:YCSN can improve hyperhomocysteinemia,liver function,blood lipid,oxidation and inflammation in patients with NAFLD and HHcy.
Objective: To investigate the clinical efficacy of Yinchenhao Tang combined with Sinisan( YCSN) on non-alcoholic fatty liver disease( NAFLD) with hyperhomocysteinemia( HHcy). Method: Totally 126 cases of NAFLD with HHcy in Beijing Shichahai Community Health Service Center were randomly divided into NAFLD control group,traditional Chinese medicine( TCM) group,and modern medicine group,with 42 cases in each group. The TCM group was treated with YCSN orally,the modern medicine group was treated with polyene phosphatidylcholine capsules and folic acid tablets,and the NAFLD control group was treated with placebo. The course of treatment was 3 months. The clinical efficiency,liver function,Hcy,blood lipid,oxidative inflammation index and symptom score in two groups were observed before and after treatment. Result: The total effective rate of the TCM group was 92. 86%,while that of the modern medicine group was 88. 10%. There was no significant difference in the clinical efficiency between the two groups. There was no difference in the indexes of groups before treatment. After treatment, alanine aminotransferase( ALT),aspartate aminotransferase( AST),Hcy,total cholesterol( TC),total triglyceride( TG),low-density lipoprotein( LDL),malondialdehyde( MDA),highsensitive C reactive protein( hs-CRP),serum creatinine( SCr),blood urea nitrogen( BUN),and symptom scores in the TCM group and the modern medicine group were significantly lower than those before the treatment( P <0. 05),and lower than those in the NAFLD control group( P < 0. 05); and high-density lipoprotein( HDL) and superoxidase dismutase( SOD) in the TCM group and the modern medicine group significantly increased( P <0. 05),and higher than those of NAFLD control group( P < 0. 05). Compared with the modern medicine group,ALT,Hcy,TC,TG,MDA,hs-CRP,and symptom scores in TCM group were significantly lower than those before the treatment( P < 0. 05),while SOD in the TCM group was significantly increased( P < 0. 05). Conclusion:YCSN can improve hyperhomocysteinemia,liver function,blood lipid,oxidation and inflammation in patients with NAFLD and HHcy.
引文
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[12]贺晓芳,邓力军,季菲.疏肝清热祛湿法治疗非酒精性脂肪性肝病的临床观察[J].中国中西医结合消化杂志,2017,25(2):85-88.
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[17]张颖.高同型半胱氨酸血症在脑梗死氧化应激机制中的作用研究[J].现代诊断与治疗,2017,28(10):1851-1852.
[18]程雯,王华,陈淑雯,等. 2型糖尿病患者同型半胱氨酸水平与糖尿病肾病、胰岛素抵抗及糖脂代谢的关系探讨[J].上海预防医学,2016,28(2):125-128.
[19] DAI Y,ZHU J, MENG D, et al. Association of homocysteine level with biopsy-proven non-alcoholic fatty liver disease:a Meta-analysis[J]. J Clin Biochem Nutr,2016,58(1):76-83.
[20] Zviagintseva T D, HlushchenkoSV.Hyperhomocysteinemia-a predictor of inflammatory changes in the liver[J]. Lik Spra,2014,33(11):154-155.
[21] YANG H T,Lee M,Hong K S,et al. Efficacy of folic acid supplementation in cardiovascular disease prevention:an updated Meta-analysis of randomized controlled trials[J]. Eur J Intern Med,2012,23(8):745-754.
[22]穆杰,王庆国,王雪茜,等.论肝郁生痰为非酒精性脂肪肝病机[J].环球中医药,2017,10(1):34-36.
[23]黄立飞.浅谈中医对非酒精性脂肪肝病因病机的认识及辨证论治[J].中医临床研究,2017,9(9):88-90.
[24]陈一凡,孙会卓,罗慜婧,等.“茵陈-郁金”药对配伍对肝纤维化模型大鼠作用效果研究[J].贵阳中医学院学报,2018,40(2):13-15,26.
[25]张海燕,邬伟魁,李芳,等.栀子保肝利胆作用及其肝毒性研究[J].中国中药杂志,2011,36(19):2610-2614.
[26]张海虹,卫璐戈,李会芳.栀子苷对正常和黄疸模型大鼠的亚急性肝、肾毒性[J].中国实验方剂学杂志,2018,24(20):140-144.
[27]王雪芹,赵洋,汪新体,等.醋炙柴胡的化学成分及药理作用研究进展[J].药物评价研究,2018,41(1):163-168.
[28]尚立芝,王付,王琦,等.柴胡疏肝散对肝纤维化大鼠TGF-β1/Smad信号通路的影响[J].中国实验方剂学杂志,2015,21(12):125-128.
[2] Ofosu A,Ramai D,Reddy M. Non-alcoholic fatty liver disease:controlling an emerging epidemic,challenges,and future directions[J]. Ann Gastroenterol,2018,31(3):288-295.
[3]王源源,肖新华.高尿酸血症与非酒精性脂肪肝病相关性研究进展[J].临床与病理杂志,2017,37(10):2215-2219.
[4] Pervez M A,Khan D A,Ijaz A,et al. Effects of deltatocotrienol supplementation on liver enzymes,inflammation,oxidative stress and hepatic steatosis in patients with nonalcoholic fatty liver disease[J]. Turk J Gastroenterol,2018,29(2):170-176.
[5] Visram M, Radulovic M, Steiner S, et al.Homocysteine regulates fatty acid and lipid metabolism in yeast[J]. J Biol Chem,2018,293(15):5544-5555.
[6] XU Z B,WANG W D,ZHANF L F,et al. Yinxingye capsule intervened vascular endothelial cell apoptosis of hyperhomocysteinemia rats:an experimental study[J].Chin J Integr Trad West Med,2015,35(9):1099-104.
[7] Polyzos S A,Kountouras J,Patsiaoura K,et al. Serum homocysteine levels in patients with nonalcoholic fatty liver disease[J]. Ann Hepatol,2011,11(1):68-76.
[8]张夏,罗伟生,胡振斌,等.非酒精性脂肪肝中医药研究进展[J].辽宁中医药大学学报,2018,20(7):180-182.
[9]赵嘉晶,汪颖珏,朱永新,等.茵陈蒿汤加减方对非酒精性脂肪肝患者糖、脂及尿酸代谢的影响[J].四川中医,2018,36(3):112-114.
[10]范建高.中国非酒精性脂肪性肝病诊疗指南(2010年修订版)[J].中国医学前沿杂志:电子版,2012,4(7):4-10.
[11]张声生,李军祥.非酒精性脂肪性肝病中医诊疗专家共识意见(2017)[J].临床肝胆病杂志,2017,33(12):2270-2274.
[12]贺晓芳,邓力军,季菲.疏肝清热祛湿法治疗非酒精性脂肪性肝病的临床观察[J].中国中西医结合消化杂志,2017,25(2):85-88.
[13]赖小莲.基于脂肪衰减参数评价非酒精性单纯性脂肪肝中医体质的临床研究[D].福州:福建中医药大学,2017.
[14]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药卫生出版社,2002:383-385.
[15]周雨,张智伟,王京奇.从“二次打击”学说探讨中药防治非酒精性脂肪肝的研究进展[J].中医药导报,2017,23(18):109-111.
[16]刘瑞侠,黄有烨,胡红琳.肥胖症非酒精性脂肪肝病的发病机制研究进展[J].安徽医学,2017,38(4):512-516.
[17]张颖.高同型半胱氨酸血症在脑梗死氧化应激机制中的作用研究[J].现代诊断与治疗,2017,28(10):1851-1852.
[18]程雯,王华,陈淑雯,等. 2型糖尿病患者同型半胱氨酸水平与糖尿病肾病、胰岛素抵抗及糖脂代谢的关系探讨[J].上海预防医学,2016,28(2):125-128.
[19] DAI Y,ZHU J, MENG D, et al. Association of homocysteine level with biopsy-proven non-alcoholic fatty liver disease:a Meta-analysis[J]. J Clin Biochem Nutr,2016,58(1):76-83.
[20] Zviagintseva T D, HlushchenkoSV.Hyperhomocysteinemia-a predictor of inflammatory changes in the liver[J]. Lik Spra,2014,33(11):154-155.
[21] YANG H T,Lee M,Hong K S,et al. Efficacy of folic acid supplementation in cardiovascular disease prevention:an updated Meta-analysis of randomized controlled trials[J]. Eur J Intern Med,2012,23(8):745-754.
[22]穆杰,王庆国,王雪茜,等.论肝郁生痰为非酒精性脂肪肝病机[J].环球中医药,2017,10(1):34-36.
[23]黄立飞.浅谈中医对非酒精性脂肪肝病因病机的认识及辨证论治[J].中医临床研究,2017,9(9):88-90.
[24]陈一凡,孙会卓,罗慜婧,等.“茵陈-郁金”药对配伍对肝纤维化模型大鼠作用效果研究[J].贵阳中医学院学报,2018,40(2):13-15,26.
[25]张海燕,邬伟魁,李芳,等.栀子保肝利胆作用及其肝毒性研究[J].中国中药杂志,2011,36(19):2610-2614.
[26]张海虹,卫璐戈,李会芳.栀子苷对正常和黄疸模型大鼠的亚急性肝、肾毒性[J].中国实验方剂学杂志,2018,24(20):140-144.
[27]王雪芹,赵洋,汪新体,等.醋炙柴胡的化学成分及药理作用研究进展[J].药物评价研究,2018,41(1):163-168.
[28]尚立芝,王付,王琦,等.柴胡疏肝散对肝纤维化大鼠TGF-β1/Smad信号通路的影响[J].中国实验方剂学杂志,2015,21(12):125-128.