皂术茵陈方治疗非酒精性脂肪性肝炎的临床观察
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摘要
目的通过评价皂术茵陈方调节非酒精性脂肪性肝炎(NASH)的氧化应激状态,探讨其抗NASH的作用机制。方法选取经肝活检证实为NASH患者的90例,采用随机数字表法分为治疗组和对照组各45例。治疗组予中药皂术茵陈方治疗,对照组予以维生素E治疗,两组均治疗12周。评价治疗前后两组患者的中医证候疗效、生化指标疗效、肝脏脂肪含量测定疗效;检测两组患者治疗前后血清空腹血糖(FBG)、空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)及丙二醛(MDA)含量变化。结果治疗12周后,治疗组的中医证候疗效、血生化指标疗效、肝脏脂肪含量测定疗效总有效率分别为88.89%(40/45)、77.78%(35/45)、71.11%(32/45),对照组分别为64.44%(29/45)、51.11%(23/45)、46.67%(21/45),差异均有统计学意义(P<0.05);两组治疗后血清FBG、FINS及HOMA-IR均较治疗前显著降低(P<0.05),且以治疗组下降明显(P<0.05);两组治疗后血清SOD、GSH-Px水平均较治疗前显著升高(P<0.05),MDA水平较治疗前显著下降(P<0.05),且以治疗组改变明显(P<0.05)。结论皂术茵陈方可通过调节NASH患者的胰岛素抵抗及氧化应激状态治疗NASH。
Objective To observe the mechanism of Zaozhu Yinchen Recipe(ZZYCR) for regulating non-alcoholic steatohepatitis(NASH) in oxidative stress state. Methods Ninety NASH patients confirmed by liver biopsy were assigned to the treatment group and the control group by random digit table, 45 in each group. Patients in the treatment group took ZZYCR, while those in the control group took vitamin E. The therapeutic course for all was 12 weeks. The curative effect of TCM syndrome, biochemical indices, and liver fat contents were evaluated in both groups before and after treatment. Levels of serum fasting blood glucose(FBG) and fasting insulin(FINS), insulin resistance index(HOMA-IR), contents of superoxide dismutase(SOD), glutathione peroxidase(GSH-Px) and malondialdehyde(MDA) were measured in both groups before and after treatment. Results After 12 weeks of treatment, the total effective rates of TCM syndromes, blood biochemical indices, and liver fat content in the treatment group were 88.89%(40/45), 77.78%(35/45), and 71.11%(32/45), respectively, showing statistical difference as compared with the control group [64.44%(29/45), 51.11%(23/45), 46.67%(21/45); P<0.05]. The levels of serum FBG and FINS, and HOMA-IR in both groups were significantly lower after treatment than before treatment(P<0. 05), and more significantly seen in the treatment group(P<0.05). After treatment serum levels of SOD and GSH-Px were significantly higher in both groups(P<0.05). The level of MDA was significantly lower in the two groups after treatment than before treatment(P<0. 05), and more significantly in the treatment group(P<0. 05). Conclusion ZZYCR treated NASH patients by regulating insulin resistance and oxidative stress.
Objective To observe the mechanism of Zaozhu Yinchen Recipe(ZZYCR) for regulating non-alcoholic steatohepatitis(NASH) in oxidative stress state. Methods Ninety NASH patients confirmed by liver biopsy were assigned to the treatment group and the control group by random digit table, 45 in each group. Patients in the treatment group took ZZYCR, while those in the control group took vitamin E. The therapeutic course for all was 12 weeks. The curative effect of TCM syndrome, biochemical indices, and liver fat contents were evaluated in both groups before and after treatment. Levels of serum fasting blood glucose(FBG) and fasting insulin(FINS), insulin resistance index(HOMA-IR), contents of superoxide dismutase(SOD), glutathione peroxidase(GSH-Px) and malondialdehyde(MDA) were measured in both groups before and after treatment. Results After 12 weeks of treatment, the total effective rates of TCM syndromes, blood biochemical indices, and liver fat content in the treatment group were 88.89%(40/45), 77.78%(35/45), and 71.11%(32/45), respectively, showing statistical difference as compared with the control group [64.44%(29/45), 51.11%(23/45), 46.67%(21/45); P<0.05]. The levels of serum FBG and FINS, and HOMA-IR in both groups were significantly lower after treatment than before treatment(P<0. 05), and more significantly seen in the treatment group(P<0.05). After treatment serum levels of SOD and GSH-Px were significantly higher in both groups(P<0.05). The level of MDA was significantly lower in the two groups after treatment than before treatment(P<0. 05), and more significantly in the treatment group(P<0. 05). Conclusion ZZYCR treated NASH patients by regulating insulin resistance and oxidative stress.
引文
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[7] 邓银芝,黄铁军,张明哲,等.非酒精性脂肪肝病患者血清PTX3 水平与胰岛素抵抗以及氧化应激相关分析[J].中国肝脏病杂志(电子版),2015,7(2) :101-105.
[8] Sanyal AJ,Chalasani N,Kowdley KV,et al.Pioglitazone,vitamin E,or placebo for nonalcoholic steatohepatitis[J].N Engl J Med,2010,362(18):1675-1685.
[9] 唐金模,梁惠卿,王宏国,等.皂术茵陈方治疗非酒精性脂肪肝性肝炎的临床疗效及对游离脂肪酸及肿瘤坏死因子α的影响[J].中国中西医结合杂志,2016,36(5):544-548.
[10] Chen SD,Li J,Zhou HH,et al.Study on effects of Zhizi (Fructus gardeniae) on non-alcoholic fatty liver disease in the rat[J].J Tradit Chin Med,2012,32(1):82-86.
[2] Cholankeril G,Patel R,Khurana S,et al.Hepatocellular carcinoma in non-alcoholic steatohepatitis:Current knowledge and implications for management[J].World J Hepatol,2017,9(11):533-543.
[3] Berlanga A,Guiu-Jurado E,Porras JA,et al.Molecular pathways in non-alcoholic fatty liver disease[J].Clin Exp Gastroenterol,2014,7:221-239.
[4] 陈少东,杨嘉恩,王宏国,等.皂术茵陈方治疗非酒精性脂肪性肝炎40例临床研究[J].中医药通报,2015,14(1):46-48.
[5] 中国中西医结合学会消化系统疾病专业委员会.非酒精性脂肪性肝病的中西医结合诊疗共识意见[J].中国中西医结合杂志,2011,31(2):155-158.
[6] Mattews DR,Hosker JP,Rudenski AS,et al.Homeostasis model assessment:insulin resistance and beta-cell function form fasting plasma,glucose and insulin concentrations in men[J].Diabetologia,1985,28(7) :412-419.
[7] 邓银芝,黄铁军,张明哲,等.非酒精性脂肪肝病患者血清PTX3 水平与胰岛素抵抗以及氧化应激相关分析[J].中国肝脏病杂志(电子版),2015,7(2) :101-105.
[8] Sanyal AJ,Chalasani N,Kowdley KV,et al.Pioglitazone,vitamin E,or placebo for nonalcoholic steatohepatitis[J].N Engl J Med,2010,362(18):1675-1685.
[9] 唐金模,梁惠卿,王宏国,等.皂术茵陈方治疗非酒精性脂肪肝性肝炎的临床疗效及对游离脂肪酸及肿瘤坏死因子α的影响[J].中国中西医结合杂志,2016,36(5):544-548.
[10] Chen SD,Li J,Zhou HH,et al.Study on effects of Zhizi (Fructus gardeniae) on non-alcoholic fatty liver disease in the rat[J].J Tradit Chin Med,2012,32(1):82-86.