苦黄颗粒治疗湿热蕴结型非酒精性脂肪性肝病临床研究

Clinical Study on the Treatment of Non-alcoholic Fatty Liver Disease with Dampness-Heat Accumulation Syndrome with Kuhuang Granules

目的:观察苦黄颗粒治疗湿热蕴结型非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)的临床疗效。方法:将62例NAFLD患者按照随机数字表法分为对照组和治疗组,每组各31例。对照组给予多烯磷脂酰胆碱治疗,治疗组在对照组治疗的基础上加用苦黄颗粒。测定两组患者治疗前后肝脏受控衰减指数(controlled attenuation parameter,CAP)及肝脏硬度值(liver stiffness measurement,LSM);比较两组患者治疗前后中医证候积分、血脂[高密度脂蛋白(high density lipoprotein cholesterol,HDL)、三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)]及肝功能[(丙氨酸转氨酶(alanine transaminase,ALT)、天冬氨酸转氨酶(aspartateaminotransferase,AST)、γ-谷氨酰转肽酶(γ glutamyltranspeptidase,GGT)]变化情况。比较两组患者临床疗效、肝脏脂肪定量疗效及腹部彩超测定肝脏脂肪疗效。结果:(1)磁共振肝脏脂肪定量疗效:治疗组有效率为95.00%,显著高于对照组的84.00%,差异具有统计学意义(P<0.05)。(2)腹部彩超测定肝脏脂肪疗效:治疗组有效率为93.50%,高于对照组的77.40%,差异具有统计学意义(P<0.05)。(3)临床疗效:治疗组有效率为90.32%,高于对照组的61.29%,差异具有统计学意义(P<0.05)。(4)两组患者治疗后CAP值低于本组治疗前,且治疗后治疗组低于对照组(P<0.05)。(5)两组患者治疗后AST、ALT、GGT低于本组治疗前,且治疗后治疗组低于对照组(P<0.05)。(6)两组患者治疗后TC低于本组治疗前,且治疗后治疗组低于对照组,差异具有统计学意义(P<0.05);两组患者TG及HDL比较,差异无统计学意义(P>0.05)。(7)两组患者治疗后LSM值小于本组治疗前,差异具有统计学意义(P<0.01),但治疗后组间比较,差异无统计学意义(P>0.05)。(8)两组患者治疗后周身困重、脘腹胀满或疼痛、大便黏滞不爽、口干口苦等中医证候积分比较,差异具有统计学意义(P<0.05)。结论:苦黄颗粒治疗湿热蕴结型NAFLD,可减轻肝脏脂肪含量,改善肝功能,降低血脂水平,且能有效缓解临床症状。

Objective:To observe the clinical efficacy of Kuhuang Granules on non-alcoholic fatty liver disease(NAFLD) with damp-heat accumulation syndrome.Methods:A total of 62 NAFLD patients were randomly divided into the control group and the treatment group,with 31 cases in each group.The control group received polyene phosphatidylcholine treatment,while the treatment group received Kuhuang Granules in addition to the control group′s treatment.The controlled attenuation parameter(CAP) and liver stiffness measurement(LSM) were measured before and after treatment in both groups.The changes in TCM syndrome scores,blood lipids [including high density lipoprotein cholesterol(HDL),triacylglycerol(TG),total cholesterol(TC)],and liver function [including alanine transaminase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptidase(GGT)] were compared before and after treatment.The clinical efficacy,quantitative liver fat efficacy,and liver fat efficacy measured by abdominal ultrasound were compared between the two groups.Results:(1) Quantitative liver fat efficacy:The effective rate of the treatment group was 95.00%,which was significantly higher than 84.00% of the control group,with a statistically significant difference(P<0.05).(2) Liver fat efficacy measured by abdominal ultrasound:The effective rate of the treatment group was 93.50%,which was higher than 77.40% of the control group,with a statistically significant difference(P<0.05).(3) Clinical efficacy:The effective rate of the treatment group was 90.32%,which was higher than 61.29% of the control group,with a statistically significant difference(P<0.05).(4) After treatment,the CAP values in both groups were lower than those before treatment,and the treatment group had lower values than the control group(P<0.05).(5) After treatment,AST,ALT,and GGT in both groups were lower than those before treatment,and the treatment group had lower values than the control group(P<0.05).(6) After treatment,TC in both groups was lower than that before treatment,and the treatment group had lower values than the control group,with a statistically significant difference(P<0.05);there were no statistically significant differences in TG and HDL between the two groups(P>0.05).(7) After treatment,LSM values in both groups were lower than those before treatment,with a statistically significant difference(P<0.01),but there was no statistically significant difference between the groups after treatment(P>0.05).(8) After treatment,there were statistically significant differences in symptoms such as general heaviness,abdominal distension or pain,sticky stools,jaundice,and dry mouth and bitter taste between the two groups(P<0.05).Conclusion:Kuhuang Granules can reduce liver fat content,improve liver function,lower blood lipid levels,and effectively alleviate clinical symptoms in the treatment of NAFLD with dampness-heat accumulation syndrome.