自拟疏肝健脾方对肝郁脾虚型非酒精性单纯性脂肪肝患者短链脂肪酸的影响

Effect of self-made Shugan Jianpi prescription on short chain fatty acids in patients with non-alcoholic fatty liver of stagnation of liver qi and spleen deficiency type

目的探讨自拟疏肝健脾方对肝郁脾虚型非酒精性单纯性脂肪肝(NAFL)患者短链脂肪酸(SCFA)的影响。方法选择2019年6月至2020年12月大连市第六人民医院收治的肝郁脾虚型NAFL患者120例,采用随机数字表法分为对照组和观察组,各60例。对照组给予常规西药治疗,观察组在对照组治疗的基础上联合给予自拟疏肝健脾方治疗,2组均治疗3个月,并进行临床疗效评价。比较2组治疗前后的中医症候评分、脂肪衰减指数(CAP)、内脏脂肪面积(VFA)、血脂指标、肝功能指标及不良反应情况。应用气相色谱仪检测2组SCFA水平并比较。结果观察组临床总有效率高于对照组,差异有统计学意义(91.67%vs71.67%,P<0.05)。2组治疗后中医症候评分、CAP、VFA,以及血清TC、TG、LDL-C、AST、ALT、GGT水平均较治疗前降低(P均<0.05),血清HDL-C水平较治疗前升高(P<0.05),同时观察组治疗后上述指标的改善均优于对照组(P均<0.05)。2组治疗后乙酸水平较治疗前明显升高(P<0.05),异戊酸水平较治疗前明显降低(P<0.05),且观察组治疗后乙酸、异戊酸水平的改善均优于对照组(P<0.05)。治疗期间,2组不良反应发生率差异无统计学意义(8.33%vs6.67%,P>0.05)。结论在西药治疗的基础上,疏肝健脾方治疗肝郁脾虚型NAFL的临床疗效明显,有助于缓解临床症状,改善血脂水平及肝功能,作用机制可能与改善肠道SCFA水平有关。

ObjectiveTo explore the effect of self-made Shugan Jianpi prescription on short-chain fatty acids(SCFAs)in patients with non-alcoholic fatty liver(NAFL)of stagnation of liver qi and spleen deficiency type.MethodsOne hundred and twenty patients with NAFL of stagnation of liver qi and spleen deficiency type treated at Dalian Sixth People's Hospital from June 2019 to December 2020 were selected.Using the random number table method,the patients were randomly divided into a control group and an observation group,with 60 cases in each group.Both groups were treated with conventional Western medicine,and the observation group was additionally given self-made Shugan Jianpi prescription.All patients were treated for 3 months,and the clinical curative effect was compared between the two groups.Traditional Chinese medicine(TCM)symptom score,controlled attenuation parameter(CAP),visceral fat area(VFA),blood lipid index,liver function index,and adverse reactions were compared between the two groups before and after treatment.The levels of SCFAs in the two groups were detected by gas chromatograph and compared.ResultsThe total clinical effective rate in the observation group was significantly higher than that of the control group(91.67%vs71.67%,P<0.05).After treatment,the TCM symptom score,CAP,VFA,and serum TC,TG,LDL-C,AST,ALT,and GGT in both groups were significantly lower than those before treatment(P<0.05),and serum HDL-C was significantly higher(P<0.05);the improvement of these indexes in the observation group after treatment was significantly better than that in the control group(P<0.05).After treatment,acetic acid levels in the two groups were higher than those before treatment(P<0.05),while isovaleric acid levels were lower(P<0.05);the improvement of these indexes in the observation group after treatment was significantly better than that of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(8.33%vs6.67%,P>0.05).ConclusionOn the basis of Western medicine treatment,Shugan Jianpi prescription has obvious clinical effects in the treatment of NAFL of stagnation of liver qi and spleen deficiency type,which is helpful to alleviate clinical symptoms and improve blood lipid levels and liver function.The mechanism may be related to the improvement of intestinal SCFA level.