异甘草酸镁联合降脂治疗中、重度NASH的疗效及机制分析

Clinical effect of magnesium isoglycyrrhizinate on moderate and severe nonalcoholic steatohepatitis and its mechanism analyse

目的观察并分析异甘草酸镁联合降脂药物治疗中、重度非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)的疗效及机制。方法选取河北大学附属医院诊治的42例中、重度NASH患者为研究对象,按照随机原则分为实验组和对照组,对照组采用辛伐他汀降脂治疗,实验组在此基础上联合异甘草酸镁治疗,所有患者均治疗6周。记录治疗前后NASH分级、临床症状以及肝功能、血脂水平、电解质、肝纤维化指标的变化。结果所有患者均完成6周治疗,无脱失病例,治疗后肝区疼痛、乏力、腹胀、大便不畅等临床症状获得改善或消失。实验组中5例重度NASH降为中度,8例中度降为轻度,对照组仅3例重度降为中度,2组NASH分级变化具有统计学意义(P<0.05)。与治疗前比较,对照组、实验组天冬氨酸氨基转移酶(aspartate aminotransferase,AST),丙氨酸氨基转移酶(ALT),γ-谷氨酰转肽酶(γ-glutamyltranspetidase,γ-GT),血清总胆红素(total bilirubin,TBIL)均显著降低(P<0.05);组间比较,实验组上述肝功能指标均显著低于对照组(P<0.05)。2组患者甘油三脂(triglyceride,TG)及总胆固醇(total cholesterol,TC),低密度脂蛋白(low densith lipoprotein,LDL)水平显著降低(P<0.05),但组间比较差异不显著。实验组III型前胶原蛋白(procollagen III,PC III)、IV型胶原(collagen IV,IV-C)较治疗前显著降低(P<0.05),对照组无明显变化。结论异甘草酸镁联合降脂治疗可显著降低中、重度脂肪肝患者转氨酶,降低血脂水平,改善肝纤维化过程,而且治疗期间不良反应发生率较低。

Objective To observe the clinical effect of magnesium isoglycyrrhizinate on moderate and severe nonalcoholic steatohepatitis(NASH) and analyse its mechanism. Methods 42 cases with moderate and severe nonalcoholic steatohepatitis were selected in our study. All patients were divided into observation group and control group randomly. Control group were received simvastatin while the observation group were received simvastatin combined with magnesium isoglycyrrhizinate treatment. The course was 6 weeks.The changes of NASH classiifcation, clinical symptom, liver function, lipid levels and liver ifbrosis items in two groups before and after treatment were observed and recorded. Results All patients were received 6 week treatment, none of them dropped out. The clinical symptoms were improved in both two groups. There were 5 severe NASH improved to moderate NASH, 8 moderate NASH improved to mild NASH in observation group while only 3 severe NASH improved to moderate NASH in control group. The difference of NASH classiifcation between two groups was signiifcant(P<0.05). Compared to pre-treatment, the AST, ALT, TBIL,γ-GT were decreased in both two groups. But the liver function items in observation were lower than control group(P<0.05). The lipid level were decreased in both two group and there were no signiifcant differences between two groups after treatment. The level of PC III, HA, C-IV were decreased in observation group while had no changes in control group. Conclusion The magnesium isoglycyrrhizinate could decrease the AST, ALT and lipid level, improve the classiifcation of liver ifbrosis, and had low rate of side effect during treatment.