水飞蓟素联合二甲双胍治疗肥胖型非酒精性脂肪肝的临床研究

Clinical effect of silymarin combined with metformin on obese patients with nonalcoholic fatty liver disease

目的分析水飞蓟素联合二甲双胍治疗肥胖型非酒精性脂肪肝的作用.方法肥胖型非酒精性脂肪肝患者48例,分为两组,试验组24例给予水飞蓟素联合二甲双胍治疗;对照组24例服用水飞蓟素及维生素C片治疗,疗程均为4～6月.治疗前后测定各组患者血清转氨酶(ALT、AST)、血脂(TG、TC、LDL-C及HDL-C)、血清TNFα、胰岛素抵抗指数(IRI)及肝/脾CT比值,同时观察不良反应.结果治疗后两组患者血清ALT均明显降低,其中尤以试验组降低明显(P＜0.01);试验组患者治疗后各项血脂水平均显著改善;试验组胰岛素抵抗指数于治疗后明显下降(P＜0.05),而对照组无明显改变(P＞0.05);两组患者治疗后血清TNFα均明显下降,尤以试验组下降明显(P＜0.01);同时试验组治疗后肝/脾CT比值显著升高(P＜0.01).用药期间两组患者均未出现显著不良反应.结论水飞蓟素联合二甲双胍对肥胖型非酒精性脂肪肝有显著疗效且用药安全.

Objective To assess the therapeutic effect of silymarin combined with metformin on obese patients with non-alcoholic fatty liver disease, Methods 48 obese patients with non-alcoholic fatty liver disease were randomly divided into experiment group treated with silymarin combined with meffonnin （n = 24） and control group treated with silymarin combined with vitamin c （n= 24） respectively for consecutive 4-6 months. Serum transaminase levels, triglyceride, cholesterol, TNF-alpha, insulin resistance index（IRI） and liver/spleen CF ratio were detected pre- and post-treatment, respectively. Side-effect was also observed during the experiment. Results The levels of serum ALT both in experiment group and control group was obviously reduced at the end point compared with the baseline, especially in the former group（ P 〈 0.01 ）; the disturbance of TG ,TC ,LDL-C and HDL-C were all markedly ameliorated in exeriment group compared with control group after treatment. The level of IRI in experiment group was significantly decreased at the end point compared with the baseline（ P 〈 0.05） ,while the change was not obvious in control group（ P 〉 0.05） ; The levels of serum TNFα in experiment group and control group was all obviously reduced at the end point compared with the baseline （P 〈 0.01 or P 〈 0.05）, meanwhile, liver/spleen CF ratio in experiment group was obviously increased after treatment（ P 〈 0.01 ）, and no severe side-effects occurred during the experiment. Conclusion Silymarin combined with mefformin is an effective and safe remedy for obese patients with non-alcoholic fatty liver disease.