从痰论治非酒精性脂肪性肝炎痰瘀证对纤溶状态的影响

Effects of Resolving Phlegm Method on Fibrinolytic Status in Non-alcoholic Steatohepatitis Patients of Phlegm and Blood-stasis Syndrome

目的观察从痰论治非酒精性脂肪性肝炎(Non-alcoholic steatohepatitis,NASH)痰瘀证的临床疗效。方法62例NASH痰瘀证患者随机分为两组,治疗组34例,给予化痰利湿、舒肝利胆、活血化瘀中药(组成:青黛10g明矾3g草决明15g生山楂15g醋柴胡10g郁金10g丹参12g泽兰12g六一散15g)每日1剂,水煎分两次口服;对照组28例,予熊去氧胆酸片口服,每次150mg,每日3次。两组共治疗12周,并分别于治疗前后评价肝功能(ALT、AST、ALP)、胰岛素抵抗指标(HOMA-IR、Ins)、组织纤溶酶原激活物(t-PA)、1型纤溶酶原激活物抑制物(PAI-1)及主要症状、体征改善情况。结果(1)治疗组治疗后ALT、AST、HOMA-IR、t-PA、PAI-1及主要症状均较治疗前改善(P<0.05或P<0.01);(2)与对照组治疗后比较,ALP、HOMA-IR、t-PA、PAI-1差异有显著性(P<0.05或P<0.01);(3)熊去氧胆酸片对肝功能指标的改善以谷丙转氨酶、t-PA显著(P<0.01),HOMA-IR、Ins、PAI-1及症状亦有所改善。结论从痰论治NASH痰瘀证能有效改善肝功能及纤溶状态,且优于熊去氧胆酸片。

Objective To observe the effect of resolving phlegm method （RPM） on fibrinolytic status in non-alcoholic steatohepatitis （NASH） patients of phlegm blood-stasis （PBS） syndrome type. Methods Sixty- two patients were randomly assigned to 2 groups, namely the treated group （ n = 34） treated with Chinese herbs for resolving phlegm and dampness, smoothing liver and gallbladder, promoting blood circulation and removing blood stasis （composition： Indigo Naturalis 10 g, Alumen 3 g, Semen Cassiae 15 g, Fructus Crataegi 15 g, vinegar prepared Radix Bupleuri 10 g, Radix Curcumae 10 g, Radix Salviae Miltiorrhizae 12 g, Herba Lycopi 12 g, talc 12 g and Radix Glycyrrhizae 2 g）, one dose twice per day orally, and the control group （n = 28） with ursodeoxycholic acid tablet （UAT） 150 mg three times per day. The treatment course for both groups was 12 weeks. Liver function （ALT, AST, ALP）, insulin resistance （IR） index represented by homeostasis model-IR （HOMA-IR） and insulin （Ins）, levels of tissue plasminogen activator （t-PA） and plasminogen activator inhibitor-1 （PAI-1）, as well as main symptoms and physical signs were assessed before and after treatment. Resuits （1） Compared with those before treatment, levels of ALT, AST, HOMA-IR, t-PA, PAI-1 and main symptoms were all improved in the treated group （P 〈 0.05 or P 〈 0.01 ） ; （2） There was significant difference in ALP, HOMA-IR, t-PA and PAI-1 between the treated group and the control group （P 〈 0.05 or P 〈 0.01 ） ; （3） The improvement in liver function related indexes in the control group was mainly the level of ALT, t-PA （P〈0.01）, and also shown on HOMA-IR, Ins and PAI-1. Conclusion RPM could effectively improve liver function and fibrinolytic status. Its effect was better than that of UAT.