血脂康对非酒精性脂肪性肝病合并颈动脉粥样硬化各中医证型的干预影响

Effect of Xuezhikang Capsule in Intervening Different Chinese Medical Syndrome Patterns of Non-alcoholic Fatty Liver Disease Complicated with Carotid Atherosclerosis

目的探讨血脂康对非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)合并颈动脉粥样硬化(carotid atherosclerosis,CAS)不同中医证型血脂水平的干预影响,找出血脂康治疗NAFLD合并CAS的最有效中医证型,指导其辨证用药。方法对符合诊断的74例NAFLD合并CAS患者进行中医辨证分型,分为4组:脾虚痰湿证组(34例)、湿热内蕴证组(24例)、痰瘀互结证组(12例)和肝肾阴虚证组(4例,样本数太少,未纳入统计分析)。前3组患者均接受血脂康治疗3个月。检测血脂康干预前后各证型组的血脂[甘油三酯(triglyceride,TG)、总胆固醇(total cholestero,l TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholestero,lLDL-C)]、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor,TNF-α)等指标,并进行组内干预前后及组间的比较。结果 (1)脾虚痰湿证组总体疗效优于湿热内蕴证组及痰瘀互结证组(P<0.01),总有效率分别为97.06%、91.67%、91.67%;(2)各证型组的血脂(TG、TC、LDL-C)、hs-CRP、TNF-α较治疗前均明显降低(P<0.01);(3)治疗后,TG降低幅度3组间比较差异无统计学意义(P>0.05),但其他指标降低幅度均为脾虚痰湿证组大于其他两组,差异有统计学意义(P<0.05,P<0.01)。结论血脂康可降低NAFLD合并CAS患者脾虚痰湿证、湿热内蕴证、痰瘀互结证的血脂、hs-CRP、TNF-α水平,其中脾虚痰湿证可能是血脂康治疗的最有效中医证型。

Objective To observe the intervening effects of Xuezhikang Capsule （XZK） on levels of blood lipid and other related indices in patients with different Chinese medical syndrome patterns of non-alcoholic fatty liver disease complicated carotid atherosclerosis （NAFLD-CAS）,and to seek out the most appropriate pattern to indicate XZK for making guidance of its utilization. Methods Chinese medical syndrome in 74 patients of NAFLD-CAS were classified into 4 patterns,34 of Pi-deficiency phlegm-dampness pattern （A）,24 of dampness-heat accumulation pattern （B）,12 of phlegm-stasis intertwined pattern （C）,and 4 of Gan-Shen yin-deficiency pattern （D）. Excepting those of pattern D were excluded due to too small samples,all patients were treated with XZK for 3 months. Blood levels of blood lipids,including triglyceride （TG）,total cholesterol （TC）,and low-density lipoprotein cholesterol （LDL-C）,as well as high-sensitivity C-reactive protein （hs-CRP）,and tumor necrosis factor α （TNF-α） were detected and compared before and after treatment. Results The effective rate of XZK on patients of the three patterns,in A-C order,was 97.06%,91.67%,91.67%,respectively,with the optimal overall efficacy showed on pattern A. All the indices detected significantly decreased after treatment in all three patterns （P0.01）,among them,excepting the difference of TG level between groups showed no significance （P0.05）,the decrements of others were more significant in pattern A than in other two patterns （P0.05 or P0.01）. Conclusion XZK could reduce the levels of blood lipids,hs-CRP and TNF-α in NAFLD-CAS patients,and the Pi-deficiency phlegm-dampness syndrome pattern was the optimal indication of XZK treatment.