辛伐他汀治疗非酒精性脂肪性肝病患者的效果与血脂动态变化的观察

Efficacy of Simvastatin in the treatment of nonalcoholic fatty liver disease and observation on changes of blood lipid

目的探讨不同剂量的辛伐他汀治疗非酒精性脂肪性肝病(NAFLD)的效果及其与血脂水平变化的关系。方法将120例NAFLD患者随机分为大剂量组(辛伐他汀40 mg/d)、小剂量组(辛伐他汀10 mg/d)和对照组,每组40例。在治疗前和治疗6个月后分别检测血脂、肝功能和肝脏B超,比较各组血脂变化和疗效差异。结果治疗前三组总胆固醇(TC)、三酰甘油(TG)水平差异均无统计学意义(均P>0.05)。治疗后各组TC、TG水平[大剂量组:(3.27±0.65)、(2.45±0.63)mmol/L;小剂量组:(4.42±0.87)、(3.32±0.72)mmol/L;对照组:(5.60±0.93)、(3.51±1.36)mmol/L]均较治疗前[大剂量组:(6.78±1.13)、(4.90±1.77)mmol/L;小剂量组:(6.49±1.06)、(4.88±1.64)mmol/L;对照组:(6.83±1.24)、(4.93±1.80)mmol/L]显著降低(均P<0.05)。治疗后除小剂量组TG与对照组TG差异无统计学意义(P>0.05)外,各组间TC、TG比较差异均有统计学意义(均P<0.05),且在大剂量组、小剂量组、对照组依次升高。大剂量组、小剂量组和对照组有效率分别为90.00%(36/40)、82.50%(33/40)和60.00%(24/40),大剂量组和小剂量组疗效比较,差异无统计学意义(P>0.05),但两组疗效与对照组比较差异均有统计学意义(均P<0.05)。结论辛伐他汀能通过降低血脂水平,从而有效改善肝细胞功能,缓解NSFLD临床症状。但增加辛伐他汀剂量并不能进一步提高疗效。

Objective To explore the efficacy of different doses of Simvastatin in the treatment of nonalcoholic fatty liver dis- ease （NAFLD） and its relationship with changes of blood lipid level. Methods 120 patients with NAFLD were randomly divid- ed into high dose group （Simvastatin 40 mg/d）, small dose group （Simvastatin 10 mg/d） and control group, each group had 40 cases. Blood lipid, liver function and liver B-mode ultrasonography were detected before treatment and 6 months after treat- ment, and the serum lipid changes and the curative effect were analyzed. Results Before treatment, the total cholesterol （TC）, triglyceride （TG） were not significantly different among three groups （/9 〉 0.05）. After treatment, the TC, TG [high dose group： （3.27±0.65）, （2.45±0.63） mmol/L; small dose group： （4.42±0.87）, （3.32±0.72） mmol/L; control group： （5.60±0.93）, （3.51±1.36） mmol/L] were significantly lower than before [high dose group： （6.78±1.13）, （4.90±1.77） mmol/I4 small dose group： （6.49±1.06）, （4.88±1.64） retool/L; control group （6.83±1.24）, （4.93±1.80） mmol/L], the differences were significant （all P 〈 0.05）. Except for TG had no statistical difference between the small dose group and the control group after treatment （P 〉 0.05）, the TC, TG levels were significant different among three groups （all P 〈 0.05）, and the levels ordinal increased in high dose group, small dose group and control group. The effective power in high dose group, low dose group and control group was 90.00% （36/40）, 82.50% 03/40） and 60.00% （24/40） respectively, which had no significant difference between high dose group and small dose group （P 〉 0.05）, but those in the two groups were higher than those in the control group （all P 〈 0.05）. Conclusion Simvas- tatin can decrease the blood lipid levels, improve liver function, and relieve the clinical symptoms of NSFLD effectively. But there is no further improved efficacy by increasing dose of Simvastatin.