基于内毒素肠渗漏二次打击理论的健脾磨积汤联合西药治疗非酒精性脂肪性肝病的临床观察

The clinical observation of nonalcoholic fatty liver disease treated by “Jianpi Moji Decoction ”combined western medicine based on the theory of the endotoxin intestinal leakage about “second hit”

目的观察健脾磨积汤联合西药治疗非酒精性脂肪性肝病的临床疗效。方法将60例非酒精性脂肪性肝病患者随机分为对照组和治疗组,每组30例。对照组予多烯磷脂酰胆碱胶囊,治疗组在此基础上加用健脾磨积汤。两组疗程均为3个月,观察比较肝功能、血脂相关指标、内毒素及相关炎症因子(TNF-α、IL-6和IL-8)水平、中医证候积分的变化情况。结果 1治疗前后组内比较,治疗组ALT、GGT、TG水平差异有统计学意义(P<0.05),对照组ALT、TG水平差异有统计学意义(P<0.05);组间治疗后比较,ALT、TG水平差异有统计学意义(P<0.05)。2治疗前后组内比较,治疗组内毒素、TNF-α、IL-6及IL-8水平差异有统计学意义(P<0.05),对照组仅内毒素水平差异有统计学意义(P<0.05);组间治疗后比较,内毒素、TNF-α、IL-6及IL-8水平差异有统计学意义,治疗组改善程度明显优于对照组(P<0.05)。3治疗前后组内比较,治疗组胃脘胀满、胁肋疼痛、纳呆少食、倦怠乏力积分差异有统计学意义(P<0.05),对照组胃脘胀满及纳呆少食积分差异有统计学意义(P<0.05);组间治疗后比较,胃脘胀满、胁肋疼痛、纳呆少食、倦怠乏力积分差异有统计学意义,治疗组各症状积分的改善均优于对照组(P<0.05)。结论健脾磨积汤联合西药治疗非酒精性脂肪性肝病,可显著缓解临床症状,改善肝功能、降低血脂水平,其机制可能与减轻内毒素肠渗漏的"二次打击"有关。

Objective To observe the clinical curative effect of the treatment in nonalcoholic fatty liver disease treated with＂Jianpi Moji Decoction＂combined with western medicine. Methods 60 NAFLD cases were randomly divided into control group and treatment group,30 cases were in each group. Each case was given Essentiale,meanwhile the treatment group was given＂Jianpi Moji Decoction＂on the basis treatment,and both treated for 3 months. The changes of liver function,lipids profile,endotoxin and TNF-α,IL-6,IL-8 levels and TCM syndrome integral of two groups before and after treatment were observed. Results 1 Compared before and after treatment in each group,there was significant difference in levels of ALT,GGT and TG in treatment group（ P 0. 05） and ALT and TG level in the control group（ P 0. 05）. Compared between two groups after treatment,there was significant difference in levels of ALT and TG（ P 0. 05）. 2Compared beteeen the two groups before and after treatment,the endotoxin and TNF alpha,IL-6 and IL 8 level was significantly different in treatment group（ P 0. 05）,and endotoxin was significantly different in the control group（ P 0. 05）; Compared between two groups after treatment,endotoxin and TNF alpha,IL-6 and IL-8 level was significantly different and the treatment group was improved more significant than control group（ P 0. 05）. 3Compared before and after treatment in each group,the score of bilges full,side rib pain,stay,eat less,languid was significantly different in the treatment group（ P 0. 05）. Compare with two groups,and the syndrome was significantly improved in treatment group than that of control group（ P 0. 05）. Conclusion ＂Jianpi Moji Decoction＂combined with western medicine can significantly relieve the clinical symptoms,improve liver function,reduce the lipid profile level in treating nonalcoholic fatty liver disease,and the mechanism of‘Jian Pi Mo Ji＇＂Jianpi Moji Decoction＂may be related to reduce the leakage of endotoxin about the bowel＂second hit＂.