四生降脂疏肝汤治疗痰湿内阻型非酒精性脂肪性肝病的临床观察

Clinical observation of Sisheng-jiangzhi-shugan decoction on NAFLD of phlegm-wet resistance type

目的观察四生降脂疏肝汤治疗痰湿内阻型非酒精性脂肪性肝病(NAFLD)的临床疗效。方法将60例痰湿内阻型NAFLD患者应用基础治疗加四生降脂疏肝汤治疗,连续治疗3个月。观察中医临床症状及体征改善情况;测量患者身高、体质量和腰臀围,计算体质量指数(BMI)、腰围/臀围(WHR);测定血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]指标,检测空腹血糖(FPG)及空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR);测定肝功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(γ-GT)]、肾功能[肌酐(Cr)]指标;观察中医证候疗效和临床疗效。结果经四生降脂疏肝汤治疗后,患者临床症状及体征有不同程度的改善,其中以大便黏滞不爽、右胁肋胀闷、食欲不振症状改善最显著。治疗后1、3个月WHR较治疗前降低,治疗后3个月WHR较治疗后1个月降低明显(P<0.01)。治疗后1、3个月TC、TG、LDL-C、HOMA-IR均较治疗前降低(P<0.05,P<0.01),HDL-C较治疗前升高(P<0.01);治疗后3个月TC、TG、LDL-C、HOMA-IR均较治疗后1个月降低明显(P<0.05,P<0.01),HDL-C较治疗后1个月升高明显(P<0.01)。本组中医证候总有效率92.9%,临床总有效率87.5%。结论四生降脂疏肝汤可改善痰湿内阻型NAFLD患者的临床症状,促进脂质代谢。

Objective To observe the clinical effect of Sisheng - jiangzhi - shugan decoction on the treat- ment of nonalcoholic fatty liver disease （NAFLD） of phlegm - wet resistance type. Methods 60 NAFLD patients with phlegm - wet resistance type were treated by Sisheng - jiangzhi - shugan decoction on the basis of basic treatment, continuously treatment for 3 months. The height, body mass, waist and hip circumference were measured, body mass index （BMI） and waist circumference/hip circumference ratio （WHR） were calculated. The blood lipid indexes including total cholesterol （TC） , triglycerides （TG）, low density hpoprotein （LDL- C）, high- density lipoprbtein cholesterol （ HDL - C） were detected. The fasting plasma glucose （FPG） and fasting insulin （FINS） were detected, and the homeostasis model assessment insulin resistance index （ HOMA - IR） was calculated. The liver function including alanine aminotransferase （ ALT）, aspartic aminotransferase （AST） and γ - glutamamide transferase （ γ - GT） and the creatinine （Cr） of Kidney function were detected. Results After treatment with Sisheng -jiangzhi - shugan decoction, the clinical symptoms and signs were improved with different degree of the majority patients. The fecal viscous, swell and stuffy of the right rib and loss of appetite had most significant improvements. The WHR after 1,3 months treatment were reduced, and which after 3 months treatment was lower than that after 1 month treatment （P 〈0.01）. The TC, TG, LDL -C and IOMA -IR after 1 and 3 months treatment were reduced （ P 〈 0. 05, P 〈 0.01）, and the HDL - C was increased （P 〈 0.01）. The TC, TG, LDL - C and HOMA - IR after 3 months treatment were lower than that after 1 month treatment （P 〈 0.05, P 〈 0.01 ）, and the HDL- C was higher（ P 〈 0.01 ）. The total effective rate was 87, 5%. Conclusion Sisheng - jiangzhi - shugan decoction canimprove the clinical symptoms and promote lipid metabolism on the treatment of NAFLD Of phlegm - wet resistance type.