皂术茵陈方治疗非酒精性脂肪性肝炎的临床观察及其对肠道菌群的影响

Effect of Zaozhu Yinchen Recipe on Intestinal Flora in Treatment of Nonalcoholic Steatohepatitis

目的评价皂术茵陈方调节肠道菌群治疗非酒精性脂肪性肝炎(NASH)的临床疗效及其作用机制。方法选取福建中医药大学附属厦门市中医院肝病中心门诊就诊的NASH患者80例,采用随机数字表法分为治疗组(40例)和对照组(40例)。治疗组予中药皂术茵陈方治疗,对照组予以枯草杆菌二联活菌肠溶胶囊治疗,两组疗程均为12周。评价治疗前后两组患者的症状、体征积分以及血清ALT、AST活性;检测两组患者血清内毒素水平以及肠道菌群变化。结果治疗12周后,治疗组的临床总有效率达87.5%(35/40),较之对照组的65%(26/40)有统计学意义(χ~2=7.966,P<0.05);两组患者ALT、AST活性以及血清内毒素水平较治疗前均有明显下降(P<0.05),且以治疗组的ALT、AST活性下降值大于对照组(t=2.254,t=2.325,P<0.05);两组患者肠道菌群中的双歧杆菌、乳酸杆菌、拟杆菌数量较治疗前显著升高,而肠球菌、肠杆菌显著降低(P<0.05)。结论皂术茵陈方具有改善肝功能、治疗NASH的临床疗效,其作用机制与调节肠道菌群紊乱、恢复肠道微生态平衡、减轻肠源性内毒素血症相关。

Objective To evaluate the clinical efficacy and mechanism of Zaozhu Yinchen Recipe（ ZZYCR） in treatment of nonalcoholic steatohepatitis（ NASH） by regulating intestinal microflora. Methods Eighty NASH patients were recruited from Center for Liver Diseases,Xiamen Hospital of Traditional Chinese Medicine,Fujian University of Traditional Chinese Medicine. They were assigned to the treatment group and the control group by random number table,40 cases in each group. Patients in the treatment group took ZZYCR,while those in the control group took live combined Bacillus Subtilis and Enterococcus Faecium Enteric-coated Capsule. The therapeutic course for all was 12 weeks. Their symptoms and scores for signs were evaluated before and after treatment. Activities of alanine aminotransferase（ ALT） and aspartate aminotransferase（ AST） were detected in the two groups before and after treatment. Serum endotoxin levels and intestinal flora changes were measured in both groups. Results The total effective rate was 87. 5%（ 35/40） after 12 weeks treatment in the treatment group,significantly higher than that in the control group [65%（ 26/40）,χ^2= 7. 966,P 〈 0. 05） ]. The decrements of ALT and AST activities were significantly higher in the treatment group than in the control group（t = 2. 254,t = 2. 325,P 〈 0. 05）. In the two groups,the numbers of Bacillus bifidus,Bacillus lacticus,and Bacteroides significantly increased more,and enterococcus and Enterobacteria decreased more in the intestinal flora in the two groups after treatment than before treatment（P 〈 0. 05）. Conclusions ZZYCR had the effect of improving liver function. Its mechanism might be closely related to correcting intestinal flora disturbance,restoring intestinal microecological balance,and reducing intestinal endotoxemia.