小檗碱对非酒精性脂肪性肝病患者血清骨钙素的影响

Effect of berberine on serum osteocalcin in patients with non-alcoholic fatty liver disease

目的:探讨小檗碱对伴糖代谢紊乱的非酒精性脂肪性肝病(NAFLD)患者的血清未羧化骨钙素(ucOC)水平的影响。方法:对伴有糖耐量受损或2型糖尿病的114例NAFLD患者,进行生活方式干预,其中57例(小檗碱组)加小檗碱治疗(0.5 g/次,每日3次),共干预16周,其余57例仅进行生活方式干预,作为对照组。评价干预前后患者ucOC水平变化及血糖、血脂和肝脏脂肪含量(HFC)等指标,分析ucOC变化的影响因素。结果:与对照组相比,小檗碱组患者血清ucOC水平升高更明显(P<0.001)。校正年龄、性别和体质指数(BMI)后,小檗碱组血清ucOC的改善情况[4.60(3.50,5.70)]仍明显优于对照组[0.96(-0.14,2.05),P<0.001],平均差异为3.64(95%CI 1.74~5.55)。亚组分析显示,在非肥胖老年男性患者中,小檗碱升高ucOC的作用更加明显。偏相关分析显示,在校正年龄、性别后,治疗前后血清ucOC水平差值与BMI、体质量、腰围、HFC、糖化血红蛋白(HbA1c)、总胆固醇(TC)的差值负相关(P<0.05)。结论:小檗碱能改善伴糖代谢紊乱的非酒精性脂肪性肝病患者代谢异常,可能与其升高血清ucOC水平有关。

Objective:To investigate the effect of berberine on the serum uncarboxylated osteocalcin(ucOC)in non-alcoholic fatty liver disease(NAFLD)patients with impaired glucose metabolism.Methods:A total of 114 NAFLD patients with impaired glucose tolerance or type 2 diabetes mellitus were treated with lifestyle intervention.Among whom,57 patients received berberine treatment with 0.5 g every time and 3 times a day.The intervention continued for 16 weeks.The osteocalcin level,serum glucose level,lipid concentration,and hepatic fat content(HFC)were measured before and after the intervention,and the relating factors of osteocalcin level were analyzed.Results:Serum osteocalcin level was significantly elevated in the berberine group compared with the control group(P<0.001).After adjusting age,gender,and body mass index(BMI),the improvement of serum osteocalcin level in the berberine group(4.60[3.50,5.70])was still significantly higher than that in the control group(0.96[-0.14,2.05],P<0.001),with mean difference of 3.64(95%CI 1.74-5.55).Subgroup analysis showed that the effect of osteocalcin improvement of berberine was more significant in non-obese old male patients.Partial correlation analysis showed that the difference of serum osteocalcin level was negatively correlated with BMI,body weight,waist circumference,HFC,glycated hemoglobin 1c(HbA1c),and total cholesterol(TC)before and after treatment after age and gender adjustment(P<0.05).Conclusions:The effect of berberine on improving metabolic disorders in patients with NAFLD accompanied by impaired glycometabolism is related to the increase of serum uncarboxylated osteocalcin level.