复方甘草酸苷联合阿托伐他汀治疗NAFLD的疗效及对肝纤维化和胰岛素抵抗指标的影响

Compound glycyrrhizin combined with atorvastatin in treatment of non-alcoholic fatty liver disease

目的探究复方甘草酸联合阿托伐他汀治疗非酒精性脂肪肝病(NAFLD)的效果及对患者Ⅲ型前胶原肽(PCⅢP)、Ⅳ型胶原(Ⅳ-C)和胰岛素抵抗指数(HOMA-IR)的影响。方法选取衢州市人民医院2016年5月至2018年5月收治的NAFLD患者80例,按照随机数字表法分为对照组和观察组,每组40例。对照组患者口服复方甘草酸苷治疗,观察组在对照组基础上联合阿托伐他汀治疗。对比两组患者的临床疗效,治疗前后ALT、AST、γ-谷氨酰转移酶(γ-GT),血清TC、TG、LDL-C、HDL-C,透明质酸(HA)、PCⅢP、Ⅳ-C,游离脂肪酸(FFA)、空腹胰岛素(FINS)、空腹血糖(FBG)、HOMA-IR,以及不良反应发生情况。结果观察组的治疗有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组ALT、AST、γ-GT、TG、TC、LDL-C、HA、PCⅢP、Ⅳ-C、FFA、FINS、HOMA-IR较治疗前均明显降低(均P<0.05),HDL-C明显升高(均P<0.05),且观察组各指标均明显优于对照组(均P<0.05)。两组患者治疗期间不良反应合计发生率比较差异无统计学意义(P>0.05)。结论复方甘草酸苷联合阿托伐他汀治疗NAFLD能够显著减轻患者肝功能损害,降低血脂水平,减轻肝纤维化和胰岛素抵抗,安全性较高。

Objective To investigate the efficacy of compound glycyrrhizin combined with atorvastatin in treatment of patients with nonalcoholic fatty liver disease(NAFLD)and its effect on type III procollagen peptide(PCIIIP),type IV collagen(IV-C)and insulin resistance index(HOMA-IR).Methods From May 2016 to May 2018,80 patients with NAFLD were randomly divided into control group and study group with 40 patients in each group.The patients in the control group were treated with compound glycyrrhizin,and the patients in the observation group were treated with compound glycyrrhizin and atorvastatin.The therapeutic effects were compared between the two groups.The liver function,blood lipid,hyaluronic acid(HA),PCⅢP,Ⅳ-C before and after treatment were compared between the two groups.Free fatty acid(FFA),fasting insulin(FINS),and HOMA-IR were calculated.Results The effective rate of clinical treatment was 92.5%in the study group and 75.0%in the control group(P<0.05).After treatment,the levels of glutamate-alanine aminotransferase(ALT),glutamic oxalacetic transaminase(AST),γ-glutamyl transferase(γ-GT)in the study were significantly lower than those in the control group(P<0.05).After treatment,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)were significantly decreased in both groups.The indexes in the study group were significantly better than those in the control group(P<0.05).After treatment,HA,PCⅢP,Ⅳ-C,FFA,FINS,HOMA-IR were significantly decreased in both groups,and the indexes in the study group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Compound glycyrrhizin combined with atorvastatin in the treatment of non-alcoholic fatty liver can significantly reduce liver function damage,reduce blood lipid level,reduce liver fibrosis and insulin resistance.