自拟疏肝健脾化浊汤联合常规疗法治疗青少年肝郁脾虚型非酒精性脂肪性肝病的回顾性研究

Self-formulated Shugan Jianpi Huazhuo Decoction combined with conventional therapy in treating juvenile nonalcoholic fatty liver disease of liver depression and spleen deficiency syndrome: a retrospective study

目的观察自拟疏肝健脾化浊汤联合常规疗法治疗青少年肝郁脾虚型非酒精性脂肪性肝病(NAFLD)的临床疗效。方法回顾性分析2017年4月至2019年4月本院诊治的81例青少年肝郁脾虚型NAFLD患者的临床资料,根据治疗方法分组,采用自拟疏肝健脾化浊汤联合常规疗法者为治疗组(43例),单纯采用常规疗法者为对照组(38例)。两组均连续治疗12周后评价临床疗效,比较血清脂代谢指标、肝功能、脂联素、胰岛素样生长因子-1(IGF-1)水平及超声影像学评分的变化情况,同时进行安全性评价。结果 (1)治疗组、对照组总有效率分别为90.70%、73.68%;治疗组临床疗效优于对照组(P<0.05)。(2)治疗前后组内比较,两组血清三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转移酶(GGT)水平降低(P<0.05),高密度脂蛋白胆固醇(HDL-C)、脂联素、胰岛素样生长因子-1(IGF-1)水平升高(P<0.05);组间治疗后比较,治疗组血清TG、TC、LDL-C、ALT、AST、GGT水平低于对照组(P<0.05),脂联素、IGF-1水平高于对照组(P<0.05),HDL-C水平差异无统计学意义(P>0.05)。(3)治疗前后组内比较,两组患者各脂肪肝分级超声影像学评分均降低(P<0.05);组间治疗后比较,治疗组患者各脂肪肝分级超声影像学评分均低于对照组(P<0.05)。(4)两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论与单纯采用常规疗法相比,加用自拟疏肝健脾化浊汤治疗青少年肝郁脾虚型NAFLD疗效满意,能更好地调节脂代谢、保护肝功能、升高脂联素和IGF-1水平,并改善超声影像学表现,且安全性良好。

Objective To observe the clinical effect of self-formulated Shugan Jianpi Huazhuo Decoction combined with conventional therapy on juvenile nonalcoholic fatty liver disease(NAFLD) of liver depression and spleen deficiency syndrome. Methods The clinical data of 81 adolescent NAFLD patients with liver depression and spleen deficiency syndrome diagnosed and treated in our hospital from April 2017 to April 2019 were retrospectively analyzed. According to the treatment methods, they were divided into treatment group(43 cases) and control group(38 cases). The treatment group was treated with self-formulated Shugan Jianpi Huazhuo Decoction combined with conventional therapy, while the control group was treated with conventional therapy alone. After 12 weeks of continuous treatment, the clinical efficacy of the two groups was evaluated. The index changes of serum lipid metabolism, liver function, adiponectin, insulin-like growth factor-1(IGF-1) and ultrasound imaging score were comparatively analyzed, and treatment safety was assessed simultaneously. Results(1)The total effective rates of the treatment group and the control group were 90.70% and 73.68% respectively, suggesting better clinical effects in the treatment group than that in the control group(P<0.05).(2)After treatment, the levels of serum triglyceride(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), alanine aminotransferase(ALT), aspartate aminotransferase ( AST) and Gamma-Glutamyl Transpeptidase( GGT) decreased( P<0.05),while the levels of high density lipoprotein cholesterol( HDL-C), adiponectin and IGF-1 increased in both groups( P<0.05). After treatment,the levels of serum TG,TC,LDL-C,ALT,AST and GGT in the treatment group were lower than those in the control group( P<0.05),while the levels of adiponectin and IGF-1 were higher than those in the control group( P<0.05),and there was no significant difference in HDL-C level( P>0.05).(3)After treatment,ultrasound imaging scores of fatty liver grades in both groups decreased( P<0.05),and the scores in treatment group were lower than those in the control group( P<0.05).(4) There was no significant difference in the incidence of adverse reactions between the two groups( P>0.05). Conclusion Compared with conventional therapy alone, self-formulated Shugan Jianpi Huazhuo Decoction combined with conventional therapy can achieve satisfactory results in treating adolescents with NAFLD of liver depression and spleen deficiency syndrome as it can better regulate lipid metabolism,protect liver function,increase adiponectin and IGF-1 levels and improve ultrasound imaging results while having good safety.