葛根芩连汤治疗肠道湿热型代谢相关脂肪性肝病的临床效果及对糖脂代谢指标的影响

Clinical effect of Gegen Qinlian decoction in the treatment of metabolic associated fatty liver disease with intestinal damp heat type and its influences on glucose and lipid metabolism indexes

目的探讨葛根芩连汤治疗肠道湿热型代谢相关脂肪性肝病(MAFLD)的临床效果及对糖脂代谢指标的影响。方法选取2019年12月至2021年3月我院内分泌科收治的62例肠道湿热型MAFLD患者,将其随机分为对照组和治疗组,各31例。两组患者均由专科护士进行生活方式干预及治疗宣教,指导饮食运动,按照西医治疗原则,给予降糖、降脂、降压等对症治疗;治疗组在此基础上加用葛根芩连汤。比较两组患者治疗前、后的中医证候积分、体质量指数(BMI)、腰围、肝脏脂肪含量及糖脂代谢指标[空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、超敏C反应蛋白(hs-CRP)]。结果治疗后,两组的中医证候积分均低于治疗前,且治疗组明显低于对照组,差异具有统计学意义(P<0.05)。治疗后,治疗组的BMI、腰围及肝脏脂肪含量均低于治疗前,差异具有统计学意义(P<0.05);治疗组的肝脏脂肪含量明显低于对照组,差异具有统计学意义(P<0.05)。治疗后,治疗组的FBG、FINS、ALT、AST、TC、TG、LDL-C、hs-CRP水平及HOMA-IR明显低于治疗前,差异具有统计学意义(P<0.05);治疗后,治疗组的FINS、ALT、TG、LDL-C、hs-CRP水平及HOMA-IR明显低于对照组,差异具有统计学意义(P<0.05)。结论葛根芩连汤治疗肠道湿热型MAFLD的临床效果显著,可明显降低患者的肝脏脂肪含量,改善血糖、胰岛素、肝功能及血脂水平,降低hs-CRP水平,调控代谢。

Objective To investigate the clinical effect of Gegen Qinlian decoction in the treatment of metabolic associated fatty liver disease(MAFLD)with intestinal damp heat type and its influences on glucose and lipid metabolism indexes.Methods A total of 62 patients with MAFLD with intestinal damp heat admitted in the endocrinology department of our hospital from December 2019 to March 2021 were randomly divided into control group and treatment group,with 31 cases in each group.The two groups of patients were treated by specialized nurses for lifestyle intervention and treatment education,guiding diet and exercise,and giving symptomatic treatment such as hypoglycemic,lipid-lowering and antihypertensive treatment according to the treatment principles of western medicine;on this basis,the treatment group was treated with Gegen Qinlian decoction.The TCM syndrome score,body mass index(BMI),waist circumference,liver fat content and glucose and lipid metabolism indexes[fasting blood glucose(FBG),fasting insulin(FINS),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),high sensitivity C-reactive protein(hs-CRP)]were compared between the two groups before and after treatment.Results After treatment,the score of TCM syndrome in both groups were lower than those before treatment,and that in the treatment group was significantly lower than the control group,and the difference was statistically significant(P<0.05).After treatment,the BMI,waist circumference and liver fat content in the treatment group were lower than those before treatment,and the differences were statistically significant(P<0.05);the liver fat content in the treatment group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the levels of FBG,FINS,ALT,AST,TC,TG,LDL-C,hs-CRP and HOMA-IR in the treatment group were significantly lower than those before treatment,and the differences were statistically significant(P<0.05);after treatment,the levels of FINS,ALT,TG,LDL-C,hs-CRP and HOMA-IR in the treatment group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Gegen Qinlian decoction in the treatment of MAFLD with intestinal damp heat has a significant clinical effect,which can significantly reduce the liver fat content of patients,improve blood sugar,insulin,liver function and blood lipids levels,reduce hs-CRP level,and regulate metabolism.