多烯磷脂酰胆碱联合扶正化瘀片治疗非酒精性脂肪性肝病患者肝脏超声脂肪变性评分变化

Observation of hepatic steatosis score by ultrasonography in patients with nonalcoholic fatty liver diseases after polyene phosphatidylcholineand Fuzheng Huayu capsule combination treatment

目的探讨多烯磷脂酰胆碱联合扶正化瘀片治疗非酒精性脂肪性肝病(NAFLD)患者的疗效及对肝脏超声脂肪变性评分的影响。方法2018年1月~2020年1月我院诊治的NAFLD患者132例,采用随机数字表法分为对照组66例和联合组66例,分别给予多烯磷脂酰胆碱或多烯磷脂酰胆碱联合扶正化瘀片治疗24周。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)水平,采用化学发光法检测血清高敏C反应蛋白(hs-CRP)和白介素-10(IL-10)水平,采用超声肝脏脂肪变性评分。结果在治疗结束时,联合组血清ALT、AST和GGT水平分别为(39.4±4.1)U/L、(35.8±6.6)U/L和(81.4±10.1)U/L,显著低于对照组[分别为(54.3±5.2)U/L、(50.9±7.4)U/L和(108.8±12.6)U/L,P<0.05];联合组血清TC、TG和LDL-C水平分别为(3.5±1.0)mmol/L、(2.2±0.6)mmol/L和(2.7±0.6)mmol/L,显著低于对照组[分别为(4.2±1.2)mmol/L、(2.9±0.8)mmol/L和(3.4±0.8)mmol/L,P<0.05],而血清HDL-C水平为(1.7±0.6)mmol/L,显著高于对照组[(1.3±0.5)mmol/L,P<0.05];联合组肝脏超声脂肪变性评分和血清TNF-α水平分别为(0.9±0.2)分和(3.5±0.8)ng/L,显著低于对照组[分别为(1.7±0.3)分和(4.2±1.0)ng/L,而血清IL-10水平为(28.9±7.4)ng/L,显著高于对照组(24.1±6.7)ng/L,P<0.05]。结论应用多烯磷脂酰胆碱联合扶正化瘀片治疗NAFLD患者可更好地发挥肝功能改善和降脂效果,改善了肝脏脂肪变性,可能与抑制了炎症反应有关。

Objective The purpose of this study was to investigate the efficacy of polyene phosphatidylcholine and Fuzheng Huayu capsule,a herbal medicine,combination in the treatment of patients with non-alcoholic fatty liver diseases(NAFLD)and its effect on hepatic steatosis score(HSSu)by ultrasonography.Methods A total of 132 patients with NAFLD were recruited in our hospital between January 2018 and January 2020,and were randomly divided into control(n=66)and observation group(n=66),receiving orally polyene phosphatidylcholine or polyene phosphatidylcholine and Fuzheng Huayu combination therapy for 24 weeks.Serum tumor necrosis factor-α(TNF-α),high sensitivity C-reactive protein(hs-CRP)and interleukin-10(IL-10)levels were assayed.The hepatic steatosis scores was evaluated by ultrasonography.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma glutamine transferase(GGT),serum alkaline phosphatase(ALP),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-c)levels were detected routinely.Results At the end of 24 week observation,serum ALT,AST and GGT levels in the observationgroup were(39.4±4.1)U/L,(35.8±6.6)U/L and(81.4±10.1)U/L,significantly lower than[(54.3±5.2)U/L,(50.9±7.4)U/L and(108.8±12.6)U/L,respectively,P<0.05]in the control;blood TC,TG and LDL-C levels were(3.5±1.0)mmol/L,(2.2±0.6)mmol/L and(2.7±0.6)mmol/L,significantly lower than[(4.2±1.2)mmol/L,(2.9±0.8)mmol/L and(3.4±0.8)mmol/L,respectively,P<0.05],while blood HDL-C level was(1.7±0.6)mmol/L,significantly higher than[(1.3±0.5)mmol/L,P<0.05]in the control group;the hepatic steatosis score and serum TNF-αlevel were(0.9±0.2)and(3.5±0.8)ng/L,significantly lower than[(1.7±0.3)and(4.2±1.0)ng/L,while serum IL-10 level was(28.9±7.4)ng/L,significantly higher than(24.1±6.7)ng/L,P<0.05]in the control.Conclusion The oral administration of polyene phosphatidylcholine and Fuzheng Huayu combination in the treatment of patients with NAFLD could improve liver function test normal and decrease blood lipids,which might be related to the intrahepatic steatosis and inflammatory reactions.