附子理中汤结合芒硝外敷对非酒精性脂肪肝临床疗效及肝功能、血清瘦素水平影响研究

Influence of Fuzi Lizhong Decoction(附子理中汤)Combined with Mirabilite on Clinical Efficacy Liver Function and Serum Leptin Levels of Non-alcoholic Fatty Liver Patients

目的探究附子理中汤结合芒硝外敷对非酒精性脂肪肝患者临床疗效、肝功能及血清瘦素水平影响。方法研究纳入151例非酒精性脂肪肝患者,均由医院2019年2月—2021年2月收治,采取随机数字表法将151例患者分成两组,对照组患者(76例)采取西药多烯磷脂酰胆碱胶囊治疗,观察组患者(75例)采取多烯磷脂酰胆碱胶囊+附子理中汤结合芒硝外敷治疗,两组均治疗3个月,比较两组患者治疗效果、治疗前后中医证候(恶心呕吐、腹胀便溏、纳差、肢体困重、肝脾肿大等)积分变化及肝功能指标[谷丙转氨酶(ALT)以及谷草转氨酶(AST)]、γ谷氨酸氨基转移酶变化、治疗前后两组患者血清白介素-6(IL-6)白介素10(IL-10)及转换生长因子β1(TGF-β1)、肿瘤坏死因子α(TNF-α)、γ-干扰素(IFN-γ)水平、体重指数(BMI)及腰围变化、血清瘦素(LEP)水平变化、肝/脾CT比值变化及血脂指标变化及肠道微生态指标变化、不良反应。结果观察组与对照组有效率比较,分别为98.67%(74/75)、90.79%(69/76),前者更高(P<0.05);治疗前,两组患者中医证候(恶心呕吐、腹胀便溏、纳差、肢体困重、肝脾肿大等)积分、ALT及AST及γ谷氨酸氨基转移酶、IL-6、IL-10及TGF-β1、TNF-α、IFN-γ、BMI、腰围及LEP水平、肝/脾CT比值、总胆固醇(TC)及甘油三酯(TG)、高密度脂蛋白(HDL)及低密度脂蛋白(LDL)等血脂指标、肠球菌及肠杆菌、双歧杆菌及乳酸杆菌等肠道微生态指标比较,P>0.05,治疗后各组患者中医证候(恶心呕吐、腹胀便溏、纳差、肢体困重、肝脾肿大等)积分、ALT及AST及γ谷氨酸氨基转移酶、IL-6、IL-10及TGF-β1、TNF-α、IFN-γ、BMI、腰围及LEP水平、肝/脾CT比值、HDL及LDL、TC、TG、肠球菌及肠杆菌、双歧杆菌及乳酸杆菌等肠道微生态指标均改善,观察组患者治疗后各组患者中医证候(恶心呕吐、腹胀便溏、纳差、肢体困重、肝脾肿大等)积分、ALT及AST及γ谷氨酸氨基转移酶、IL-6、IL-10及TGF-β1、TNF-α、IFN-γ、BMI、腰围及LEP水平、肝/脾CT比值、HDL及LDL、TC、TG、肠球菌及肠杆菌、双歧杆菌及乳酸杆菌等肠道微生态指标均优于对照组患者(P<0.05);观察组(0.00%)与对照组不良反应率(1.32%)均较低(P>0.05)。结论附子理中汤结合芒硝外敷治疗非酒精性脂肪肝患者临床疗效显著,患者肠道微生态及肝功能改变,血脂水平改善,不良反应少,安全可靠,值得应用及推广。

Objective To investigate the effect of external application of Fuzi Lizhong Decoction(附子理中汤)combined with mirabilite on clinical efficacy,liver function and serum leptin level of patients with non-alcoholic fatty liver disease.Methods A total of 151 patients with non-alcoholic fatty liver disease were included in this study,all of whom were admitted to the hospital in February 2019 and February 2021.The patients were divided into two groups by random number table method.The control group(76 patients)were treated with western medicine polyene phosphatidylcholine capsule.The observation group(75 cases)were treated with polyene phosphatidylcholine capsule+Fuzi Lizhong Decoction combined with mirabilite external application.Both groups were treated for 3 months.The treatment effect,the changes in TCM syndrome scores(nausea and vomiting,disten-sion and diarrhea,poor appetite,drowsiness of limbs,hepatosplenomegaly,etc.)and liver function indexes[alanine aminotrans-ferase(ALT)and aspartate aminotransferase(AST)]andγ-aminoglutamic acid transferase before and after treatment were com-pared between the two groups.The serum levels of interleukin-6(IL-6),interleukin-10(IL-10),transforming growth factorβ1(TGF-β1),tumor necrosis factorα(TNF-α),γ-interferon(IFN-γ),body mass index(BMI),waist circumference and serum leptin(LEP)in two groups before and after treatment were compared.The changes of liver/spleen CT ratio,the changes in lipid indexes,the changes in intestinal microecological indexes and adverse reactions were observed.Results The effective rate of the observation group and the control group was 98.67%(74/75)and 90.79%(69/76),respectively,and the former was higher(P<0.05).Before treatment,TCM syndromes(nausea and vomiting,distension and diarrhea,poor appetite,drowsiness of limbs,hepatosplenomegaly,etc.)scores,the levels of ALT,AST,γ-glutamate aminotransferase,IL-6,IL-10,TGF-β1,TNF-α,IFN-γ,BMI,waist circumference and LEP,liver/spleen CT ratio,levels of total cholesterol(TC)and triglyceride(TG),high density lipoprotein(HDL)and low density lipoprotein(LDL)and intestinal microecological indexes such as Enterococcus and Enterobacterium,Bifidobacterium and Lactobacillus were not significant(P>0.05).After treatment,scores of TCM syndromes(nausea and vomiting,distension and diarrhea,poor appetite,drowsiness of limbs,hepatosplenomegaly,etc.),levels of ALT,AST,γ-glutamate aminotransferase,IL-6,IL-10,TGF-β1,TNF-α,IFN-γ,BMI,waist circumference and LEP,liver/spleen CT ratio,levels of HDL and LDL,TC,TG,Enterococcus and Enterobacterium,Bifidobacterium and Lactobacillus,and other intestinal microecological indexes were improved.Those in the observation group were better than those in the control group(P<0.05).The adverse reaction rates of the observation group(0.00%)and the control group(1.32%,1/76)were both lower(P>0.05).Conclusion Fuzi Lizhong Decoction combined with mirabilite external application in the treatment of patients with non-alcoholic fatty liver disease has significant clinical efficacy.It can make the intestinal microecology and liver function change,im-prove blood lipid levels,with less adverse reactions.It is safe and reliable,worthy of application and promotion.