荷叶调脂疏肝汤联合GLP-1受体激动剂治疗糖耐量异常并非酒精性脂肪肝的临床效果

Clinical Effect of Heye Tiaozhi Shugan Decoction(荷叶调脂疏肝汤) Combined with Glucagon-like Peptide-1 Receptor Agonists on Impaired Glucose Tolerance in Patients with Non-alcoholic Fatty Liver Disease

目的 研究荷叶调脂疏肝汤联合胰高血糖素样肽-1(GLP-1)受体激动剂治疗糖耐量异常(IGT)并非酒精性脂肪肝(NAFLD)的临床疗效。方法 将医院2020年1月—2021年1月间收治的102例IGT并NAFLD患者采用随机数字表法均分为观察组与对照组,两组均应用GLP-1受体激动剂,观察组该基础上加用荷叶调脂疏肝汤,连续治疗12周,统计两组治疗效果。结果 治疗后,两组肝郁脾虚证症状,包括胁肋痛、腹痛、乏力、烦躁易怒、腹痛欲泻、溏便不爽、食欲不振、喜太息以及各项目总积分均较同组治疗前显著下降(P<0.05),且观察组治疗后,各症状积分及总积分均显著低于对照组(P<0.05)。两组治疗后,空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)以及空腹血糖(FPG)水平均较同组治疗前显著下降(P<0.05),且观察组治疗后,FINS、HOMA-IR以及FPG水平均显著低于对照组治疗后水平(P<0.05)。两组治疗后,甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)均较同组治疗前显著下降(P<0.05),高密度脂蛋白(HDL-C)显著上升(P<0.05),观察组治疗后体质量指数(BMI)较其治疗前显著下降(P<0.05),对照组治疗前后BMI无显著性改变(P>0.05),且观察组治疗后,脂代谢相关指标TG、TC、LDL-C以及BMI水平均显著低于对照组(P<0.05),HDL-C水平显著高于对照组(P<0.05)。治疗后,两组肝功能相关指标丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)以及γ-谷氨酰转肽酶(GGT)水平均较同组治疗前显著降低(P<0.05),但观察组治疗后肝功能相关指标水平均显著低于对照组治疗后(P<0.05)。治疗后,观察组肝脏B超分级较其治疗前有显著性改变(P<0.05),对照组治疗前后肝脏彩超分级改变不显著(P>0.05),治疗后,观察组肝脏彩超分级显著优于对照组(P<0.05)。观察组治疗有效率显著高于对照组(P<0.05)。治疗期间,观察组在初次注射利拉鲁肽时有1例患者出现过敏反应,经降低药物注射剂量后过敏反应消失,后逐渐适应,两组均未出现药物相关不良的严重不良反应。结论 在GLP-1RAs的基础上联合应用荷叶调脂疏肝汤能有效改善IGT并NAFLD患者临床症状,调节患者血糖血脂,抑制IR,改善肝功能,且治疗安全性高。

Objective To investigate the clinical effect of Heye Tiaozhi Shugan Decoction(荷叶调脂疏肝汤)combined with glucagon-like peptide-1(GLP-1)receptor agonists on impaired glucose tolerance(IGT)in patients with non-alcoholic fatty liver disease(NAFLD).Methods A total of 102 patients with IGF and NAFLD in the hospital from January 2020 to January 2021 were enrolled and equally divided into two groups by random number table methods.Both groups received GLP-1 receptor agonists.Based on this,the observation group received Heye Tiaozhi Shugan Decoction.The treatment lasted for 12 weeks,and then the clinical outcomes were compared between the two groups.Results The scores of liver-depression and spleen deficiency symptoms including pain in the ribs,abdominal pain,weakness,irritability,abdominal pain and diarrhea,loose bowel movements,loss of appetite and deep sighing,as well as the total TCM syndrome score were significantly decreased in both groups after treatment(P<0.05),and the post-treatment scores were significantly lower in the observation group than those in the control group(P<0.05).Levels of fasting insulin(FINS),insulin resistance index(HOMA-IR)and fasting plasma glucose(FPG)were also decreased in both groups after treatment(P<0.05),and the post-treatment levels of those indicators were significantly lower in the observation group than those in the control group(P<0.05).Meantime,a significant decrease in levels of triglyceride(TG),total cholesterol(TC)and low density lipoprotein(LDL-C)as well as a significant increase in the level of high density lipoprotein(HDL-C)were observed in both groups after treatment,and both changes were more obvious in the observation group than those in the control group(all P<0.05).The body mass index(BMI)was significantly decreased in the observation group and showed no significant change in the control group,so the BMI was significantly lower in the observation group than that in the control group(P<0.05).After treatment,the levels of liver function related indexes including alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and gamma glutamyl transpeptidase(GGT)were significantly decreased in both groups(P<0.05),and the levels were significantly lower in the observation group than hose tin the control group(P<0.05).The ultrasound grading was significantly improved in the observation group,while there was no significant change in the control group(P<0.05),so the post-treatment ultrasound grading was significantly better in the observation group than that in the control group(P<0.05).The clinical efficacy rate of the observation group was significantly higher than that of the control group(P<0.05).During the treatment period,one patient in the observation group had an allergic reaction during the initial injection of liraglutide.The allergic reaction disappeared after the drug injection was reduced,and then the patient gradually adapted to it,and no serious adverse reactions related to drug-related adverse effects occurred in either group.Conclusion Application of Heye Tiaozhi Shugan Decoction combined with GLP-1 receptor agonists can effectively and safely ameliorate the clinical symptoms,regulate the blood glucose and lipids,inhibit IR and improve liver function in patients with IGT and NAFLD.