双重血浆置换术联合补肝利脂汤治疗重度高甘油三酯血症合并非酒精性脂肪性肝病患者的疗效分析

Effect analysis of double filtration plasmapheresis combined with Bugan Lizhi decoction in the treatment of severe hypertriglyceridemia complicated with non-alcoholic fatty liver disease

目的探究双重血浆置换术(double filtration plasmapheresis,DFPP)联合补肝利脂汤治疗重度高甘油三酯血症合并非酒精性脂肪性肝病的临床疗效。方法本研究为随机对照试验。选取2021年6月至2022年6月安康市中医医院收治的68例重度高甘油三酯血症合并非酒精性脂肪性肝病患者为研究对象,采用随机数字表法分为对照组与观察组,每组34例。对照组男18例,女16例,年龄(42.62±8.55)岁,采用DFPP+苯扎贝特治疗,DFPP治疗后第1天开始口服苯扎贝特,每次0.2 g,每日3次,持续治疗24周。观察组男20例,女14例,年龄(43.43±7.25)岁,采用DFPP+补肝利脂汤治疗,DFPP治疗后第1天开始口服补肝利脂汤,每次200 ml,每日1剂,饭前30 min内服用,持续治疗24周。对比治疗前后两组甘油三酯、载脂蛋白A-Ⅰ(ApoA-Ⅰ)、载脂蛋白B(ApoB)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等血脂指标以及丙氨酸转氨酶(ALT)、白蛋白(ALB)、天冬氨酸转氨酶(AST)等肝功能生化指标,并比较两组肝脏影像学结果。采用χ^(2)检验、t检验进行统计分析。结果治疗24周后,观察组甘油三酯、LDL-C、ApoB均低于对照组[(4.13±1.09)mmol/L比(6.03±1.65)mmol/L、(3.13±0.58)mmol/L比(3.91±0.75)mmol/L、(0.76±0.23)g/L比(0.86±0.17)g/L],HDL-C、ApoA-I均高于对照组[(1.88±0.53)mmol/L比(1.42±0.43)mmol/L、(1.81±0.39)g/L比(1.58±0.32)g/L],差异均有统计学意义(t=5.602、4.797、2.039、3.930、2.658,均P<0.05);观察组ALT、AST均低于对照组[(28.62±3.23)U/L比(34.32±1.68)U/L、(21.29±4.34)U/L比(35.44±5.72)U/L],ALB高于对照组[(49.21±4.31)g/L比(45.34±4.28)g/L],差异均有统计学意义(t=9.138、11.488、3.715,均P<0.05);肝脏影像学检查结果显示,观察组的肝脏肋下斜径小于对照组[(9.98±3.54)cm比(12.05±4.78)cm],差异有统计学意义(t=2.029,P=0.046);对照组患者轻、中、重度肝脂肪浸润分别为7例(20.59%)、15例(44.12%)、12例(35.29%),观察组分别为20例(58.82%)、11例(32.35%)、3例(8.82%),差异有统计学意义(χ^(2)=12.275,P=0.002)。结论DFPP联合补肝利脂汤能有效改善重度高甘油三酯血症合并非酒精性脂肪性肝病患者的生化指标和肝脏功能,对肝脏影像学表现有积极影响,对重度高甘油三酯血症合并非酒精性脂肪性肝病的治疗具有潜在应用价值。

Objective To explore the effect of double filtration plasmapheresis(DFPP)combined with Bugan Lizhi decoction in the treatment of severe hypertriglyceridemia complicated with non-alcoholic fatty liver disease.Methods This study was a randomized controlled trial.A total of 68 patients diagnosed with severe hypertriglyceridemia combined with non-alcoholic fatty liver disease in the Gastroenterology Department of Ankang Hospital of Traditional Chinese Medicine from June 2021 to June 2022 were selected as the study objects,and were divided into a control group and an observation group by the random number table method,with 34 cases in each group.In the control group,18 males and 16 females,aged(42.62±8.55)years,were treated with DFPP plus oral bezafibrate:on the first day after DFPP treatment,bezafibrate 0.2 g was taken orally,3 times a day,for 24 weeks.In the observation group,20 males and 14 females,aged(43.43±7.25)years,were treated with DFPP+oral Bugan Lizhi decoction:the above traditional Chinese medicine was taken orally on the first day after blood purification treatment,200 ml each time,1 dose per day,within 30 minutes before meals,for 24 weeks.Biochemical indexes such as triglyceride,apolipoprotein A-Ⅰ(ApoA-Ⅰ),apolipoprotein B(ApoB),high density lipoprotein cholesterol(HDL-C),and low density lipoprotein cholesterol(LDL-C)and liver function biochemical indexes such as alanine aminotransferase(ALT),albumin(ALB),and aspartate aminotransferase(AST)were compared between the two groups before and after treatment.The liver function indexes and liver imaging results were compared between the two groups before and after treatment.χ^(2)test and t test were used for statistical analysis.Results After 24 weeks of treatment,the levels of triglyceride,LDL-C,and ApoB in the observation group were lower than those in the control group[(4.13±1.09)mmol/L vs.(6.03±1.65)mmol/L,(3.13±0.58)mmol/L vs.(3.91±0.75)mmol/L,(0.76±0.23)g/L vs.(0.86±0.17)g/L],and the levels of HDL-C and ApoA-I were higher than those in the control group[(1.88±0.53)mmol/L vs.(1.42±0.43)mmol/L,(1.81±0.39)g/L vs.(1.58±0.32)g/L],with statistically significant differences(t=5.602,4.797,2.039,3.930,and 2.658,all P<0.05).After 24 weeks of treatment,the levels of ALT and AST in the observation group were lower than those in the control group[(28.62±3.23)U/L vs.(34.32±1.68)U/L,(21.29±4.34)U/L vs.(35.44±5.72)U/L],and the level of ALB was higher than that in the control group[(49.21±4.31)g/L vs.(45.34±4.28)g/L],with statistically significant differences(t=9.138,11.488,and 3.715,all P<0.05).The results of liver imaging examination after 24 weeks of treatment showed that the oblique diameter of liver subcostal in the observation group was smaller than that in the control group[(9.98±3.54)cm vs.(12.05±4.78)cm],with a statistically significant difference(t=2.029,P=0.046).There were 7 cases(20.59%),15 cases(44.12%),and 12 cases(35.29%)of mild,moderate,and severe hepatic cellular fat infiltration in the control group,and 20 cases(58.82%),11 cases(32.35%),and 3 cases(8.82%)in the observation group,with a statistically significant difference(χ^(2)=12.275,P=0.002).Conclusion DFPP combined with Bugan Lizhi decoction can effectively improve the biochemical indicators and liver function in severe hypertriglyceridemia complicated with non-alcoholic fatty liver disease patients,with positive effects on hepatic imaging manifestations,suggesting its potential application value in the treatment of severe hypertriglyceridemia complicated with non-alcoholic fatty liver disease.