FibroScan-CAP评价水飞蓟宾联合运动疗法治疗非酒精性脂肪性肝炎疗效分析

Evaluation analysis of FibroScan-CAP on Silibinin and exercise therapies for treament of nonalcoholic fatty hepatitis

目的应用瞬时弹性成像(FibroScan)技术受控衰减参数(CAP)观察水飞蓟宾联合运动疗法治疗非酒精性脂肪性肝炎(NASH)的临床疗效。方法 2013年3月-2014年9月鹤壁市传染病医院门诊及住院的NASH患者65例,均在积极治疗原发病的基础上给以飞蓟宾胶囊,开始每次2粒(70 mg),3次/d口服,4周为1疗程,12周为总疗程。并同时进行运动疗法:由2名接受专业培训的临床医师负责评估,并且个体化定制个人运动计划。每2~4周检测并记录患者临床症状、体质量指数(BMI)、腰围/臀围(ACR)、肝功能、血脂指标的变化以及CAP。结果联合治疗后乏力、纳差、腹胀、肝区隐痛等比例与治疗前比较差异均有统计学意义(P<0.01);治疗后TG、TC、ALT、AST水平及BMI、ACR等较治疗前改善明显,差异有统计学意义(P<0.05或P<0.01);治疗后第8、12周CAP较治疗前差异有统计学意义(P<0.05、P<0.01)。结论飞蓟宾联合运动疗法可以改善NASH患者的临床症状、血清生化指标、BMI及ACR。应用FibroScan-CAP动态检测肝脂肪变是一种无创、定量、快速、可靠的评估脂肪性肝病的新方法。

Objective To observe the effect of silibinin combined with exercise in treating non-alcoholic fatty hepatitis(NASH),using transient elastography(FibroScan) of the controlled attenuation parameter(CAP).Methods A total of 65 patients of NASH in Hebi Infectious Disease Hospital from March2013 to September 2014,on top of the original treatment plan,were all administered with oral Sillibinin Capsule,2 capsules(70 mg) each time,3 times daily,4 weeks for one course of treatment,12 weeks for the total of 3 courses.At the same time,the patients received exercise therapies including assessment and design of personalized sports program by two specialist physicians with professional training.The clinical symptoms,body mass index(BMI),waist/hip(ACR),liver function,changes of serum lipids and CAP of NASH patients were detected and recorded every 2-4 weeks.Results After the combination therapy,the differences between the treated and untreated patients for the proportion of fatigue,anorexia,abdominal distension,liver area pain were statistically significant(P<0.01).after the treatment,the levels of TC,ALT,AST,BMI,TG and ACR were significantly improved,compared with no treatment(P<0.05 or 0.01).CAP at the 8th and 12 th week post-treatment was statistically significant(P<0.05,P<0.01).Conclusions Silibinin and exercise therapies can improve clinical symptoms,serum biochemical parameters,BMI and ACR of NASH patients.Dynamic detection of hepatic steatosis by FibroScan-CAP is a novel method for the evaluation of NASH with the advantage of being noninvasive,quantitative,rapid and reliable.