分期辨证治疗酒精性脂肪肝

本人总结多年治疗脂肪肝的临床经验，认为本病发展具有不同的病理阶段，病因为肝失疏泄、脾失运作、湿热内存、痰浊、郁结、瘀血阻滞，终成痰瘀互结，闭阻肝内转换脉络。根据其发展规律，可将酒精性脂肪肝分四期、早期、轻度、中度、重度分期辨证治疗或以痰为主，或以瘀为主，或以痰瘀同治，

解酒肝康汤治疗酒精性脂肪肝临床疗效评价

目的:观察解酒肝康汤治疗酒精性脂肪肝的临床疗效。方法:将160例酒精性脂肪肝患者随机分为治疗组和对照组,每组各80例。治疗组口服解酒肝康汤剂,3个月为1个疗程,对照组口服益肝灵胶囊、叶酸、Vc等药物,连服3个月。两组患者于治疗前及治疗期间每月检查1次肝功能、血脂、血流变和B超,同时,每周观察病记录症状、体症改善情况,于3个月末统计疗效。结果:治疗组与对照组的总有效率分别是92.5%和71.3%,两组比较,有显著性差异(P<0.05)。在症状、体征和B超改善方面,治疗组与对照组比较,亦有显著性差异(P<0.05);治疗后肝功能、血脂、血流变明显改善,两组比较,均有显著性差异(P<0.01,P<0.05)。结论:解酒肝康汤是治疗酒精性脂肪肝的有效药物。

枸杞多糖对Ⅱ型糖尿病大鼠非酒精性脂肪肝的干预作用

目的:观察枸杞多糖对Ⅱ型糖尿病大鼠非酒精性脂肪肝的干预作用。方法:取58只6周龄纯系雄性Wistar大鼠,随机选取10只作为空白对照组,给予常规饲料喂养;剩余大鼠采用高糖高脂饮食与腹腔注射小剂量链脲佐菌素建立Ⅱ型糖尿病大鼠模型。将成模大鼠随机分为模型对照组和枸杞多糖高、中、低剂量组,每组10只。枸杞多糖高、中、低剂量组分别给予枸杞多糖300,150,75μg/g灌胃,正常对照组和模型对照组给予等体积生理盐水,1 d 2次,持续14周。每周称量体质量1次,并随体质量调整给药剂量。灌胃结束后的第2天称量大鼠体质量,空腹于尾静脉取血;摘除肝脏并称量质量,计算肝重指数;采用全自动生化分析仪测定血清丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)、血清三酰甘油(TG)、总胆固醇(TC)、空腹血糖(FBG)及游离脂肪酸(FFA);制作肝脏病理切片,光镜下进行组织病理学观察。结果:与正常对照组对比,模型对照组大鼠肝重指数、ALT、AST、TG、TC、FBG和FFA水平均升高,差别均有统计学意义(P<0.01)。与模型对照组对比,枸杞多糖中剂量组、高剂量组大鼠体质量升高,枸杞多糖中剂量组、高剂量组大鼠TC水平下降,枸杞多糖各剂量组大鼠肝湿重、肝重指数、FBG、FFA、ALT、AST、TG水平降低,差别有统计学意义(P<0.05,P<0.01),肝脏病变程度有所改善。结论:枸杞多糖可降低大鼠血清中ALT、AST、TG、TC、FBG和FFA水平,改善Ⅱ型糖尿病大鼠非酒精性脂肪肝病变。

Insulin sensitizers in treatment of nonalcoholic fatty liver disease:Systematic review

AIM: To summarize the evidence available for the clinical effectiveness of insulin sensitizers in the treatment of nonalcoholic fatty liver disease (NAFLD) systematically. METHODS: Relevant articles were located using computer-assisted searches of Medline (1966-March 2006), EMBASE (1988-March 2006), CINAHL (1982-March 2003), Educational Resource Information Center (1966-March 2006), Library, Information Science & Technology Abstracts (1967-March 2006), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (1994-2006), dissertations in ProQuest and FirstSearch databases. Manual searches were made in the abstracts from meetings of the American Gastroenterological Association (1999-2006), and the American Association for the Study of Liver Diseases (2003-2005). Studies were retrieved using the following selection criteria: (1) clinical trials using insulin sensitizers in subjects with NAFLD, (2) adult patients, (3) published as full manuscripts or abstracts, and (4) English, Spanish, German, and French languages only. Data were abstracted independently by two reviewers following standardized procedures. A face-to- face comparison of data was conducted to ensure the completeness and reliability of the abstraction process. RESULTS: Nine studies were included, six using metformin and three using thiazolidinediones. Only two studies were placebo-controlled trials. The mediansample size for all studies was 18 subjects. In the placebo-controlled trials, metformin improved insulin resistance markers and liver function tests, but not histological scores. In the single-arm trials, metformin and thiazolidinediones improved insulin resistance markers and liver function tests, and beneficial histological changes were reported. There is limited high-quality information available from which to draw categorical conclusions about the clinical use of insulin sensitizers in NAFLD.CONCLUSION: Current information indicates that the use of insulin sensitizers in NAFLD improves insulin resistance and liver function. Histological changes must be corroborated in randomized controlled trials.

Treatment of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease （NAFLD） is the most common cause for elevated liver enzymes in the developed nations. Beyond prevention programs which are of particular interest because of the increasing number of overweight children, treatment should be focussed on the most important risk factors, obesity and insulin resistance. As a consequence of elucidating the pathomechanisms of NAFLD, the number of potential therapeutic options increased. However, many studies investigating the therapeutic effect show shortcomings in at least one of the following points： lack of a serial liver biopsy, short term of treatment and limited number of included patients. The second generation insulin sensitizer pioglitazone and rosiglitazone show the most promising improvements in NAFLD, but weight gain and potential hepatotoxidty calls for attention. In conclusion, a general recommendation for the application of specific drugs cannot be given. Besides controlled clinical trials, weight reduction and physical activity to improve insulin sensitivity in obese patients should be the priority objective.

Therapeutic strategies for pediatric non-alcoholic fatty liver disease: A challenge for health care providers

Non-alcoholic steato-hepatitis (NASH) is related to insulin resistance and, thus, frequently occurs as part of the metabolic changes that accompany obesity, diabetes and hyperlipidemia. In childhood, the overwhelming boost of obesity and its co-morbidities have lead to the extraordinarily increased prevalence of NASH. Establishing effective therapeutic strategies to treat the disease represents the challenge for hepatologists and gastroenterologists in the next decade. Therapeutic approaches have aimed at treating associated conditions (obesity, insulin resistance, hyperlipemia, etc ) or reducing liver oxidative damage (vitamin E).

Blood F_2-isoprostanes are significantly associated with abnormalities of lipid status in rats with steatosis

AIM: To investigate oxidative stress and lipid peroxi-dation in hepatic steatosis and the underlying implica-tions in pathological mechanisms of non-alcoholic fatty liver disease (NAFLD). METHODS: F_2-isoprostanes (iPF2α-) in blood and liver samples from steatotic (n = 9) and control (n = 7) rats were measured as in vivo marker of lipid peroxida-tion by a mass spectrometric approach. The lipid pro-fi le and endogenous antioxidant status (SOD and CAT) in the rats were also analyzed. RESULTS: Signifi cantly higher levels of iPF2α-(mean 3.47 vs 2.40 pmol/mg tissue, P = 0.004) and lower activities of SOD (mean 1.26 U vs 1.40 U, P < 0.001) and CAT (mean 1026.36 U/mg vs 1149.68 U/mg pro-tein, without signifi cance) were observed in the livers of steatotic rats. Plasma total iPF2α-was signifi cantly correlated with the abnormalities of blood lipids as well as alanine aminotransferase (ALT) levels in the rats with simple steatosis, whereas no similar tendencies were observed in the control rats. CONCLUSION: Enhancement of hepatic oxidative imbalance occurring at the steatotic stage of NAFLD suggests a possibility that manifestation of the local ⅢⅢⅢoxidative damage precedes that of systemic oxidative imbalance. Predominant metabolic features of the in-creased lipid peroxidation further suggest a close asso-ciation of the oxidative imbalance and the dyslipidemia with functional deterioration of the steatotic liver. The fi ndings need to be further evaluated, especially in hu-man studies.

Colon hydrotherapy plus Traditional Chinese Medicine to treat non-alcoholic fatty liver disease:a pilot study

OBJECTIVE: To demonstrate the potential to treat non-alcoholic fatty liver disease(NAFLD) with colon hydrotherapy(CHT) plus Traditional Chinese Medicine(TCM).METHODS: A total of 20 patients were enrolled into the study and received CHT with TCM for 2 weeks.Body mass index(BMI) and levels of serum triglycerides(TG) and total cholesterol(TC) were compared between pre-treatment and post-treatment.RESULTS: Two-week treatment with CHT plus TCM significantly lowered BMI and reduced blood lipids.BMI decreased from 29.5 ± 4.3 to 25.4 ± 1.0, while mean TG levels decreased by 0.70 mmol/L on average from baseline and mean TC levels decreased by0.37 mmol/L. Forty-five percent of patients exhibited TC decreasing by more than 10% from baseline and25%ofpatientsexhibited TCdecreasingbymore than 20%. Sixty percent of patients exhibited TG decreasing by more than 20% and 20% of patients exhibited TG decreasing by more than 40%. However,high-density and low-density lipoprotein cholester-ol levels did not change significantly after intervention. No serious adverse events were reported.CONCLUSION: Our findings suggest that CHT plus TCM to treat NAFLD is promising and it might be a new treatment strategy for management of NAFLD.