目的:采用中西医结合方法治疗非酒精性脂肪肝,观察临床疗效. 方法:选择106例非酒精性脂肪肝患者,按每日就诊先后顺序随机分为中药汤剂组(C组)、中药汤剂加熊去氧胆酸组(C+U组)和护肝片组(H组).C组以清热利湿、活血解郁为治则,予自拟中...目的:采用中西医结合方法治疗非酒精性脂肪肝,观察临床疗效. 方法:选择106例非酒精性脂肪肝患者,按每日就诊先后顺序随机分为中药汤剂组(C组)、中药汤剂加熊去氧胆酸组(C+U组)和护肝片组(H组).C组以清热利湿、活血解郁为治则,予自拟中药方剂“保肝降脂汤”口服,C+U 组予同样中药方剂加熊去氧胆酸口服,H组予护肝片口服,疗程均为3 mo.分别于治疗前后检测患者的肝功能、血脂,并行肝脏的B超、CT影像学检查,分析、比较三种治疗方案的临床效果. 结果:治疗后,C+U组肝功能血清酶水平明显低于另两组(ALT:622.29±13.17nkat/L vs 728.98±15.17nkat/L和622.29±13.17 nkat/L vs 693.97±15.17 nkat/L;AST:511.77±12.00nkat/L vs 650.13±11.50 nkat/L和511.77±12.00 nkat/L vs 667.80±12.34 nkat/L;ALP:777.99±11.84 nkat/L vs 1563.31±16.00 nkat/L 和777.99±1 1.84 nkat/L vs 1605.32±20.1 nkat/L;γ-GGT: 1605.32±20.17 nkat/L vs 731.81±15.00 nkat/L和1605.32±20.17 nkat/L vs 756.32±14.17 nkat/L;P<0.011,C组与H组比较,各血清酶水平相近(ALT:728.98±15.17 nkat/L vs 693.97±15.17 nkat/L;AST:650.13±11.50 nkat/L vs 667.80±12.34 nkat/L;ALP:1563.31±16.00 nkat/L vs 1605.32±20.17; γ-GGT:731.81±15.00 nkat/L vs 756.32±14.17 nkat/L; P>0.05);C+U组、C组的总胆固醇(TC)、甘油三脂(TG)较治疗前均明显下降(C+U组治疗前后TC:7.85±0.08 mmol/L vs 2.47±0.06 mmol/L,TG:4.47±0.05 mmol/L vs 0.79±0.02 mmol/L;C组治疗前后TC:7.92±0.06 mmol/L vs 4.37±0.07 mmol/L,TG:4.34±0.05 mmol/L vs 2.46±0.05 mmol/L; P<0.01),C+U组下降较C组更为显著(2.47±0.06 mmol/L vs 4.37±0.07 mmol/L和0.79±0.02 mmol/L vs 2.46±0.05 mmol/L,P<0.01);影像学的改善为C+U组优于C组, C组优于H组,三组脂肪肝消除率分别为41.7%、27.5% 和6.67%(P<0.05);三组治疗方法的综合疗效显示,C+U 组、C组的治愈率和总有效率均高于H组,(治愈率:30.6% vs 3.3%和20.0% vs 3.3%;总有效率:94.4% vs 56.7%和82.5%vs 56.7%:P<0.01);C+U组的治愈率和总有效率高于C组,但无统计学意义. 结论:“保肝降脂汤”治疗非酒精性脂肪肝,在改善肝功能的同时,能有效地降低血脂,消除或减轻脂肪肝:该方剂与熊去氧胆酸合用,则更能显著地降低肝功能血清酶和血脂水平,肝脏的影像学改变也更加明显减轻,从而进一步提高了疗效.展开更多
Background/Aims: Whether primary biliary cirrhosis (PBC) autoimmune hepatitis (AIH) overlap syndrome requires immunosuppressive therapy in addition to ursodeoxycholic acid (UDCA) is a controversial issue. Methods: Sev...Background/Aims: Whether primary biliary cirrhosis (PBC) autoimmune hepatitis (AIH) overlap syndrome requires immunosuppressive therapy in addition to ursodeoxycholic acid (UDCA) is a controversial issue. Methods: Seventeen patients with simultaneous form of strictly defined overlap were followed for 7.5 years. First-line treatment was UDCA alone (UDCA) in 11 and combination of immunosuppressors and UDCA (UDCA+ IS) in 6. Results: Characteristics at presentation were not significantly different between the 2 groups. In the UDCA+ IS group (f-up 7.3 years), biochemical response in terms of AIH features (ALT< 2ULN and IgG< 16 g/L) was achieved in 4/6 and fibrosis did not progress. In the UDCA group, biochemical response was observed in three patients together with stable or decreased fibrosis (f-up 4.5 years) whereas the eight others were non-responders with increased fibrosis in four (f-up 1.6 years). Seven of these eight patients subsequently received combined therapy for 3 years. Biochemical response was obtained in 6/7 and no further increase of fibrosis was demonstrated. Overall, fibrosis progression in non-cirrhotic patients occurred more frequently under UDCA monotherapy (4/8) than under combined therapy (0/6) (P=0.04). Conclusions: Combination of UDCA and immunosuppressors appears to be the best therapeutic option for strictly defined PBC-AIH overlap syndrome.展开更多
文摘目的:采用中西医结合方法治疗非酒精性脂肪肝,观察临床疗效. 方法:选择106例非酒精性脂肪肝患者,按每日就诊先后顺序随机分为中药汤剂组(C组)、中药汤剂加熊去氧胆酸组(C+U组)和护肝片组(H组).C组以清热利湿、活血解郁为治则,予自拟中药方剂“保肝降脂汤”口服,C+U 组予同样中药方剂加熊去氧胆酸口服,H组予护肝片口服,疗程均为3 mo.分别于治疗前后检测患者的肝功能、血脂,并行肝脏的B超、CT影像学检查,分析、比较三种治疗方案的临床效果. 结果:治疗后,C+U组肝功能血清酶水平明显低于另两组(ALT:622.29±13.17nkat/L vs 728.98±15.17nkat/L和622.29±13.17 nkat/L vs 693.97±15.17 nkat/L;AST:511.77±12.00nkat/L vs 650.13±11.50 nkat/L和511.77±12.00 nkat/L vs 667.80±12.34 nkat/L;ALP:777.99±11.84 nkat/L vs 1563.31±16.00 nkat/L 和777.99±1 1.84 nkat/L vs 1605.32±20.1 nkat/L;γ-GGT: 1605.32±20.17 nkat/L vs 731.81±15.00 nkat/L和1605.32±20.17 nkat/L vs 756.32±14.17 nkat/L;P<0.011,C组与H组比较,各血清酶水平相近(ALT:728.98±15.17 nkat/L vs 693.97±15.17 nkat/L;AST:650.13±11.50 nkat/L vs 667.80±12.34 nkat/L;ALP:1563.31±16.00 nkat/L vs 1605.32±20.17; γ-GGT:731.81±15.00 nkat/L vs 756.32±14.17 nkat/L; P>0.05);C+U组、C组的总胆固醇(TC)、甘油三脂(TG)较治疗前均明显下降(C+U组治疗前后TC:7.85±0.08 mmol/L vs 2.47±0.06 mmol/L,TG:4.47±0.05 mmol/L vs 0.79±0.02 mmol/L;C组治疗前后TC:7.92±0.06 mmol/L vs 4.37±0.07 mmol/L,TG:4.34±0.05 mmol/L vs 2.46±0.05 mmol/L; P<0.01),C+U组下降较C组更为显著(2.47±0.06 mmol/L vs 4.37±0.07 mmol/L和0.79±0.02 mmol/L vs 2.46±0.05 mmol/L,P<0.01);影像学的改善为C+U组优于C组, C组优于H组,三组脂肪肝消除率分别为41.7%、27.5% 和6.67%(P<0.05);三组治疗方法的综合疗效显示,C+U 组、C组的治愈率和总有效率均高于H组,(治愈率:30.6% vs 3.3%和20.0% vs 3.3%;总有效率:94.4% vs 56.7%和82.5%vs 56.7%:P<0.01);C+U组的治愈率和总有效率高于C组,但无统计学意义. 结论:“保肝降脂汤”治疗非酒精性脂肪肝,在改善肝功能的同时,能有效地降低血脂,消除或减轻脂肪肝:该方剂与熊去氧胆酸合用,则更能显著地降低肝功能血清酶和血脂水平,肝脏的影像学改变也更加明显减轻,从而进一步提高了疗效.
文摘Background/Aims: Whether primary biliary cirrhosis (PBC) autoimmune hepatitis (AIH) overlap syndrome requires immunosuppressive therapy in addition to ursodeoxycholic acid (UDCA) is a controversial issue. Methods: Seventeen patients with simultaneous form of strictly defined overlap were followed for 7.5 years. First-line treatment was UDCA alone (UDCA) in 11 and combination of immunosuppressors and UDCA (UDCA+ IS) in 6. Results: Characteristics at presentation were not significantly different between the 2 groups. In the UDCA+ IS group (f-up 7.3 years), biochemical response in terms of AIH features (ALT< 2ULN and IgG< 16 g/L) was achieved in 4/6 and fibrosis did not progress. In the UDCA group, biochemical response was observed in three patients together with stable or decreased fibrosis (f-up 4.5 years) whereas the eight others were non-responders with increased fibrosis in four (f-up 1.6 years). Seven of these eight patients subsequently received combined therapy for 3 years. Biochemical response was obtained in 6/7 and no further increase of fibrosis was demonstrated. Overall, fibrosis progression in non-cirrhotic patients occurred more frequently under UDCA monotherapy (4/8) than under combined therapy (0/6) (P=0.04). Conclusions: Combination of UDCA and immunosuppressors appears to be the best therapeutic option for strictly defined PBC-AIH overlap syndrome.
