疏肝清热祛湿法治疗非酒精性脂肪性肝病的临床观察  

Clinical observation on treatment of nonalcoholic fatty liver disease with Shugan Qingre Qushi principle

作　　者：贺晓芳[1] 邓力军[1] 季菲[1] 

机构地区：[1]北京市鼓楼中医医院内科,北京100009

出　　处：《中国中西医结合消化杂志》2017年第2期85-88,共4页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：北京市中医药薪火传承3+3工程项目(No:2009-JC-07)

摘　　要：[目的]探讨疏肝清热祛湿法治疗非酒精性脂肪性肝病(NFALD)的临床效果。[方法]收集2013年6月~2014年8月在我院门诊确诊为NFALD的患者91例,其中46例为中药治疗组,予口服疏肝清热祛湿中药加减,并予适当饮食、运动干预,控制血糖。另外45例为同期接受常规治疗的NFALD患者,处理措施包括饮食、运动指导,根据患者血糖、血脂情况对症用药控制血糖(二甲双胍片等)、血脂(他汀类)。观察治疗时间3个月,比较2组患者主要症状评分(右胁胀满、右胁疼痛、神疲乏力)、肝功能(ALT、AST、GGT)、血脂(TG、TC)、体质量指数(BMI)、超声诊断弥漫性脂肪肝分度。[结果]1主要症状积分:治疗前,中药治疗组(6.5±1.5)分,对照组(6.4±1.4)分,差异无统计学意义(t=0.329,P=0.743);治疗后,中药治疗组(1.8±0.6)分,对照组(2.3±0.7)分,2组症状积分均较前降低(P<0.05),且前者低于后者(t=-3.661,P<0.001)。2BMI:治疗前,中药治疗组26.2±2.3,对照组26.8±2.7,差异无统计学意义(t=-1.142,P=0.257);治疗后,中药治疗组23.9±2.5,对照组26.1±3.3,仅中药治疗组较治疗前下降明显,差异有统计学意义(P<0.05),并低于对照组(t=-3.590,P<0.001)。3肝功能与血脂:2组治疗前的血清酶、血脂数值接近(P>0.05),治疗后各指标均较治疗前改善(P<0.05),中药治疗组的各指标均值低于对照组,其中ALT、AST的组间差异有统计学意义(P<0.05)。4B超分度疗效:中药治疗组显效9例,有效24例(共治愈17例),无效13例,总有效率71.7%;对照组显效3例,有效20例(共治愈13例),无效22例,总效率51.1%(Z=-2.334,P=0.020)。[结论]中医疏肝清热祛湿法对于NFALD可能具有较好疗效,药效机理可能是基于对包括血脂在内的全身代谢的调整,但由于研究对象样本量有限,且未进行随机化处理,较为准确的结论尚需大样本随机对照研究的确认。[Objective]To investigate the efficacy of Shugan Qingre Qushi（smoothing the liver, clearing away heat and dispel dampness）principle treating NAFLD. [Methods]Selected 91 NAFLD patients of out- patient department of our hospital from June 2013 to August 2014. There were 46 patients in the Chinese medicine treatment group（treatment group）and 45 patients in the control group. Both groups were treated by guiding diet and exercise, controlling blood sugar. The treatment group was treated with oral modified Shugan Qingre Qushi decoction on the basis of the above mentioned measures. While the control group was treated with blood lipid control by oral statins. The two groups of patients were followed up for 3 months, and the main symptom scores, liver function（ALT, AST, GGT）, blood lipid, body mass index（BMI）, and the grade of homogenous fatty liver using ultrasound were observed and compared. [Results] 1. The main symptom scores were 6.5±1.5 in the treatment group,6.4±1.4 in the control group before treatment（t= 0. 329,P=0. 743）. After treatment,the main symptom scores in the treatment group and the control group were 1.8±0.6 and 2.3±0.7,which were shorter than those before treatment（P〈0.05）. The scores of treatment group were lower than those of the control group（t=-3. 661,P〈 0. 001）. 2. The BMI was 26.2 ±2.3 in the treatment group,26.8±2.7 in the control group before treatment（t=-1. 142,P= 0. 257）. After treatment,those were 23.9±2.5 and 26.1±3.3（t=-3. 590,P〈0. 001）. Only the treatment group＇s BMI was lower than before （P〈0.05）. 3. The values of serum enzyme （ ALT, AST, GGT） and blood lipid （TG,TC）were closed in two groups before treatment（P〉0.05）,and both improved after treatment（P〈 0.05）. The results of the treatment group were better than that of the control group,and the differences in ALT and AST were statistically significant（P〈0.05）. 4. The effect of ultrasound grading.9 cases signifi- cantly effective,24 effective（17 cases cur

关 键 词：非酒精性脂肪性肝病 中医 中药 疏肝清热祛湿法 

分 类 号：R259[医药卫生—中西医结合]