葛根芩连汤联合恩替卡韦治疗乙型肝炎后肝硬化合并糖代谢异常对脂肪细胞因子和肝纤维化指标的影响  

Effect of Gegen Qinlian Decoction combined with entecavir on adipocytokines and liver fibrosis indexes in the treatment of hepatic cirrhosis with abnormal glucose metabolism after hepatitis B

作　　者：苟娟[1] 李鳌 金梅[1] GOU Juan;LI Ao;JIN Mei(Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院,重庆402160

出　　处：《现代中西医结合杂志》2018年第36期4028-4032,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察葛根芩连汤联合恩替卡韦治疗乙型肝炎后肝硬化合并糖代谢异常患者的临床疗效及对脂肪细胞因子和肝纤维化指标的影响。方法将97例乙型肝炎后肝硬化合并糖代谢异常患者随机分为对照组(48例)和观察组(49例),对照组给予常规综合调节血糖及恩替卡韦片治疗,观察组在对照组基础上加用葛根芩连汤治疗,2组均以3个月为1个疗程。观察2组治疗前及治疗1个疗程后肝功能指标[天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)]、血糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)]、血清脂肪因子(瘦素、内脂素、脂联素、网膜素)和肝纤维化指标[层黏连蛋白(LN)、透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)和Ⅲ型前胶原肽(PC-Ⅲ)]水平的变化情况,统计2组治疗1个疗程后中医症候疗效和糖代谢异常疗效。结果 2组治疗后肝功能指标、血糖代谢指标、肝纤维化指标水平均较治疗前显著降低(P均<0. 05),且观察组治疗后以上指标水平均显著低于对照组(P均<0. 05)。2组治疗后血清瘦素、内脂素水平均显著降低(P均<0. 05),且观察组均显著低于对照组(P均<0. 05);脂联素、网膜素水平均显著升高(P均<0. 05),且观察组均显著高于对照组(P均<0. 05)。观察组中医症候治疗总有效率、糖代谢异常治疗总有效率均显著高于对照组(P均<0. 05)。结论葛根芩连汤联合恩替卡韦可显著改善乙型肝炎后肝硬化合并糖代谢异常患者中医症候、糖代谢异常状态及肝功能,调节血清脂肪因子表达,并可抑制肝纤维化。Objective It is to observe the clinical efficacy of Gegen Qinlian Decoction combined with entecavir in the treatment of patients with cirrhosis and abnormal glucose metabolism after hepatitis B and its effects on adipocytokines and liver fibrosis indexes.Methods 97 patients with post-hepatitis B cirrhosis and abnormal glucose metabolism were randomly divided into control group(48 cases)and observation group(49 cases).The control group received routine comprehensive regulation of blood glucose and entecavir tablets.The observation group was treated with Gegen Qinlian Decoction based on the control group,both groups were treated for 3 months.The changes of liver function indexes[(aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBil)],blood glucose metabolism indexes[fasting blood glucose(FPG),postprandial 2h blood glucose(2hPG),fasting insulin(FINS)and insulin resistance index(HOMA-IR)],serum adipokines(leptin,visfatin,adiponectin,retinoid)and liver fibrosis indexes[Laminin(LN),Hyaluronic Acid(HA),TypeⅣCollagen(Ⅳ-C)and TypeⅢprocollagen peptide(PC-Ⅲ)]were observed before and after 1 course of treatment in the two groups.The curative effect of TCM symptoms and abnormal glucose metabolism were assessed in the two groups.Results The levels of liver function indexes,blood glucose metabolism indexes and liver fibrosis indexes in the two groups were significantly lower than those before treatment in the two groups(P<0.05),and the above indicators were significantly lower in the observation group than those in the control group(P<0.05).After treatment,the levels of serum leptin and visfatin were significantly lower while that of adiponectin and reticulum were significantly higher than those before treatment in the two groups(P<0.05),and the improvements of these indexes in the observation group were significantly better than those in the control group(P<0.05).The total effective rates of TCM symptom and abnormal glucose metabolism were significantly higher in the observation group than

关 键 词：葛根芩连汤 恩替卡韦 乙型肝炎后肝硬化 糖代谢异常 脂肪细胞因子 肝纤维化 

分 类 号：R657.31[医药卫生—外科学]