电针结合生活方式控制治疗肥胖型非酒精性脂肪性肝病:随机对照研究  

Electroacupuncture combined with lifestyle control on obese nonalcoholic fatty liver disease: a randomized controlled trial

作　　者：董灿[1] 张彩荣[1] 薛博瑜[2] 缪伟峰[1] 方南元[2] 李康 欧增建 徐钰淇 DONG Can;ZHANG Cai-rong;XUE Bo-yu;MIU Wei-feng;FANG Nan-yuan;LI Kang;OU Zeng-jian;XU Yu-qi(Department of Acupuncture and Moxibustion,Nanjing Hospital of TCM Affiliated to Nanjing University of Chinese Medicine,Nanjing 210012,Jiangsu Province,China;First Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing 210046,Jiangsu Province;Clinical Medical College of Nanjing University of Chinese Medicine)

机构地区：[1]南京中医药大学附属南京中医院针灸科,江苏南京210012 [2]南京中医药大学第一临床医学院,江苏南京210046 [3]南京中医药大学第二临床医学院

出　　处：《中国针灸》2020年第2期129-134,共6页Chinese Acupuncture & Moxibustion

基　　金：国家自然科学基金青年项目:81403376;南京市卫计委资金资助项目:YKK16167;江苏省“333工程”培养资金资助项目:(2016)Ⅲ-0094。

摘　　要：目的:观察电针结合生活方式控制对肥胖型非酒精性脂肪性肝病(NAFLD)患者肝脏脂肪情况、肝脏酶学、糖脂代谢和人体学指标的影响。方法:将90例肥胖型NAFLD患者随机分为观察组(45例,脱落4例)和对照组(45例,脱落1例)。对照组予生活方式控制;观察组在对照组的基础上予针刺中脘、曲池、水分、滑肉门、大横、关元、气海等,其中滑肉门、大横连接电针,予疏密波,频率2 Hz/100 Hz,留针30 min,隔日1次,每周3次,两组均治疗12周。比较两组治疗前后的肝脏脂肪情况[肝脏脂肪受控衰减参数(CAP)、肝脏硬度(LSM)]、肝脏酶学指标[谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰胺转移酶(GGT)]、糖脂代谢和胰岛素敏感性指标[空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、人体学参数指标[体质量(BW)、体质量指数(BMI)、体脂率(FP)、腰围(WC)、臀围(HC)和腰臀比(WHR)]的变化情况。结果:①两组治疗后肝脏CAP、LSM以及血清ALT、AST、GGT均较治疗前明显下降(P<0.05);观察组治疗后CAP、ALT低于对照组(P<0.05)。②两组治疗后FINS、HOMA-IR、TC、TG、LDL-C较治疗前明显下降(P<0.01,P<0.05),HDL-C较治疗前显著上升(P<0.05),观察组治疗后FPG较治疗前下降(P<0.05);观察组治疗后FINS、HOMA-IR、TC、TG低于对照组(P<0.05)。③两组治疗后BW、BMI、FP、WC、HC、WHR均较治疗前显著下降(P<0.01);观察组治疗后WC、WHR低于对照组(P<0.05)。结论:电针结合生活方式控制可以有效治疗肥胖型NAFLD,在改善肝脏脂肪含量、糖脂代谢、胰岛素抵抗、腰围和腰臀比方面优于单纯生活方式控制。Objective To observe the effect of electroacupuncture(EA) combined with lifestyle control on hepatic fat status, hepatic enzymology, glycolipid metabolism and anthropological parameters in patients with obese nonalcoholic fatty liver disease(NAFLD). Methods A total of 90 patients with obese NAFLD were randomized into an observation group(45 cases, 4 cases dropped off) and a control group(45 cases, 1 case dropped off). Lifestyle control was implemented in the control group. On the basis of the treatment in the control group, acupuncture was applied at Zhongwan(CV 12), Quchi(LI 11), Shuifen(CV 9), Huaroumen(ST 24), Daheng(SP 15), Guanyuan(CV 4), Qihai(CV 6), etc. EA was provided at Huaroumen(ST 24) and Daheng(SP 15) with dilatational wave, 2 Hz/100 Hz in frequency, 30 min each time, once every other day, 3 times a week. The treatment for 12 weeks was required in both of the two groups. Hepatic fat status [controlled attenuation parameter(CAP) and liver stiffness measurement(LSM)], hepatic enzymology [alanine aminotransferase(ALT), aspartate aminotransferase(AST) and γ-glutamyl transferase(GGT)], glycolipid metabolism and insulin sensitivity[fasting plasma glucose(FPG), fasting serum lisulin(FINS), homeostasis model assessment of insulin resistance(HOMA-IR), total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C)] and anthropological parameters [body weight(BW), body mass index(BMI), fat percentage(FP), waist circumference(WC), hip circumference(HC) and waist-to-hip ratio(WHR)] in the two groups were observed before and after treatment. Results ①Compared before treatment, hepatic CAP, LSM, serum ALT, AST and GGT after treatment were obviously reduced in the two groups(P<0.05, P<0.01). After treatment, CAP and ALT in the observation group were lower than the control group(P<0.05). ②Compared before treatment, FINS, HOMA-IR, LDL-C, TC and TG after treatment were obviously reduced in the two groups(P<0.05, P<0.01),while the levels of HDL-C

关 键 词：非酒精性脂肪性肝病 肥胖 电针 生活方式控制 随机对照试验 

分 类 号：R246.1[医药卫生—针灸推拿学]