基于FIBROSCAN检测评价健脾疏肝活血化痰法治疗代谢相关脂肪性肝病的临床观察  

Clinical Observation on the Treatment of Metabolic-Associated Fatty Liver Disease with the Method of Invigorating Spleen,Soothing Liver,Activating Blood,and Resolving Phlegm Based on FibroScan

作　　者：李杰[1] 徐春军[1] 孙凤霞[1] 李晓玲[1] 王琮[1] 孙宁宁[1] LI Jie;XU Chun-jun;SUN Feng-xia;LI Xiao-ling;WANG Cong;SUN Ning-ning(Department of Hepatology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010)

机构地区：[1]首都医科大学附属北京中医医院肝病科,北京100010

出　　处：《世界中西医结合杂志》2023年第3期579-583,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：北京市属医院科研培育计划项目(PZ2019011)。

摘　　要：目的基于FIBROSCAN检测评价健脾疏肝活血化痰法治疗代谢相关脂肪性肝病(Metabolic associated fatty liver disease,MAFLD)的临床疗效。方法选取2018年9月—2020年2月期间于首都医科大学附属北京中医医院肝病科门诊治疗的120例脂肪肝患者,治疗过程中脱落12例,最后计入108例(所有患者均为超重并伴有脂肪堆积的患者),按照随机数字表法分为对照组和治疗组Ⅰ、治疗组Ⅱ,每组各36例。对照组单用水飞蓟宾胶囊;治疗组Ⅰ予健脾疏肝活血化痰中药内服;治疗组Ⅱ予健脾疏肝活血化痰中药内服联合穴位贴敷。治疗3个月后,观察比较3组患者治疗前后中医证候积分、血脂[包括甘油三酯(Triglyceride,TG)、总胆固醇(Total cholesterol,TC)]、空腹血糖(Fasting blood glucose,FBG)、体质量指数(Body Mass Index,BMI)、FIBROSCAN分值并评价综合疗效。结果入组所有病例纳入FIBROSCAN检测肝脏脂肪变性定量数值(CAP)相关性研究,可以发现CAP与BMI、TG、肝硬度均有明显相关性,差异有统计学意义(P<0.05),与TC、FBG未发现相关性,差异无统计学意义(P>0.05)。治疗后治疗组Ⅱ临床总有效率91.67%(33/36)、治疗组Ⅰ临床总有效率88.89%(32/36)优于对照组61.11%(22/36),差异有统计学意义(P<0.05)。治疗后对照组纳呆、乏力倦怠、胁肋胀痛积分及总积分均较治疗前明显降低,差异有统计学意义(P<0.05),而脘腹胀满及便溏积分与治疗前比较,差异无统计学意义(P>0.05);治疗组Ⅰ和治疗组Ⅱ中医证候积分与治疗前比较均明显降低,差异有统计学意义(P<0.01);治疗组Ⅰ和治疗组Ⅱ患者总积分均低于对照组,差异有统计学意义(P<0.05);治疗组Ⅱ患者脘腹胀满、胁肋胀痛积分均低于治疗组Ⅰ,差异有统计学意义(P<0.05)。治疗后治疗组Ⅰ和治疗组ⅡCAP、BMI、TG均明显低于治疗前,差异有统计学意义(P<0.05),且治疗组疗效均优于对照组,差异有统计学意义(P<0.05)。结论�Objective To evaluate the clinical efficacy of the method of invigorating spleen,soothing liver,activating blood,and resolving phlegm in the treatment of metabolic-associated fatty liver disease(MAFLD)based on FibroScan.Methods A total of 120 patients with MAFLD treated in the Department of Hepatology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University from September 2018 to February 2020 were inchuded.Since 12 patients dropped off during the treatment,108 patients(overweight with fat accumulation)were enrolled in this study and assigned into a control group and observation groups I and II according to the random number table method,with 36 patients in each group.The control group was treated with silymarin capsules,the observation group I with the Chinese medicinal prescription for invigorating spleen,soothing liver,activating blood,and resolving phlegm,and the observation group II with the Chinese medicinal prescription for invigorating spleen,soothing liver,activating blood,and resolving phlegm and acupoint application.The treatment in each group lasted for 3 months.The TCM symptom scores,blood lipid indicators[triglycerides(TG)and total cholesterol(TC)],fasting blood glucose(FBG),body mass index(BMI),and CAP score of FibroScan were compared between before and after treatment as well as among the three groups.The comprehensive clinical efficacy was evaluated for each group.Results The CAP score of FibroScan was correlated with BMI and TG(P<0.05),while it was not correlated with TC or FBG(P>0.05).The total effective rates of the observation groups II(91.67%,33/36)and I(88.89%,32/36)were higher than that(61.11%,22/36)of the control group(P<0.05).In the control group,the scores of anorexia,fatigue,and distending pain in hypochondrium and the total score of TCM symptoms significantly declined(P<0.05)and the scores of abdominal fullness and distention and loose stool did not change significantly(P>0.05)after treatment compared with those before treatment.In observation groups I and II,the sc

关 键 词：代谢相关脂肪性肝病 穴位贴敷 肝脏弹性测定 

分 类 号：R575.5[医药卫生—消化系统]