盐酸小檗碱片治疗非酒精性脂肪性肝病的效果及对患者肠道菌群的影响  

Efficacy of berberine hydrochloride tablets for non-alcoholic fatty liver disease and its effect on intestinal flora of patients

作　　者：何亚红 李珍[1] 李华铭[1] HE Yahong;LI Zhen;LI Huaming(Department of Gastroenterology,Hangzhou Third People's Hospital,Hangzhou 310009,China)

机构地区：[1]杭州市第三人民医院消化内科,310009

出　　处：《浙江医学》2024年第20期2155-2160,I0003,共7页Zhejiang Medical Journal

基　　金：杭州市卫生科技计划项目(A20200209)。

摘　　要：目的观察盐酸小檗碱治疗非酒精性脂肪性肝病(NAFLD)的效果,并分析其对患者肠道菌群的影响。方法前瞻性选取2020年8月至2022年7月在杭州市第三人民医院就诊的NAFLD患者40例,采用随机数字表法将NAFLD患者分为药物治疗组10例和非药物治疗组30例,另择同期在本院体检的年龄和性别相匹配的健康志愿者10人为健康组。药物治疗组患者予低脂饮食+盐酸小檗碱片口服治疗(0.3 g/次,3次/d,疗程为12周)。非药物治疗组患者仅嘱低脂饮食治疗。比较药物治疗组与非药物治疗组患者治疗后血清肝功能指标、血脂水平、BMI等。收集3组研究对象的粪便标本进行16S核糖体DNA(16S rDNA)检测,观察肠道菌群结构的变化。结果治疗前,药物治疗组与非药物治疗组血清ALT、AST、TG、TC水平及BMI比较差异均无统计学意义(均P>0.05)。药物治疗组与非药物治疗组治疗后血清AST、TC水平比较差异均无统计学意义(均P>0.05),药物治疗组患者治疗后血清ALT、TG水平及BMI均低于非药物治疗组(均P<0.05)。与健康组比较,药物治疗组与非药物治疗组的肠道菌群丰富度一致,但各组的肠道菌群多样性存在一定差异;与非药物治疗组比较,药物治疗组主要是通过减少致病菌(疣微菌门、异杆菌属、杜氏杆菌、丹毒丝菌属)和提高抗炎菌或有益菌(拟杆菌属、毛螺菌属、罗姆布氏菌属)的丰富度来改善肠道健康。结论盐酸小檗碱片可改善NAFLD患者的脂质代谢、肝功能指标及BMI,可能通过优化肠道菌群结构起作用,主要是通过减少致病菌和提高抗炎菌或有益菌的丰富度来改善肠道健康。Objective To investigate the efficacy of berberine hydrochloride tablets for non-alcoholic fatty liver disease(NAFLD)and its effect on gut microbiota of patients.Methods Forty NAFLD patients who visited Hangzhou Third People's Hospital from August 2020 to July 2022 were randomly divided into a berberine group(10 cases)and a non medicine group(30 cases),and 10 age and gender-matched healthy subjects were enrolled as healthy control group.The berberine group received a low-fat diet and oral berberine hydrochloride tablets(0.3 g/each,3 times/day,for 12 weeks),while the non-medicine group received a low-fat diet and oral placebo.Serum liver function indicators,blood lipid levels,and BMI were compared between the berbering group and the non-medicine group after treatment.Fecal samples from all three groups were collected for 16S ribosomal DNA(16S rDNA)detection to observe changes in gut microbiota profile.Results Before treatment,there were no significant differences in serum alanine transaminase(ALT),aspartate amino-transferase(AST),triglyceride(TG),total cholesterol(TC)levels,or body mass index(BMI)between the berbering group and the non-medicine group(all P>0.05).After treatment,there were no significant differences in serum AST or TC levels between two groups(all P>0.05);however,the serum ALT,TG levels and BMI of berbering group were significantly lower than those of non-medicine group(all P<0.05).Compared to non-medicine group,the abundance of pathogenic bacteria(such as Verrucomicrobiota Allobaculum,Dubosiella and Erysipelothrix)was reduced and the abundance of anti inflammatory or beneficial bacteria(such as Bacteroides_pectinophilus_group,Lachnospiraceae and Romboutsia)was increased.Conclusion Berberine hydrochloride tablets can improve lipid metabolism,liver function indicators and BMI in NAFLD patients,which may be mediated by optimizing the gut microbiota profile.

关 键 词：非酒精性脂肪性肝病 肠道菌群 16S核糖体DNA 盐酸小檗碱片 

分 类 号：R575.5[医药卫生—消化系统]