本文選題：非酒精性脂肪性肝病 + 消脂清肝湯　； 參考：《中國(guó)中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：背景:非酒精性脂肪性肝病(NAFLD)是一種與胰島素抵抗(IR)和遺傳易感性相關(guān)的代謝應(yīng)激性肝損傷,已成為發(fā)達(dá)國(guó)家慢性肝病的首要病因,也是我國(guó)臨床常見病和多發(fā)病。除直接或通過(guò)促進(jìn)并存的其他肝病的進(jìn)展,導(dǎo)致肝衰竭和肝細(xì)胞癌(HCC)外,NAFLD還參與2型糖尿病和動(dòng)脈硬化等疾病的發(fā)病。積極治療此病可減少肝纖維化、肝硬化的發(fā)生,并減少代謝綜合征及心、腦血管事件的發(fā)生。中醫(yī)藥治療本病積累了豐富的臨床經(jīng)驗(yàn),療效顯著。臨床上普遍認(rèn)為,本病病理因素以痰濁、瘀血為著,臨床上本病亦多以痰阻血瘀證型多見。消脂清肝湯(炒白術(shù),澤瀉,綿萆參,丹參,生山楂,制首烏,茵陳,荷葉,決明子,雞骨草,虎杖,紅曲等)是中國(guó)中醫(yī)科學(xué)院西苑醫(yī)院肝病科治療NAFLD的臨床有效方劑,本方針對(duì)痰阻血瘀的病理基礎(chǔ)組方,經(jīng)過(guò)前期的基礎(chǔ)研究(藥效學(xué)、急性毒理)和臨床觀察已證實(shí)其療效確切,是臨床治療NAFLD的有效方劑。目的:依據(jù)中醫(yī)學(xué)理論和臨床實(shí)踐,結(jié)合現(xiàn)代醫(yī)學(xué),觀察中藥效方消脂清肝湯對(duì)于非酒精性脂肪性肝病患者的臨床療效:生化學(xué)改善率(肝功能、血脂)、中醫(yī)癥狀改善率、體征消失率、影像學(xué)改變率(B超);并通過(guò)相關(guān)指標(biāo)檢測(cè)探索其可能的作用機(jī)制:抗炎(TNF-α)、降脂(TC、TG、FFA)、抗氧化(MDA、SOD)、對(duì)抗胰島素抵抗(HOMA-IR、脂聯(lián)素)。方法:本臨床研究來(lái)源于北京市中醫(yī)藥科技發(fā)展資金項(xiàng)目(2014-JJ42),由西苑醫(yī)院肝病科確診為NAFLD痰阻血瘀型患者60例進(jìn)行臨床研究,采用隨機(jī)分配原則,將60例合格對(duì)象分為治療組30例,對(duì)照組30例。治療組予消脂清肝湯,1次1袋(100ml),1日2次,治療16周;對(duì)照組予多烯磷脂酰膽堿膠囊,1次2粒(456mg),1日3次,治療16周。觀察指標(biāo)包括體重、腰圍、中醫(yī)證侯、腹部超聲、血脂、肝功能、空腹血糖、胰島素、腫瘤壞死因子、血清超氧化物歧化酶、血清丙二醛、游離脂肪酸、脂聯(lián)素等。觀察兩組的治療差異。結(jié)果:1.治療組的總有效率86.7%,對(duì)照組的總有效率76.7%,治療8周后、治療16周后未見明顯不良反應(yīng)。治療組與對(duì)照組的總體療效相對(duì)比,治療組明顯優(yōu)于對(duì)照組(P0.05)。2.治療后兩組癥狀體征相互比較:治療組的療效在脅肋脹悶或痛、脘腹脹滿、食欲不振、惡心暖氣、形體肥胖等癥狀體征上,治療組顯著優(yōu)于對(duì)照組(P0.05);便溏不爽、倦怠乏力等癥狀體征與對(duì)照組療效差異不顯著,無(wú)從比較(P0.05)。3.治療后兩組肝功能相互比較:治療組療效在AST、GGT上,顯著優(yōu)于對(duì)照組(P0.05);在ALT、TBiL上差異不顯著,無(wú)從比較(P0.05)。治療組用藥后肝功能改善效果優(yōu)于對(duì)照組。4.治療后兩組血脂相互比較:治療組療效在TC、TG上,顯著優(yōu)于對(duì)照組(P0.05);在HDL-C、LDL-C上治療組與對(duì)照組療效差異不顯著,無(wú)從比較(P0.05)。5.治療后兩組炎癥壞死及血脂相關(guān)指標(biāo)比較:治療組治療后,患者胰島素、TNF-α、SOD、MDA、FFA、IR指數(shù)均有非常明顯改善(P0.01),空腹血糖、ADP均有明顯改善(P0.05);對(duì)照組治療后,患者M(jìn)DA、IR指數(shù)均有非常明顯改善(P0.01),空腹血糖、胰島素、TNF-α、SOD、FFA、ADP均有明顯改善(P0.05)。兩組治療后互相比較,治療組療效在MDA、ADP上,非常顯著優(yōu)于對(duì)照組(P0.01);在SOD、FFA療效上治療組顯著優(yōu)于對(duì)照組(P0.05);在空腹血糖、胰島素、TNF-α、IR指數(shù)上治療組與對(duì)照組差異不顯著,無(wú)從比較(P0.05)。結(jié)論:1.治療組使用消脂清肝湯治療非酒精性脂肪性肝病(痰阻血瘀型)患者的臨床療效顯著優(yōu)于使用多烯磷脂酰膽堿膠囊治療的對(duì)照組。2.本方治療非酒精性脂肪性肝病的作用,可能與抗炎(TNF-α)、降脂(TC、TG、FFA)、抗氧化(MDA、SOD)、對(duì)抗胰島素抵抗(HOMA-IR、脂聯(lián)素)有關(guān)。
[Abstract]:Background: nonalcoholic fatty liver disease (NAFLD) is a metabolic stress liver injury associated with insulin resistance (IR) and genetic susceptibility. It has become the primary cause of chronic liver disease in developed countries. It is also a common and frequently occurring disease in our country. HCC), in addition, NAFLD is also involved in the pathogenesis of type 2 diabetes and arteriosclerosis. The active treatment of this disease can reduce liver fibrosis, liver cirrhosis, and reduce the occurrence of metabolic syndrome and heart and cerebrovascular events. It is a clinical effective prescription for the treatment of NAFLD in the Xiyuan Hospital of Chinese Academy of science of traditional Chinese medicine (Chinese Academy of Chinese Medicine), which aims at the pathological basis of phlegm obstructing blood stasis. The basic research (pharmacodynamics, acute toxicology) and clinical observation has proved its effective curative effect, and it is an effective prescription for clinical treatment of NAFLD. Objective: To observe the clinical efficacy of the decoction of Xiao Zhi Qinggan Decoction on non-alcoholic fatty liver disease according to the theory of traditional Chinese medicine and clinical practice and modern medicine: the clinical efficacy of the decoction of Chinese medicine Xiao Zhi Qinggan Decoction The improvement rate (liver function, blood lipid), the improvement rate of TCM symptoms, the rate of signs disappearance, and the rate of imaging change (B ultrasonic); and explore the possible mechanism of action by the related indexes: anti inflammatory (TNF- alpha), lipid lowering (TC, TG, FFA), anti oxidation (MDA, SOD), anti Isle resistance (HOMA-IR, adiponectin). Methods: This clinical study originated from the science and technology of traditional Chinese medicine in Beijing. The development fund project (2014-JJ42), 60 cases of NAFLD phlegm stasis type patients diagnosed by the liver disease department of Xiyuan Hospital, were divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was treated with fat clearing liver soup, 1 times 1 bags (100ml), 2 times 1 days for 16 weeks, and the control group was given Polyene Phosphatidylcholine Capsules, 1 times 2 tablets (456mg), 3 times 1 days, treatment for 16 weeks. The observation indexes included body weight, waist circumference, TCM syndrome, abdominal ultrasound, blood lipid, liver function, fasting blood glucose, insulin, tumor necrosis factor, serum superoxide dismutase, serum malondialdehyde, free fatty acid, adiponectin, and so on. Observe the treatment difference between the two groups. Results: the total effective rate of the 1. treatment group was 86.7%, to the 1. treatment group. The total effective rate of the group was 76.7%. After the treatment for 8 weeks, there was no obvious adverse reaction after 16 weeks of treatment. The treatment group was compared with the control group. The treatment group was obviously better than the control group (P0.05) and the two groups of symptoms and signs were compared with the control group. The curative effect of the treatment group was in the ribs distension or pain, abdominal distention, loss of appetite, nausea and heat, and body obesity. On the symptoms and signs, the treatment group was significantly better than the control group (P0.05). The symptoms of loose stools and fatigue were not significantly different from those in the control group. The two groups of liver functions were compared in the treatment group after P0.05.3. treatment: the treatment group was significantly better than the control group (P0.05) on the effect of AST and GGT; there was no significant difference on ALT, TBiL, and no comparison (P0.05). The effect of liver function improvement in the treatment group was better than that of the control group after.4. treatment. The curative effect of the treatment group was significantly better than the control group (P0.05) in the treatment group on TC and TG; in HDL-C, the treatment group was not significantly different from the control group, and the two groups of inflammatory necrosis and blood lipid related indexes after P0.05.5. treatment were compared: the treatment group was treated with the treatment group. After that, the patients' insulin, TNF- alpha, SOD, MDA, FFA, IR index were significantly improved (P0.01), the fasting blood glucose and ADP were significantly improved (P0.05), and the MDA, IR index of the patients in the control group were significantly improved (P0.01). The two groups were compared with each other after treatment. The treatment group was treated with each other after treatment. The effect on MDA and ADP was significantly better than that of the control group (P0.01); in SOD, the curative effect of FFA was significantly better than that of the control group (P0.05), and there was no significant difference between the treatment group and the control group on the fasting blood glucose, insulin, TNF- alpha and IR index. Conclusion: the 1. treatment group was treated with the treatment of non-alcoholic fatty liver disease (phlegm stasis and blood stasis type) by using the decoction of clearing fat and clearing liver. The clinical efficacy of the patient is significantly better than that of the control group.2. treated with Polyene Phosphatidylcholine Capsules. The effect of the prescription on nonalcoholic fatty liver disease may be related to anti inflammatory (TNF- alpha), lipid lowering (TC, TG, FFA), antioxidant (MDA, SOD), and against insulin resistance (HOMA-IR, adiponectin).
【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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