化痰祛濕活血方對NASH患者內(nèi)毒素、膽汁酸、肝腸循環(huán)的影響
發(fā)布時間：2018-08-01 11:57
【摘要】：目的:經(jīng)對比觀察非酒精性脂肪性肝炎(NASH)患者試驗組與對照組用藥前后血清中內(nèi)毒素(ET)、膽汁酸(TBA)和患者大便桿球比的檢測數(shù)值變化情況,以研究化痰祛濕活血方對NASH患者內(nèi)毒素、膽汁酸、肝腸循環(huán)的影響,從而探究化痰祛濕活血方治療NASH的作用機制。經(jīng)比較NASH患者用藥前后及研究過程中谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、游離脂肪酸(FFA)、甘油三酯(TG)、膽固醇(TC)等血清生化指標(biāo)變化,并對比用藥前后受試患者血漿粘度、紅細(xì)胞壓積、肝脾CT比值、體重指數(shù)(BMI)、腰臀圍比(WHR)以及中醫(yī)癥候積分等臨床療效指標(biāo)的數(shù)值變化以綜合評價化痰祛濕活血方對NASH的臨床療效。方法:收取60例符合NASH診斷和納入要求的患者為研究對象,按其就診先后順序隨機分為試驗組(30例)和對照組(30例)。兩組均在科學(xué)調(diào)理飲食,增強適當(dāng)有氧運動和健康宣教的基礎(chǔ)上給予藥物治療。試驗組藥用加減化痰祛濕活血方顆粒,每天1劑,早晚沖服;對照組藥用多烯磷脂酰膽堿(易善復(fù))膠囊,1次456mg,每天3次,療程均為3個月。對初診首日及用藥第90天前后的入組患者測體重、身高以計算出體重指數(shù)(BMI),測腰圍、臀圍以計算出腰臀圍比(WHR);抽取患者清晨空腹8小時以上肘靜脈血非抗凝血5ml,離心留取血清,用酶聯(lián)免疫吸附(ELISA)法測定并觀察兩組患者用藥前后血清ET及TBA數(shù)值變化;記錄患者用藥前后肝脾CT比值、大便桿球比值、血漿粘度、紅細(xì)胞壓積的數(shù)值變化;以及患者在用藥前后及期間ALT、AST、FFA、TG、TC等生化指標(biāo)數(shù)值的變化情況。結(jié)果:1、兩組患者血清內(nèi)毒素檢測值用藥后均較用藥前下降(P0.05),試驗組與對照組相比下降較為顯著,兩組患者用藥后內(nèi)毒素檢測值比較有顯然差異(P0.05)。兩組患者血清總膽汁酸檢測值用藥后均較用藥前下降(P0.05),試驗組與對照組相比下降明顯,兩組患者用藥后膽汁酸檢測值比較有顯然差異(P0.05)。兩組患者大便桿球比值較用藥前均升高,試驗組差異明顯(P0.01),但對照組無明顯差異(P0.05),兩組患者用藥后大便桿球比值相比有顯著差異(P0.01)。2、兩組患者用藥后肝功(ALT、AST)檢測值較用藥前均有顯著下降(P0.05),而兩組患者用藥后ALT、AST水平相比無明顯差異(P0.05)。兩組患者用藥后血脂(TG、TC、FFA)檢測值對比差異顯著(P0.01),試驗組用藥后血脂(TG、TC、FFA)檢測值較用藥前均有顯著下降(P0.01),而對照組患者用藥后血脂(TG、TC、FFA)檢測值較用藥前無明顯差別(P0.05)。3、兩組患者肝脾CT比值用藥后較用藥前均有所升高(P0.05),且試驗組相比對照組升高更顯著,兩組患者用藥后肝脾CT比值對比有顯著差異(P0.05)。4、兩組體重指數(shù)及腰臀圍比值用藥后均較用藥前下降(P0.05),試驗組相比對照組降低明顯,兩組用藥后體重指數(shù)、腰臀圍比值相比有顯著差異(P0.05)。5、兩組血漿粘度及紅細(xì)胞壓積用藥后均較用藥前下降(P0.05),試驗組相比對照組降低明顯,兩組用藥后血漿粘度、紅細(xì)胞壓積相比有顯然差異(P0.05)。6、兩組患者癥候積分計算值用藥后均較用藥前下降(P0.05),且試驗組相比對照組下降更顯著,兩組患者用藥后癥候積分計算值相比有顯著差異(P0.01)。兩組患者治療效果比較,試驗組相比對照組療效更為顯著,差異明顯(P0.01)。結(jié)論:1、化痰祛濕活血方可降低NASH患者血清ET、TBA檢測值,升高NASH患者的大便桿球比值,表明化痰祛濕活血方可能通過調(diào)節(jié)NASH患者腸道菌群,降低LPS、TBA水平,達到治療NASH的效果。2、化痰祛濕活血方可降低NASH患者血ALT、AST、FFA、TG、TC檢測值,表明化痰祛濕活血方能抑制肝臟炎癥,改善脂質(zhì)代謝。3、化痰祛濕活血方可提高NASH患者肝脾CT比值,表明化痰祛濕活血方可改善NASH患者肝臟脂肪變的程度。4、化痰祛濕活血方可降低NASH患者的BMI、WHR,表明化痰祛濕活血方可通過減輕體重,縮小腰圍達到減輕肝臟脂肪變的程度。5、化痰祛濕活血方可使血漿粘度、紅細(xì)胞壓積檢測值下降,表明化痰祛濕活血方能降低NASH患者的血液粘稠度。6、化痰祛濕活血方可顯著降低NASH患者的中醫(yī)癥候積分,表明化痰祛濕活血方能顯著改善NASH患者的臨床癥狀,提高NASH的治療效果。
[Abstract]:Objective: To observe the changes of serum endotoxin (ET), bile acid (TBA) and stool ball ratio in patients with non-alcoholic steatohepatitis (NASH) before and after treatment, in order to study the effect of eliminating phlegm and eliminating dampness and activating blood on endotoxin, bile acid and hepatic intestinal circulation in NASH patients, thus exploring phlegm and eliminating dampness and activating blood circulation. The mechanism of the treatment of NASH was made by comparing the serum biochemical indexes of NASH patients before and after the treatment and the study process, such as ALT, AST, FFA, triglyceride (TG), and cholesterol (TC), and compared the plasma viscosity, the hematocrit, the CT ratio of the liver and spleen, the body mass index (BMI), and the waist of the subjects before and after the drug use. The clinical curative effect of the hip circumference ratio (WHR) and the TCM syndrome score in order to evaluate the clinical effect of the decoction of eliminating phlegm and eliminating dampness and activating blood on NASH. Methods: 60 cases of patients who were in accordance with the NASH diagnosis and the requirements were collected and divided into the test group (30 cases) and the control group (30 cases). The two groups were all in science. On the basis of conditioning diet and strengthening proper aerobic exercise and health education, the experimental group was treated with 1 doses of medicine and reduction of eliminating phlegm, eliminating dampness and activating blood circulation, taking 1 doses a day, and taking the medicine of polyene phosphatidylcholine (Yi Shanfu) capsules, 1 times a day, 3 times a day for 3 months. The first day of first visit and ninetieth days before and after medication were taken into group. The patient measured body weight and height to calculate body mass index (BMI), waist circumference, hip circumference ratio (WHR), non anticoagulant 5ml in the elbow vein blood of more than 8 hours in the early morning of the patient, centrifugation and serum, and the changes of ET and TBA in the serum of two groups before and after the use of enzyme linked immunosorbent assay (ELISA). The changes in the CT ratio of liver and spleen, the ratio of stool ball, plasma viscosity, and hematocrit, and the changes of ALT, AST, FFA, TG, TC in patients before and after the drug use. Results: 1, the serum endotoxin test values of the two groups were lower than before the medication (P0.05), and the decrease of the test group was more significant than that of the control group. There was obvious difference between the two groups of patients with endotoxin test (P0.05). The total bile acid detection value in the two groups was lower than before the medication (P0.05), the test group was significantly lower than the control group. The two groups of patients had significant difference in the bile acid detection value after the medication (P0.05). The ratio of the bowels ball in the two groups was more than before the drug use. The difference of the test group was significant (P0.01), but there was no significant difference (P0.05) in the control group (P0.05). The ratio of the stool ball in the two groups was significantly different (P0.01).2. The test values of liver function (ALT, AST) after drug use were significantly lower than before the medication (P0.05), but there was no significant difference in the level of ALT and AST (P0.05) between the two groups after medication (P0.05). The blood lipid (TG, TC, FFA) in the test group had a significant difference (P0.01). The serum lipid (TG, TC, FFA) test values of the experimental group were significantly lower than that before the medication (P0.01), while the blood lipid (TG, TC, FFA) in the control group had no significant difference (P0.05) after the drug use (P0.05), and the two groups were higher than before. High (P0.05), and the test group increased significantly compared with the control group, two groups of patients after the liver and spleen CT ratio was significantly different (P0.05).4, two groups of body mass index and waist hip ratio after medication decreased compared with before the medication (P0.05), compared with the control group decreased significantly, the two groups after the use of body mass index, waist hip circumference ratio is significantly different (P0. 05).5, the plasma viscosity and hematocrit in the two groups were lower than that before the medication (P0.05), and the test group was significantly lower than the control group. The plasma viscosity of the two groups was obviously different (P0.05).6 compared with the red blood cell pressure, and the value of the syndrome score in the two group was lower than that before the medication (P0.05), and the test group decreased more than the control group. There was significant difference between the two groups of patients after medication (P0.01). Compared with the control group, the effect of the two groups was more significant than the control group, the difference was obvious (P0.01). Conclusion: 1, phlegm dispelling dampness and activating blood can reduce the serum ET, TBA test value of the patients with NASH, increase the ratio of the stool rod ball in the NASH patients, and show the phlegm and dispelling dampness. The Huoxue recipe may reduce the LPS and TBA levels by regulating the intestinal flora of NASH patients and reduce the level of LPS and TBA. The recipe for eliminating phlegm and eliminating dampness and activating blood can reduce the serum ALT, AST, FFA, TG, TC detection values of NASH patients. It shows that the recipe of eliminating phlegm and activating blood can inhibit the liver inflammation and improve the lipid metabolism.3. Eliminating phlegm, removing dampness and activating blood circulation can improve the degree of liver fat change in NASH patients.4, eliminating phlegm and eliminating dampness and activating blood can reduce the BMI and WHR of NASH patients. It shows that the prescription of eliminating phlegm and activating blood can reduce the degree of liver fat by reducing the body weight and reducing the degree of liver fat.5. The prescription of phlegm dispelling dampness and activating blood can reduce the blood viscosity of NASH patients.6, the recipe of eliminating phlegm and eliminating dampness and activating blood can significantly reduce the TCM syndrome score of the patients with NASH, which indicates that the prescription of eliminating phlegm and activating blood can improve the clinical symptoms of NASH patients and improve the therapeutic effect of NASH.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259
[Abstract]:Objective: To observe the changes of serum endotoxin (ET), bile acid (TBA) and stool ball ratio in patients with non-alcoholic steatohepatitis (NASH) before and after treatment, in order to study the effect of eliminating phlegm and eliminating dampness and activating blood on endotoxin, bile acid and hepatic intestinal circulation in NASH patients, thus exploring phlegm and eliminating dampness and activating blood circulation. The mechanism of the treatment of NASH was made by comparing the serum biochemical indexes of NASH patients before and after the treatment and the study process, such as ALT, AST, FFA, triglyceride (TG), and cholesterol (TC), and compared the plasma viscosity, the hematocrit, the CT ratio of the liver and spleen, the body mass index (BMI), and the waist of the subjects before and after the drug use. The clinical curative effect of the hip circumference ratio (WHR) and the TCM syndrome score in order to evaluate the clinical effect of the decoction of eliminating phlegm and eliminating dampness and activating blood on NASH. Methods: 60 cases of patients who were in accordance with the NASH diagnosis and the requirements were collected and divided into the test group (30 cases) and the control group (30 cases). The two groups were all in science. On the basis of conditioning diet and strengthening proper aerobic exercise and health education, the experimental group was treated with 1 doses of medicine and reduction of eliminating phlegm, eliminating dampness and activating blood circulation, taking 1 doses a day, and taking the medicine of polyene phosphatidylcholine (Yi Shanfu) capsules, 1 times a day, 3 times a day for 3 months. The first day of first visit and ninetieth days before and after medication were taken into group. The patient measured body weight and height to calculate body mass index (BMI), waist circumference, hip circumference ratio (WHR), non anticoagulant 5ml in the elbow vein blood of more than 8 hours in the early morning of the patient, centrifugation and serum, and the changes of ET and TBA in the serum of two groups before and after the use of enzyme linked immunosorbent assay (ELISA). The changes in the CT ratio of liver and spleen, the ratio of stool ball, plasma viscosity, and hematocrit, and the changes of ALT, AST, FFA, TG, TC in patients before and after the drug use. Results: 1, the serum endotoxin test values of the two groups were lower than before the medication (P0.05), and the decrease of the test group was more significant than that of the control group. There was obvious difference between the two groups of patients with endotoxin test (P0.05). The total bile acid detection value in the two groups was lower than before the medication (P0.05), the test group was significantly lower than the control group. The two groups of patients had significant difference in the bile acid detection value after the medication (P0.05). The ratio of the bowels ball in the two groups was more than before the drug use. The difference of the test group was significant (P0.01), but there was no significant difference (P0.05) in the control group (P0.05). The ratio of the stool ball in the two groups was significantly different (P0.01).2. The test values of liver function (ALT, AST) after drug use were significantly lower than before the medication (P0.05), but there was no significant difference in the level of ALT and AST (P0.05) between the two groups after medication (P0.05). The blood lipid (TG, TC, FFA) in the test group had a significant difference (P0.01). The serum lipid (TG, TC, FFA) test values of the experimental group were significantly lower than that before the medication (P0.01), while the blood lipid (TG, TC, FFA) in the control group had no significant difference (P0.05) after the drug use (P0.05), and the two groups were higher than before. High (P0.05), and the test group increased significantly compared with the control group, two groups of patients after the liver and spleen CT ratio was significantly different (P0.05).4, two groups of body mass index and waist hip ratio after medication decreased compared with before the medication (P0.05), compared with the control group decreased significantly, the two groups after the use of body mass index, waist hip circumference ratio is significantly different (P0. 05).5, the plasma viscosity and hematocrit in the two groups were lower than that before the medication (P0.05), and the test group was significantly lower than the control group. The plasma viscosity of the two groups was obviously different (P0.05).6 compared with the red blood cell pressure, and the value of the syndrome score in the two group was lower than that before the medication (P0.05), and the test group decreased more than the control group. There was significant difference between the two groups of patients after medication (P0.01). Compared with the control group, the effect of the two groups was more significant than the control group, the difference was obvious (P0.01). Conclusion: 1, phlegm dispelling dampness and activating blood can reduce the serum ET, TBA test value of the patients with NASH, increase the ratio of the stool rod ball in the NASH patients, and show the phlegm and dispelling dampness. The Huoxue recipe may reduce the LPS and TBA levels by regulating the intestinal flora of NASH patients and reduce the level of LPS and TBA. The recipe for eliminating phlegm and eliminating dampness and activating blood can reduce the serum ALT, AST, FFA, TG, TC detection values of NASH patients. It shows that the recipe of eliminating phlegm and activating blood can inhibit the liver inflammation and improve the lipid metabolism.3. Eliminating phlegm, removing dampness and activating blood circulation can improve the degree of liver fat change in NASH patients.4, eliminating phlegm and eliminating dampness and activating blood can reduce the BMI and WHR of NASH patients. It shows that the prescription of eliminating phlegm and activating blood can reduce the degree of liver fat by reducing the body weight and reducing the degree of liver fat.5. The prescription of phlegm dispelling dampness and activating blood can reduce the blood viscosity of NASH patients.6, the recipe of eliminating phlegm and eliminating dampness and activating blood can significantly reduce the TCM syndrome score of the patients with NASH, which indicates that the prescription of eliminating phlegm and activating blood can improve the clinical symptoms of NASH patients and improve the therapeutic effect of NASH.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259
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1 金政和之;林紫雯;;NASH的肝穿刺活組織檢查[J];日本醫(yī)學(xué)介紹;2007年04期
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