皂术茵陈方治疗非酒精性脂肪性肝炎的临床疗效及对游离脂肪酸和TNF-α的影响

Abstract

目的观察皂术茵陈方治疗非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)患者的临床疗效,并探讨其对游离脂肪酸(free fatty acid,FFA)及TNF-α的影响。方法采用随机数字表法将120例NASH患者分为治疗组及对照组,每组60例。治疗组予中药皂术茵陈方,每日1剂;对照组予水飞蓟宾葡甲胺片200 mg口服,每日3次,两组均治疗24周。分别于治疗前后通过检测血清ALT、AST活性及TC、TG水平;行腹部CT计算肝脾CT比值;应用肝组织病理检查评价非酒精性脂肪性肝病活动度积分(NAFLD activity score,NAS)及纤维化程度以评价临床疗效;并检测血清FFA及TNF-α含量。结果与本组治疗前比较,两组治疗后血清ALT、AST、TC、TG、FFA、TNF-α水平、肝组织NAS积分及症状体征积分均明显降低,肝纤维化程度明显改善(P<0.05,P<0.01),且治疗组降低更明显(P<0.05)。治疗24周后,治疗组肝纤维化分期总有效率及临床总有效率分别为80.00%(48/60)、85.00%(51/60),明显高于对照组[60.00%(36/60)、73.33%(44/60)],两组比较,差异有统计学意义(P<0.05,P<0.01)。结论皂术茵陈方可改善NASH患者的临床疗效,其作用可能与抑制血清FFA及TNF-α水平有关。

Objective To observe the efficacy of Zaozhu Yinchen Recipe(ZZYCR) on non-alcoholic steatohepatitis(NASH) patients, and to explore its effect on serum free fatty acid(FFA) and tumor necrosis factor α(TNF-α).Methods Totally 120 patients with NASH were randomly assigned to the treatment group(60 cases,treated with ZZYCR, one dose per day) and the control group(60 cases, treated with Silibin Meglumine Tablets, 20 mg each time, thrice per day). The therapeutic course for all was 24 weeks. Serum levels of ALT and AST activities, TC and TG levels were detected before and after treatment. Peritoneal CT was performed in all patients, and CT ratios of liver and spleen calculated. NAFLD activity score(NAS) and degree of hepatic fibrosis were assessed using pathological examinations of liver tissue, and efficacy also evaluated. Serum contents of FFA and TNF-αwere also detected. Results Compared with before treatment in the same group, activities of ALT and AST, serum levels of TC, TG, FFA, and TNF-α, NAS, scores of symptoms and signs all obviously decreased, degree of hepatic fibrosis was obviously improved in the two groups(P < 0. 05, P < 0. 01). These changes were more obviously seen in the treatment group(P < 0. 05). After 24-week treatment, the total effective rate and total clinical efficacy were 80. 00%(48/60 cases) and 85. 00%(51/60 cases) in the treatment group, obviously higher than those in the control group [60. 00%(36/60 cases) and 73. 33%(44/60 cases) respectively], with significant difference(P < 0. 05, P < 0. 01). Conclusion ZZYCR could improve the clinical efficacy of NASH patients, and its mechanism might be associated with inhibiting serum levels of FFA and TNF-α.