中药降脂汤联合辛伐他汀治疗非酒精性脂肪肝疗效观察

目的:观察对非酒精性脂肪肝(Nonalcoholic Fatty Liver Disease,NAFLD)应用中药降脂汤联合辛伐他汀进行治疗的疗效。方法:从2016年8月-2019年8月期间于我院接受治疗的非酒精性脂肪肝患者中选取45例,给予其辛伐他汀进行治疗,以此作为本次研究的对照组;另取同期45例患者,在对照组的治疗基础上联合应用中药降脂汤进行治疗,以此作为本次研究的试验组。观察并对比患者的血脂水平、肝功能指标变化及中医症状积分。结果:治疗后,试验组患者的总胆固醇(Total Cholesterol,TC)、三酰甘油(Triglycerides,TG)及低密度脂蛋白胆固醇(Low Density Lipoprotein Cholesterol,LDL-C)水平较对照组患者明显下降(P<0.05);试验组患者的丙氨酸氨基转移酶(Alanine Transaminase,ALT)、门冬氨酸氨基转移酶(Aspartate Aminotransferase,AST)、碱性磷酸酶(Alkaline Phosphatase,ALP)及γ-谷氨酰转肽酶(Gamma-glutamyl Transferase,GGT)数值较对照组患者下降明显(P<0.05)。治疗前,两组患者主症、次症证候积分差异无统计学意义(P>0.05);治疗后,试验组患者主症、次症症状积分均显著低于对照组,差异有统计学意义(P<0.05)。结论:对非酒精性脂肪肝患者应用中药降脂汤联合辛伐他汀进行治疗,可以有效改善临床症状,降低血脂水平,对患者的恢复及预后具有积极作用。     

二陈汤加减治疗非酒精性脂肪肝30例临床观察

笔者临床运用二陈汤加减治疗非酒精性脂肪肝,疗效让人满意。     

小柴胡汤加减对代谢相关性脂肪性肝病患者肝功能及胰岛素抵抗的影响

目的:探讨小柴胡汤加减对代谢相关性脂肪性肝病患者肝功能及胰岛素抵抗的影响。方法:将70例代谢相关性脂肪性肝病患者,按随机数字表法分为对照组(35例,给予水飞蓟宾胶囊治疗)和研究组(35例,在对照组治疗基础上给予小柴胡汤加减治疗)。观察治疗前后两组中医证候积分、肝功能、胰岛素抵抗指数,统计临床疗效。结果:治疗前,两组胸胁胀闷、郁郁微烦、身体困重、腹胀不适、时欲太息、恶心欲吐、食少纳呆中医证候评分及γ-谷氨酰基转移酶(γ-GT)、脂肪肝指数(FLI)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)水平比较差异均无统计学意义(P>0.05); 治疗后,两组胸胁胀闷、郁郁微烦、身体困重、腹胀不适、时欲太息、恶心欲吐、食少纳呆中医证候评分及γ-GT、FLI、AST、ALP、ALT、FBG、FINS、HOMA-IR水平均较治疗前降低,与对照组相比,研究组胸胁胀闷、郁郁微烦、身体困重、腹胀不适、时欲太息、恶心欲吐、食少纳呆中医证候评分及γ-GT、FLI、AST、ALP、ALT、FBG、FINS、HOMA-IR水平较低,临床疗效更高,差异有统计学意义(均P<0.05)。结论:小柴胡汤加减可有效改善代谢相关性脂肪性肝病患者肝功能,降低胰岛素抵抗水平,疗效显著。     

非酒精性脂肪肝相关危险因素分析

目的：通过流行病学调查,分析NAFLD的相关危险因素,为NAFLD的防治提供理论依据。方法：805人依据体检情况分为NAFLD组和非NAFLD组。所得数据用SPSS15.0软件包进行统计,计量资料行t检验,计数资料行x2检验,患病率随年龄升高趋势行线性趋势检验,多因素分析采用Logistic回归分析。分析年龄、性别、BMI、血压、血脂、血糖等因素与NAFLD的相关性。结果：①男性NAFLD患病率（30.58%）大于女性患病率（19.49%）（P〈0.01）;女性NAFLD患病率随年龄增长呈升高趋势（P〈0.01）。②对NAFLD危险因素指标进行Logistic多因素逐步回归分析,结果显示TG、BMI、FBG、性别（男性）、DBP是NAFLD形成的主要危险因素。结论：NAFLD形成的主要危险因素包括TG、BMI、FBG、DBP、性别（男性）。     

益气通阳化痰方治疗2型糖尿病合并非酒精性脂肪肝的临床研究

目的观察益气通阳化痰方对2型糖尿病合并非酒精性脂肪肝NAFLD的治疗效果。方法将80例确诊为NAFLD的患者按入选顺序随机分成实验组和对照组,每组40例。2组患者均接受基础治疗,实验组在此基础上加服益气通阳化痰方。2组疗程均为3个月。于治疗前后进行疾病活动指数(DAI)评分、肝脏B超检查及血糖、血脂、肝功能、胰岛素抵抗程度、血浆脂联素、瘦素以及游离脂肪酸(FFA)的检测。结果治疗后实验组DAI显著优于对照组。2组患者治疗后血糖、血脂、肝功能以及胰岛素抵抗程度均有一定的改善,但实验组改善程度更加明显。2组患者在治疗后血浆脂联素和瘦素水平升高,FFA降低,但实验组改变程度更加显著。2组患者治疗后NAFLD均有不同程度的逆转,实验组治疗后呈显著逆转,治疗后3个月实验组FLD等级显著低于对照组。结论益气通阳化痰方可改善NAFLD患者的临床症状、脂肪肝分度、肝功能、血糖、血脂及胰岛素抵抗程度。     

Thymoquinone attenuates hepatic lipid accumulation by inducing autophagy via AMPK/mTOR/ULK1-dependent pathway in nonalcoholic fatty liver disease

Thymoquinone (TQ) has been proved to exert wide-ranging pharmacological activities, with anti-inflammatory, antioxidant, anticonvulsant, antimicrobial, anti-tumor, and antidiabetic properties. In this study, we investigated the beneficial effects of TQ on a high-fat diet (HFD)-induced nonalcoholic fatty liver disease (NAFLD) in C57BL/6 N mice in vivo and free fatty acid (FFA)-induced human hepatocellular carcinoma HepG2 cells in vitro. Further, the underlying mechanisms of TQ to promote hepatic autophagy were also discovered. Data showed that TQ caused (p < 0.01) body weight reduction, improved glucose homeostasis, alleviated hepatosteatosis, and decreased hepatic lipid accumulation related to the induction of autophagy in HFD-fed mice. In vitro, TQ obviously increased (p < 0.01) autophagic flux in FFA-induced HepG2 cells and consequently reduced the lipid accumulation in combination with activation of AMPK/mTOR/ULK1 signaling pathways. Moreover, pharmacological inhibition of the AMPK pathway by addition with AMPK inhibitor Compound C (CC) or silence of ULK1 by transfection with siRNA(ULK1) into HepG2 cells reversed these beneficial effects of TQ on triggering hepatic autophagy and reducing lipid accumulation (p < 0.01). Taken together, these results suggested that TQ alleviated hepatic lipid accumulation by triggering autophagy through the AMPK/mTOR/ULK1-dependent signaling pathway. Our study supports a potential role for TQ in ameliorating NAFLD.     

二陈汤及桃红四物汤对非酒精性脂肪肝CYP2E1活性影响的实验研究

目的:观察二陈汤及桃红四物汤对大鼠非酒精性脂肪肝模型肝细胞色素酶CYP2E1活性的影响,探讨二陈汤及桃红四物汤在非酒精性脂肪肝治疗中的作用。方法:制备非酒精性脂肪肝大鼠动物模型,用二陈汤及桃红四物汤分别治疗。实验结束后,检测肝细胞微粒体蛋白含量以及CYP2E1活性。结果:脂肪肝大鼠存在明显的肝细胞微粒体蛋白降低以及CYP2E1活性增强。与模型组相比,二陈汤对脂肪肝大鼠肝细胞微粒体蛋白具有明显升高作用(P<0.05);而对CYP2E1活性则具有明显降低作用(P<0.01)。桃红四物汤也有一定作用趋势,但无统计学意义。结论:二陈汤不仅能够改善高脂血症状态,也能降低CYP2E1活性,防治因此而导致的过氧化损伤过程,从多方面治疗非酒精性脂肪肝。     

Cassiae Semen improves non-alcoholic fatty liver disease through autophagy-related pathway

Objective Cassiae Semen (CS, Juemingzi in Chinese) has been used for thousands of years in ancient Chinese history for relieving constipation, improving liver function as well as preventing myopia. Here we aimed to elucidate the anti-steatosis effect and underlying mechanism of CS against non-alcoholic fatty liver disease (NAFLD). Methods High-performance liquid chromatography (HPLC) was used to identify the major components of CS water extract. Mice were fed with a high-fat and sugar-water (HFSW) diet to induce hepatic steatosis and then treated with CS. The anti-NAFLD effect was determined by measuring serum biomarkers and histopathology staining. Additionally, the effects of CS on cell viability and lipid metabolism in oleic acid and palmitic acid (OAPA)-treated HepG2 cells were measured. The expression of essential genes and proteins involved in lipid metabolism and autophagy signalings were measured to uncover the underlying mechanism. Results Five compounds, including aurantio-obtusin, rubrofusarin gentiobioside, cassiaside C, emodin and rhein were simultaneously identified in CS extract. CS not only improved the diet-induced hepatic steatosis in vivo, as indicated by decreased number and size of lipid droplets, hepatic and serum triglycerides (TG) levels, but also markedly attenuated the OAPA-induced lipid accumulation in hepatocytes. These lipid-lowering effects induced by CS were largely dependent on the inhibition of fatty acid synthase (FASN) and the activation of autophagy-related signaling, including AMP-activated protein kinase (AMPK), light chain 3-II (LC3-II)/ LC3-1 and autophagy-related gene5 (ATG5). Conclusion Our study suggested that CS effectively protected liver steatosis via decreasing FASN-related fatty acid synthesis and activating AMPK-mediated autophagy, which might become a promising therapeutic strategy for relieving NAFLD.     

软肝煎治疗非酒精性脂肪肝临床观察

[目的]观察自拟软肝煎对非酒精性脂肪肝患者的临床疗效。[方法]将符合入选标准的病例60例,随机分为治疗组和对照组,其中治疗组30例,对照组30例,分别采用软肝煎及多烯磷脂酰胆碱胶囊治疗,疗程均为12周。观察两组患者肝功、血脂、腹部B超变化。[结果]治疗组与对照组的总有效率分别为86.7%和73.3%,治疗后两组血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、总胆固醇(TC)、甘油三酯(TG)较治疗前均明显改善(P0.05),肝脏B超较治疗前改善(P0.05)。[结论]软肝煎对非酒精性脂肪肝疗效确切,值得临床推广。     

冯全生从湿浊论治非酒精性脂肪肝经验

文章总结冯全生教授论治非酒精性脂肪肝经验.冯全生认为本病与湿浊关系密切,湿浊阻滞贯穿疾病全过程,治疗上多种思路并用,如理气降浊、益气舒肝降浊、化湿降浊、活血降浊.并附验案一则,以供同道探讨.     

自拟利湿行水方合穴位埋线治疗非酒精性脂肪性肝病疗效观察

目的观察自拟利湿行水方合穴位埋线治疗非酒精性脂肪性肝病疗效及对影像学指标的影响。方法将2016年3月—2017年12月广东省中山市中医院收治的94例非酒精性脂肪性肝病患者随机分为2组,对照组47例依据《非酒精性脂肪性肝病防治指南》进行西医对症治疗,观察组47例则在此基础上加用自拟利湿行水方合穴位埋线治疗,比较2组治疗前后体质量指数(BMI)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、肝/脾CT比值及肝脏B超病变程度分级,并比较2组疗效。结果2组治疗后ALT、AST、TC、TG及LDL-C水平均显著降低(P均<0.05),HDL-C、肝/脾CT比值均显著提高(P均<0.05),且观察组治疗后以上指标均显著优于对照组(P均<0.05);2组治疗后肝脏B超病变严重程度分级均显著改善(P均<0.05),且观察组改善情况显著优于对照组(P<0.05)。观察组和对照组总有效率分别为80.8%(38/47)和95.7%(45/47),观察组客观疗效显著优于对照组(P<0.05)。结论自拟利湿行水方合穴位埋线治疗非酒精性脂肪性肝病可有效提高病情控制效果,减轻肝功能损伤,调节血脂指标,并有助于缓解临床症状,优于单纯西医疗法。     

Study on effects of zhi zi (fructus gardeniae) on non-alcoholic fatty liver disease in the rat

Objective

To investigate the effects of Zhi Zi (Fructus Gardeniae) on non-alcoholic fatty liver disease (NAFLD) induced by a high-fat diet in the rat.

Methods

A rat model of NAFLD was established using a high-fat diet. Twenty one rats were randomly divided into a normal group, a model group and a Zhi Zi treatment group, 7 rats per group. Drinking water and the drug were intragastrically administrated for 5 weeks. Samples were then taken to observe pathological changes of the liver tissue (HE staining); changes in the fat metabolism pathway e. g. triglyceride (TG) and free fatty acid (FFA) content; alterations in liver function, i.e. serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity; and differences in tumor necrosis factor α (TNF-α) and P-lkB protein expression in the liver tissue.

Results

Fatty degeneration and vacuole-like changes of different degrees occurred in hepatic cells of the model group. Markers for fat metabolism, serum ALT and AST activities, and expression of TNF-α and P-lkB proteins in liver tissue significantly increased. Fat metabolism in the Zhi Zi group significantly reduced, as shown by a drop in marker levels. Serum ALT and AST activities, and expression of TNF-α, P-lkB proteins in liver tissue were also significantly decreased in this group.

Conclusion

Zhi Zi has a very strong inhibitory action on lipidosis and inflammatory injury in the rat model of NAFLD. This mechanism may possibly be related to the inhibition of the free fatty acid metabolism pathway.     

谢晶日教授治疗非酒精性脂肪肝的临床经验浅谈

非酒精性脂肪肝是临床常见疾病,谢晶日教授着重从病因病机方面治疗,其多因湿热郁遏气机导致痰瘀互络,治疗的重点抓住肝脾的关系,调理气血,故治疗效果较佳。     

血脂康胶囊治疗合并高脂血症的非酒精性脂肪性肝病

目的:初步观察血脂康对合并高脂血症的非酒精性脂肪性肝病患者的疗效。方法:48例非酒精性脂肪性肝病合并高脂血症的患者予小剂量血脂康治疗6月,并以同期正常人32例为对照,检测治疗前后体重指数、B超、肝功、血脂、及空腹血糖、空腹胰岛素等指标,采用McAuley指数及稳态模式评估法中胰岛素抵抗指数评价胰岛素抵抗,部分患者行肝组织活检对照治疗前后组织学改变。结果:胰岛素抵抗指标在非酒精性脂肪性肝病患者中明显升高,经治疗后,胰岛素抵抗指标及血脂、转氨酶水平下降,部分患者的肝组织学指标改善、未发现肝毒性。结论:小剂量血脂康用于治疗非酒精性脂肪性肝病合并高脂血症是安全有效的。     

Lutein ameliorates high-fat diet-induced obesity,fatty liver,and glucose intolerance in C57BL/6J mice

Obesity is a multi-factorial metabolic syndrome that increases the risk of cardiovascular diseases, diabetes, and cancer. We recently demonstrated the antiadipogenic efficacy of lutein using a 3 T3-L1 cell culture model. This study aimed to examine the antiobesity efficacy of lutein on high-fat (60% kcal fat) diet-induced C57BL/6J obese mice model. Lutein (300 and 500 μM), Orlistat (30 mg/kg body weight - positive control), and its combination (orlistat, 15 mg/kg body weight+lutein, 300 μM) were administered in high-fat diet (HFD)-fed mice every other day for 24 weeks. The effect on serum and hepatic lipid parameters was estimated using biochemical assay kits. The adipose tissue expression of adipocyte differentiation markers at gene and protein levels was analyzed by RT-PCR and western blotting, respectively. The results showed that lutein administration and drug significantly reduced epididymal and abdominal adipose tissue weights. Further, lutein reduced the serum cholesterol and LDL-C concentration compared to the HFD group. The HFD-induced elevation in the hepatic triglycerides and cholesterol levels were significantly blocked by lutein and its combination with the drug. Similarly, lutein and its drug combination efficiently lowered the HFD-mediated elevated blood glucose levels. Lutein downregulated the expression of CEBP-α, PPAR-γ, and FAS in the epididymal adipose tissue. Thus, supplementation of lutein may control diet-induced obesity and associated complications in the human population.     

健肝降脂汤治疗非酒精性脂肪肝的疗效观察

[目的]观察健肝降脂汤治疗非酒精性脂肪肝的临床疗效.[方法]将确诊为非酒精性脂肪肝的120例患者,随机分为两组,治疗组给予健肝降脂汤1剂/d,水煎服300mL,早晚分服.对照组给予多稀磷酸酰胆碱胶囊2粒,3次/d,口服.两组疗程均为3个月,观察治疗前后患者症状变化、肝功能、血脂、肝脏彩超变化.[结果]治疗组达到临床基本治愈者39例,好转14例,无效6例,总有效率为88.3%.对照组分别为17例,23例,20例,总有效率为68.3%.两组总有效率比较有显著性差异(P＜0.01).[结论]健肝降旨汤能有效地降低血脂,改善肝功能,改善肝脏影像学变化,对非酒精性脂肪肝有确切疗效.     

A combination of grape extract, green tea extract and L-carnitine improves high-fat diet-induced obesity, hyperlipidemia and non-alcoholic fatty liver disease in mice

To develop a therapeutic agent for obesity-related metabolic disorders, a mixture of dietary components was prepared, including grape extract, green tea extract and l-carnitine (RGTC), and its effects on obesity, hyperlipidemia and non-alcoholic fatty liver disease examined. The RGTC dramatically inhibited the high-fat diet (HFD)-induced increase in body weight and fat in C57BL/6 mice, whereas food consumption was not affected by RGTC treatment. The RGTC also concentration-dependently suppressed the HFD-induced increase in plasma lipids, such as low-density lipoprotein cholesterol and triglycerides. In addition, increases in liver weight and liver steatosis were returned to normal by RGTC treatment in HFD-fed C57BL/6 mice. The plasma levels of glutamic-oxaloacetic transaminase and glutamic-pyruvic transaminase were also significantly down-regulated by RGTC treatment. These results suggest that RGTC suppressed HFD-induced obesity, hyperlipidemia and non-alcoholic fatty liver disease, suggesting that RGTC supplementation might be a promising adjuvant therapy for the treatment of these metabolic disorders.     

茵陈蒿汤联合酪酸梭菌治疗老年非酒精性脂肪肝病的疗效观察

目的:观察茵陈蒿汤联合酪酸梭菌治疗老年非酒精性脂肪肝病(Nonalcoholic Fatty Liver,NAFLD)的临床疗效。方法:选取我院2017年3月-2018年10月确诊为非酒精性脂肪肝病的患者72例。按随机数字表法分为两组,服用酪酸梭菌的为对照组,服用茵陈蒿汤与酪酸梭菌的为观察组。观察比较两组的高密度脂蛋白胆固醇(High Density Lipoprotein Cholesterol,HDL-C),低密度脂蛋白胆固醇(Low Density Lipoprotein Cholesterol,LDL-C),甘油三酯(Triglyceride,TG),总胆固醇(Total Cholesterol,TC),丙氨酸转氨酶(Alanine Aminotransferase,ALT),门冬氨酸转氨酶(Aspartate Aminotransferase,AST),谷氨酰转肽酶(Glutamyl Transpeptidase,GGT),血清总胆红素(Total Bilirubin,TBIL)水平和中医症状评分。结果:经治疗后,两组的HDL-C,LDL-C,TG,TC以及ALT,AST,GGT,TBIL与治疗前比较,差异具有统计学意义(P<0.05)。两组间比较,观察组变化幅度明显大于对照组,差异具有显著统计学意义(P<0.05)。在中医症状评分上,观察组也明显高于对照组,差异具有统计学意义(P<0.05)。结论:茵陈蒿汤联合酪酸梭菌治疗老年非酒精性脂肪肝病疗效显著,且安全无不良反应。