茵陈蒿汤合四逆散治疗非酒精性脂肪肝伴高同型半胱氨酸血症临床观察

目的:探讨茵陈蒿汤合四逆散对非酒精性脂肪肝(NAFLD)伴高同型半胱氨酸血症(HHcy)患者的临床疗效。方法:病例来源于北京市西城区什刹海社区卫生服务中心门诊共126例NAFLD伴HHcy患者,随机数字表法分为脂肪肝对照组(安慰剂)、西药组(多烯磷脂酰胆碱胶囊和叶酸片)、中药组(茵陈蒿汤合四逆散方),42例/组,治疗期间无脱落;连续治疗3个月。观察治疗前后临床有效率,观察肝功能丙氨酸氨基转移酶(ALT),天门冬氨酸氨基转移酶(AST)],同型半胱氨酸(Hcy),血脂总胆固醇(TC),总甘油三酯(TG),低密度脂蛋白(LDL),高密度脂蛋白(HDL)],氧化炎症指标丙二醛(MDA),超氧化物酶歧化酶(SOD),超敏C反应蛋白(hs-CRP)],安全性评价指标肾功能(血肌酐(SCr),血尿素氮(BUN)]以及症状评分。结果:中药组总有效率92. 86%;西药组总有效率88. 10%;两组总有效率比较无统计学差异。各组患者治疗前各指标无差异。治疗后中药组、西药组ALT,AST,Hcy,TC,TG,MDA,hs-CRP,症状积分较本组治疗前明显降低(P 0. 05),且低于脂肪肝对照组(P 0. 05); HDL,SOD明显升高(P 0. 05),且高于脂肪肝对照组(P 0. 05);与西药组比较,中药组ALT,Hcy,TC,TG,MDA,hs-CRP,症状积分明显降低(P 0. 05),SOD明显升高(P 0. 05)。结论:茵陈蒿汤合四逆散改善NAFLD伴Hcy患者的高同型半胱氨酸血症、肝功能、血脂以及氧化、炎症状态。

Clinical Efficacy of Yinchenhao Tang Combined with Sinisan in Treating Nonalcoholic Fatty Liver Disease with Hyperhomocysteinemia

Objective: To investigate the clinical efficacy of Yinchenhao Tang combined with Sinisan(YCSN) on non-alcoholic fatty liver disease (NAFLD) with hyperhomocysteinemia (HHcy). Method: Totally 126 cases of NAFLD with HHcy in Beijing Shichahai Community Health Service Center were randomly divided into NAFLD control group, traditional Chinese medicine(TCM) group, and modern medicine group, with 42 cases in each group. The TCM group was treated with YCSN orally, the modern medicine group was treated with polyene phosphatidylcholine capsules and folic acid tablets, and the NAFLD control group was treated with placebo. The course of treatment was 3 months. The clinical efficiency, liver function, Hcy, blood lipid, oxidative inflammation index and symptom score in two groups were observed before and after treatment. Result: The total effective rate of the TCM group was 92.86%, while that of the modern medicine group was 88.10%. There was no significant difference in the clinical efficiency between the two groups. There was no difference in the indexes of groups before treatment. After treatment,alanine aminotransferase (ALT), aspartate aminotransferase (AST), Hcy, total cholesterol (TC), total triglyceride (TG), low-density lipoprotein (LDL), malondialdehyde (MDA), high-sensitive C reactive protein (hs-CRP), serum creatinine (SCr), blood urea nitrogen (BUN), and symptom scores in the TCM group and the modern medicine group were significantly lower than those before the treatment (P<0.05), and lower than those in the NAFLD control group (P<0.05); and high-density lipoprotein (HDL) and superoxidase dismutase (SOD) in the TCM group and the modern medicine group significantly increased (P<0.05), and higher than those of NAFLD control group (P<0.05). Compared with the modern medicine group, ALT, Hcy, TC, TG, MDA, hs-CRP, and symptom scores in TCM group were significantly lower than those before the treatment (P<0.05), while SOD in the TCM group was significantly increased (P<0.05). Conclusion: YCSN can improve hyperhomocysteinemia, liver function, blood lipid, oxidation and inflammation in patients with NAFLD and HHcy.