加味茵陈五苓散治疗湿热蕴结型非酒精性脂肪性肝病的疗效及对肠道菌群的影响

目的:观察加味茵陈五苓散治疗湿热蕴结型非酒精性脂肪性肝病(NAFLD)肝功能、血脂和对肠道菌群的影响,探讨其作用机制。方法:将113例患者按SAS软件生成,随机按数字表法分为对照组57例和观察组56例。两组患者均采用非药物干预。对照组口服多烯磷脂酰胆碱胶囊,2粒/次,3次/d;和枯草杆菌二联活菌肠溶胶囊,2粒/次,3次/d。观察组在对照组治疗的基础上给予加味茵陈五苓散内服,1剂/d。两组患者均连续治疗12周。检测两组患者治疗前后丙氨酸氨基转移酶(ALT),天冬氨酸氨基转移酶(AST),高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平;进行治疗前后腹部CT和B超检查;检测治疗前后肠道菌群;进行治疗前后中医证候评分。结果:治疗后观察组患者的ALT,AST水平均低于对照组,中医证候评分低于对照组,肝/脾CT均高于对照组(P 0. 01);观察组患者实验室指标疗效优于对照组(Z=1. 955,P 0. 05);观察组患者腹部CT疗效优于对照组(Z=2. 002,P 0. 05);观察组患者腹部B超疗效优于对照组(Z=1. 961,P 0. 05);与健康对照组比较,两组NAFLD患者的肠杆菌、葡萄球菌均明显增多,拟杆菌、双歧杆菌和乳杆菌均明显减少(P 0. 01);治疗后观察组患者肠杆菌、葡萄球菌数量均少于对照组,拟杆菌、双歧杆菌和乳酸杆菌均多于对照组(P 0. 01)。结论:加味茵陈五苓散能保护NAFLD的肝功能,调节脂代谢,改善肠道菌群紊乱状态,恢复肠道微生态平衡,临床上治疗NAFLD有较好的疗效。

Effect of Modfied Yinchen Wuling San in Treating Non-alcoholic Fatty Liver Disease with Moisture and Heat Implication and on Intestinal Microflora

Objective: To observe the effect of modified Yinchen Wuling San in treating liver function and blood lipid of non-alcoholic fatty liver disease (NALFD) with moisture and heat implication and the mechanism on intestinal microflora. Method: One hundred and thirteen patients were randomly divided into control group (57 cases) and observation group (56 cases) by random number table according to SAS. Both groups''patients got non drug intervention. Patients in control group got polyene phosphatidylcholine capsules, 2 grains/time, 3 times/days, and live combined Bacillus subtilis and Enterococcus faecium Enteric-coated capsules, 2 grains/time, 3 times/days. In addition to therapy of control group, patients in observation was also given modified Yinchen Wuling San, 1 dose/day. The treatment in two groups continued for 12 weeks. Before and after treatment, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and intestinal microflora were detected. And CT and B-mode ultrasonography of abdomen were detected. And traditional Chinese medicine (TCM) syndromes were scored. Result: After treatment, levels of ALT and AST in observation group were lower than those in control group (Z=2.002, P<0.05), and score of TCM symptoms were lower than those in control group, whereas level of CT liver/spleen was higher than that in control group (P<0.01). And effect of laboratory indicators was better than that in control group (Z=1.955, P<0.05), CT was better than that in control group (Z=2.002, P<0.05), and B-mode ultrasonography of abdomen was better than that in control group (Z=1.961, P<0.05). Compared with healthy control group, enterobacteriaceae, staphylococcus of patients in two groups increased, while bacteroid, bacillus bifidus and bacillus lactis decreased (P<0.01). After treatment, enterobacteriaceae, staphylococcus in observation group were lower than those in control group, whereas bacteroid, bacillus bifidus and bacillus lactis were higher than those in control group (P<0.01). Conclusion: Modified Yinchen Wuling San can protect liver function of NAFLD, regulate lipid metabolism, ameliorate intestinal microflora, and recover the ecological equilibrium of intestine, with a good clinical effect.