【作者】 程瑞娟；

【导师】 薛博瑜；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2013， 博士

【摘要】 脂肪肝是指肝细胞内甘油三酯(TG)蓄积过多的病理改变,临床上患者除了有基础疾病及诱因相关表现外,绝大多数患者并无任何明显的症状,因此往往需藉由实验室检查、病理组织学、B超或CT等影像学检查方可确诊。现代医学对于治疗脂肪肝的降脂药物,由于具有一定的肝损作用,所以相对而言,中医药对于脂肪肝的发病机理研究及辨证分型治疗则明显呈现其优越性。本病产生主要责之于肝、脾、肾三脏,其形成与痰、湿、瘀、积等有关,所以提出补肾化痰活血法为治疗脂肪肝之大法。目的：根据中医理论与临床经验,结合现代医学,观察补肾化痰活血法对肝郁脾虚、肝肾亏虚及瘀血阻络型非酒精性脂肪肝患者的临床疗效,并结合肝功、肾功、脂质代谢、血常规等实验室检查及B超等影像学检查,探讨其作用机制及治疗效果。方法：本研究以台湾地区确诊为非酒精性脂肪肝(肝郁脾虚、肝肾亏虚及瘀血阻络型)患者80例进行临床研究,采用随机分配原则,将80例合格对象分为治疗组40例,对照组40例,进行组间及治疗前后的疗效观察,治疗组的中药组方拟如：生黄耆20g、丹参15g、炒白术10g、茯苓10g、淮山药10g、广郁金10g、陈皮l0g、垂盆草10g、柴胡10g、赤芍10g、泽泻10g、菟丝子10g、桑寄生15g、山茱萸10g、生山楂10g。水煎服,一日一剂,分二次服,并配服三七粉1.5g/次/天,三个月为一个疗程。对照组：服用瑞舒伐他汀(Rosuvastatin),10mg/d,连续三个月。观察指标包括年龄、性别、体重、肝功、肾功、脂质代谢、血常规、B超及临床症状积分等方面的比较,无显著性差异(p>0.05),两组间具有可比较性。结果：1.治疗组40例(基本治愈13例,显效19例,有效3例,无效5例),治疗组总有效率为87.5%,对照组40例(基本治愈7例,显效10例,有效9例,无效14例),总有效率为65%,治疗组临床综合疗效与对照组相比有显著性差异(p<0.05),本研究中药组方对脾虚痰湿瘀阻型脂肪肝患者的疗效优于对照组。2.两组治疗前后自身B超值比较,有非常显着性差异(p<0.01)；治疗组有19例脂肪肝转为正常,对照组有12例脂肪肝转为正常。提示中药治疗与瑞舒伐他汀有明显改善B超程度的效果。3.两组患者治疗后胸胁胀痛、疲劳乏力、腰膝酸软、面色晦暗、胸闷心悸、舌质及舌下青筋症状有显著差异(P<0.05),治疗组在胸胁胀痛、疲劳乏力、腰膝酸软、面色晦暗、胸闷心悸、舌质及舌下青筋症状方面的疗效优于对照组；治疗组症状积分均数0.91>对照组症状积分均数0.64,治疗组在食少纳呆、胸胁胀痛、疲劳乏力、腰膝酸软、便溏、面色晦暗、睡眠状况、便秘硬结、胸闷心悸、小便尿频、怕冷情况、舌质及舌下青筋、白腻苔症状方面的疗效优于对照组。4.两组患者治疗后肝功能指标(ALT、AST、ALP、r-GT)有显着性差异(P<0.05),治疗组在肝功能指标(ALT、AST、ALP、r-GT)方面的疗效优于对照组。治疗组肝功能指标差均数10.18>对照组肝功能指标差均数5.41,治疗组在肝功能指标(ALT、AST、ALP、r-GT)方面的疗效优于对照组。5.两组患者治疗后脂质代谢指标(TC、TG、HDL-C、LDL-C)有显着性差异(P<0.05),治疗组TC、TG、HDL-C、LDL-C疗效优于对照组。治疗组脂质代谢指标差均数1.20>对照组脂质代谢指标差均数1.08,治疗组TC、TG、HDL-C、LDL-C疗效优于对照组。6.两组患者治疗后BUN有非常显著性差异(P<0.01),治疗组BUN疗效明显优于对照组；两组患者治疗后Creatinine有显著性差异(P<0.05),治疗组Creatinine疗效优于对照组。治疗组肾功能指标差均数3.43>对照组肾功能指标差均数1.29,治疗组BUN、Creatinine疗效优于对照组。7.两组患者治疗后血常规指标WBC、RBC、PLT)有显著性差异(P<0.05),治疗组WBC、 RBC、PLT疗效优于对照组。治疗组血常规指标差均数6.74>对照组血常规指标差均数1.93,治疗组WBC、RBC、PLT疗效优于对照组。结论：本治疗组中药组方对于肝郁脾虚、肝肾亏虚及瘀血阻络型非酒精性脂肪肝患者的临床疗效明显优于对照组的瑞舒伐他汀。更多还原

【Abstract】 Fatty liver is the pathological changes that means excessive triglyceride (TG) accumulates in the liver cells,.In clinical most patients do not have any obvious symptoms besides basic sickness and related performance,so it always diagnoses by by experimental&histopathological check, B ultrascan or CT.Westem medicine in lowering fat has damage on liver, so in contrary, Chinese medicine on the study of fatty liver pathogenesis and the treatment determination based on syndrome differentiaton has its superiority.This disease imputes to Liver, Spleen, Kidney,its formation related to phlegm, dampness, blockage and plot, so we proposed the Bu Shen Hua Tan Huo Xie method to treat fatty liver.Objective:According to traditional Chinese medicine theory and clinical experience, combined with modern medicine, to observe the clinical efficiency of Bu Shen Hua Tan Huo Xie method about treating Gan Yu Pi Xu,Gan Shen Kui Xu and Yu Xie Zu Luo non-alcoholic fatty livers, and combine with liver function test, kidney function test, lipid metabolism test, blood routine examination and B ultrasound scan, to explore the function and treatment effects.Methods:The research studies on80non-alcoholic fatty livers who are diagnosed as Gan-Yu-Pi-Xu, Gan-Shen-Kui-Xu and Yu-Xie-Zu-Luo types in Taiwan Dstrict,adopted random allocation principle,divided the qualified cases into two groups:one treatment group of40patients,another control group of40patients.and observe the efficiency of before and after treatment between the two groups. The composition of TCM herbs in treatment group are listed as below: sheng-huang-qi20g. dan-senl5g. chao-bai-zhulOg fu-linglOg huai-shan-yaolOg guang-yu-jinlOg chen-pi10g chwei-pen-cao10g chai-hu10g chi-shao10g ze-xie10g tu-si-zi10g sang-ji-sheng15g shan-zhu-yulOg shen-san-zha10g, boiled with water,one day one package,drink two times per day,and drink with san-qi powder1.5g every day.,one course for3months.The control group:taking RosuvastatinlOmg/d for3months.The observing indexes include:age,sex,weight,liver function,kidney function,lipid metabolism,blood routine examination,B ultrasound scan and clinical symptom score,the differences between two groups has no significant meaning(p>0.05),two groups have comparability.Result:1. The treatment group has40patients(basically cured13cases,19cases were obvious effective,3cases were effective,5cases were ineffective).The effective rate of treatment group is87.5%.The control group has40patients(basically cured7cases,10cases were obvious effective,9cases were effective,14cases were ineffective).the total effective rate of control group is65%,both of the two groups have significant differences(p<0.05). It means the effect of the treatment group for Pi Xu Tan Shi Yu Zu fatty livers is better than that of control group.2. Before and after treatment,from B ultrasound scan transformation comparison,both groups have obvious significant differences(p<0.01). The treatment group has19patients of fatty liver transform into normal type.The control group has12patients of fatty liver transform into normal type. Both of the two groups have the obvious improvement in B ultrasound scan.3.After treatment,both groups shows significant differences(p<0.05) in pathological changes of distension and pain in chest,in listlessness and lassitude,in sore and weakness of the waist and knees,in gloomy complexion,in chest tightness and palpitations,in tongue and sublingual blue veins.It means that the treatment group has the better effect than the control group in pathological changes of distension and pain in chest,in listlessness and lassitude,in sore and weakness of the waist and knees,in gloomy complexion,in chest tightness and palpitations,in tongue and sublingual blue veins.The symptom score average of the treatment group0.91>the control group0.64. The treatment group has better effect than the control group in poor appetite and digestion, in pathological changes of distension and pain in chest,in listlessness and lassitude,in sore and weakness of the waist and knees,in loose stools,in gloomy complexion,in sleep,in constipation induration, in chest tightness and palpitations,in frequent urination,,in tongue and sublingual blue veins.4.After treatment,both groups in liver function index (AST, ALT, ALP, r-GT) have significant differences(p<0.05). The treatment group of average between the differences of the liver function index (AST, ALT, ALP, r-GT)10.18> the control group5.41.The treatment group has better effect than the control group in liver function index (AST, ALT, ALP, r-GT).5. After treatment,both groups in lipid metabolism index (TC, TG, HDL-C, LDL-C)have significant differences (p<0.05). The treatment group has better effect than the control group in lipid metabolism index (TC, TG, HDL-C, LDL-C). The treatment group of average between the differences of the lipid metabolism index (TC, TG, HDL-C, LDL-C)1.20> the control group1.08.The treatment group has better effect than the control group in lipid metabolism index(TC, TG, HDL-C, LDL-C).6.After treatment, both groups in BUN have obvious significant differences(p<0.01).The treatment group has very best effect than the control group in BUN. After treatment, both groups in Creatinine have significant differences(p<0.05). The treatment group has better effect than the control group in Creatinine.The treatment group of average between the differences of the kindey function index3.43>the control group1.29.The treatment group has better effect than the control group in BUN,Creatinine. 7.After treatment, both groups in blood routine examination (WBC, RBC, PLT) have significant differences(p<0.05).The treatment group has better effect than the control group in blood routine examination index(WBC, RBC, PLT). The treatment group of average between the differences of the blood routine examination index (WBC, RBC, PLT)6.74>the control group1.93. The treatment group has better effect than the control group in blood routine examination index (WBC, RBC, PLT).Conclusion:The effect of treatment group in Gan-Yu-Pi-Xu,Gan-Shen-Kui-Xu and Yu-Xie-Zu-Luo non-alcohol fatty livers is better than that of control group..更多还原