【作者】 王景荣；

【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】 背景：脂肪肝是一种临床常见的疾病,总被认为是个肥胖的代名词而忽略。在台湾,肥胖、糖尿病以及高血脂症的人口越来越多,脂肪肝的发生率呈急剧上升趋势,根据临床统计,台湾非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)的盛行率为40.8%,几乎每三位成年人中就有一位是脂肪肝患者,且部份脂肪肝患者是属于非酒精性脂肪性肝(NAFLD),可能衍生为肝纤维化及肝硬化,甚至是末期肝脏疾病,因此唤起了医界学者对它的注意。目的：根据中医理论与临床经验,结合现代医学,观察清热化痰祛瘀法对痰热瘀阻型非酒精性脂肪肝患者的临床疗效,并结合肝功、脂质代谢、肾功、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痰热瘀阻型患者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,两组进行基础治疗,治疗组施以自拟方(炒党参10g、柴胡10g、炒白术10g、茯苓10g、瓜萎10g、丹参10g、黄芩10g、垂盆草10g、赤芍10g、白芍10g、泽泻25g、生山楂10g、元胡索10g、地鳖虫10g、水蛭6g)水煎服,一日一剂,分二次服,三个月为一个疗程。对照组施以服用瑞舒伐他汀(Rosuvastatin),1Omg/d,连续三个月。观察指标包括年龄、性别、体重、B超、肝功、脂质代谢及临床症状等方面,比较两组治疗效果。结果：1.治疗组40例,完全治愈15例(37.5%),显效14例(35.5%),有效5例(12.5%),无效6例(15.0%),总有效率85.0%；对照组40例,完全治愈9例(22.5%),显效9例(22.5%),有效11例(27.5%),无效11例(27.5%),总有效率为72.5%,治疗中、治疗后未见任何不良反应。两组临床综合疗效经P<0.05,两组总体疗效比较,治疗组显著优于对照组。2.两组治疗后症状总积分比较,有非常显着差异(P<0.01),治疗组非常显著优于对照组。两组均能显著改善各临床症状和体征,差异有显着意义(P<0.05)。治疗组治疗后在食少纳呆、胁痛、疲劳乏力、口干口苦、面色晦暗、胸闷痛、睡眠状况、舌质等症状方面显著优于对照组(P<0.05)。3.两组治疗后肝功能指标(AST、ALT、ALP、γ-GT),均有非常显着改善(P<0.01)。治疗后两组疗效比较,治疗组显著优于对照组(P<0.05)。4.两组治疗后脂质代谢指标(TC、TG、HDL-C、LDL-C),均有非常显着改善(P<0.01)。治疗后两组疗效比较,在TG、HDL-C、LDL-C上,治疗组显著优于对照组(p<0.05)。TC两组疗效接近,差异无统计意义(P>0.05)。结论：治疗组使用自拟方治疗痰热瘀阻型非酒精性脂肪肝患者的临床疗效显著优于对照组。更多还原

【Abstract】 Background:Fatty liver disease (FLD) is a common clinical disease. it is always ignored as considered as obesity. In Taiwan the population of obesity, diabetes, and hyperlipidemia are gradually increased. The incidence of FLD showed a sharp upward trend. According to clinical statistics, the prevalence of non alcoholic fatty liver disease (NAFLD) patient was40.8%.almost in every three adults have one NAFLD and most of FLD patients are NAFLD, who maybe become liver fibrosis and cirrhosis, even the hepatoma. This symptom also arouse the medical scholars’attention. The disease imputes to Liver、Spleen、Kidney, its formation related to phlegm,dampness,blockage and plot,so we proposed the research of Qing Re Hua Tan Qu Yu method to treat the Tan Re Yu Zu Non-Alcoholic Fatty Liver patients in Taiwan District.Objective:According to traditional chinese medicine theory and clinical experience, combined with modern medicine.To observe the clinical effect of Qing Re Hua Tan Qu Yu method, and to be combined with liver function, renal function, lipid metabolism, blood routine examination, other laboratory tests and B ultrasound scan, to discuss the function and treatment effect.Methods:The reserach studies on80NAFLDs who are diagnosed as Tan Re Yu Zu NAFLD,adopted random allocation principle,divided the qualified cases into two groups:one treatment group of40patients, another control group of40patients.Two groups all have the basic treatment.The composition of TCM herbs in treatment group are listed as below:chao-dang-sen10g, chai-hu10g, chao-bai-zhu10g, fu-ling10g, gua-lou10g, dan-senlOg, huang-zin10g, chui-pen-cao10g, chi-shao10g, bai-shao10g, ze-xie10g, sheng-shan-zha10g, uan-hu-suo10g, di-bie-chong10g, shui-zhi6g, boiled with water,one day one package,drink two times per day,one course for3months.The control group:taking the rosuvastatin lOmg/d for3months. The observing indexes include:age, sex, weight, liver function,renal 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.Results:1. Total effective rate of treatment group is85.0%, the total effective rate of control group is72.5%, both of the two groups have significant difference (p<0.05).It means the effect of treatment group is better than that of control group.2. After treatment,it has significant differences in clinical symptom score between two groups(p<0.05),the effect of treatment group is better than that of control group. Both of them can improve clinical symptoms obviously,there is a significant difference (p<0.05).The treatment group shows improvement,in chest pain, in listlessness and lassitude, in thirsty and bitter, in gloomy complexion,in chest tightness, in sleep, in tongue and sublingual blue veins, the comparsion has significant meaning (p<0.05).3. After treatment, both groups in liver function (AST, ALT, ALP, y-GT) have significant difference (p<0.01). The treatment group has better effect than the control group in liver function index (AST, ALT, ALP, r-GT)(P<0.05).4. After treatment, both groups in lipid metabolism (TC, TG, HDL-C, LDL-C) have significant difference (p<0.01). The treatment group has better effect than the control group in lipid metabolism (TG, HDL-C, LDL-C)(p<0.05). Both groups are closely in effect of TC.Conclusion:The effect of treatment group in Tan Re Yu Zu NAFLD is better than that of control group.更多还原