Curative effect analysis of Jianpi Tiaozhi Decoction combined with atorvastatin on non-alcoholic fatty liver disease
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摘要: 目的 观察健脾调脂饮联合阿托伐他汀在非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)中的应用效果。方法 将2020年1月-2022年9月期间我院收治的NAFLD患者110例按照随机数字表法分为两组，各55例。两组均接受常规治疗，在此基础上，对照组采用阿托伐他汀治疗，研究组在对照组基础上采用健脾调脂饮治疗，两组均治疗3个月。比较两组临床疗效、治疗前后肝功能[谷丙转氨酶(alanine aminotransferase，ALT)、谷草转氨酶(aspartate aminotransferase，AST)、总胆红素(total bilirubin, STB)、直接胆红素(direct bilirubin，DBIL)、间接胆红素(indirect bilirubin，IPIL)]、脂代谢[总胆固醇(total cholesterol，TC)、甘油三酯(triglyceride, TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol，LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol，HDL-C)]及肠道微生态(双歧杆菌、乳酸杆菌、肠杆菌及肠球菌)情况，记录两组治疗期间不良反应发生情况。结果 经过3个月的治疗后，研究组治疗总有效率相较于对照组更高，差异有统计学意义(P＜0.05)；治疗后两组ALT、AST、STB、DBIL、IPIL水平较治疗前降低，且研究组较对照组低，差异有统计学意义(P＜0.05)；治疗后两组TC、TG、LDL-C水平较治疗前降低，且研究组较对照组低，两组HDL-C水平较治疗前高，且研究组较对照组高，差异有统计学意义(P＜0.05)；治疗后两组双歧杆菌、乳酸杆菌数量较治疗前增多，且研究组较对照组多，两组肠杆菌、肠球菌数量较治疗前减少，且研究组较对照组少，差异有统计学意义(P＜0.05)；两组不良反应发生率对比，差异无统计学意义(P=0.611)。结论 NAFLD患者接受健脾调脂饮联合阿托伐他汀治疗效果确切，患者肝功能、脂代谢及肠道微生态均得到良好改善，且不良反应轻微。Abstract: Objective To observe the application effect of Jianpi Tiaozhi Decoction combined with atorvastatin in the treatment of non-alcoholic fatty liver disease(NAFLD).Methods One hundred and ten patients with NAFLD admitted to hospital from January 2020 to September 2022 were divided into two groups according to the random number table method, with 55 patients in each group. Both groups received routine treatment. On this basis, the control group was treated with atorvastatin, and the study group was treated with Jianpi Tiaozhi Decoction on the basis of the control group. Both groups were treated for three months. The clinical efficacy, liver function(alanine aminotransferase[ALT], aspartate aminotransferase[AST], total bilirubin[STB], direct bilirubin[DBIL], indirect bilirubin[IPIL]), lipid metabolism(total cholesterol([TC], triglyceride[TG], low density lipoprotein cholesterol[LDL-C], high density lipoprotein cholesterol[HDL-C]) and intestinal microecology(Bifidobacterium, Lactobacillus, Enterobacter and Enterococcus) were compared in both groups before and after treatment, Adverse reactions during treatment were recorded in both groups.Results After three months of treatment, compared with control group, total effective rate of the study group was higher(P < 0.05). The levels of ALT, AST, STB, DBIL and IPIL in both groups after treatment were lower than those before treatment, and compared with control group, the levels in the study group were lower(P < 0.05). The levels of TC, TG and LDL-C in both groups after treatment were lower than those before treatment, and the study group was lower than the control group. The levels of HDL-C in the two groups were higher than those before treatment, and compared with control group, the study group was higher(P < 0.05). After treatment, the number of Bifidobacteria and Lactobacilli in the two groups increased compared with that before treatment, and the number of Enterobacteria and Enterococci in the study group was more than that in the control group, and the number of Enterobacteria and Enterococci in the two groups decreased compared with that before treatment, and the number in the study group was less than that in the control group(P < 0.05). There was no statistical significant difference in the incidence of adverse reactions between the two groups(P=0.611).Conclusion The treatment effect of Jianpi Tiaozhi Decoction combined with atorvastatin on NAFLD patients is effective. The liver function, lipid metabolism and intestinal microecology of the patients have been improved, and the adverse reactions are mild.
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表 1 两组临床疗效比较
例(%) 组别 例数 临床痊愈 显效 有效 无效 总有效 研究组 55 6(10.91) 25(45.45) 22(40.00) 2(3.64) 53(96.36) 对照组 55 2(3.64) 21(38.18) 23(41.82) 9(16.36) 46(83.64) Z/χ2 2.157 4.949 P 0.031 0.026 
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表 2 两组肝功能指标比较
X±S 组别 例数 ALT/(U/L) AST/(U/L) STB/(μmol/L) DBIL/(μmol/L) IPIL/(μmol/L) 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 研究组 55 65.86± 7.13 53.58± 5.511) 53.26± 6.83 40.85± 4.501) 18.21± 2.12 15.46± 1.931) 6.85± 1.07 4.29± 0.951) 11.89± 2.75 9.73± 1.611) 对照组 55 65.19± 7.25 56.27± 5.191) 52.79± 6.43 43.76± 4.451) 18.15± 2.20 16.51± 1.411) 6.76± 1.05 5.56± 0.871) 11.74± 2.59 10.87± 1.551) t 0.489 2.633 0.372 3.398 0.145 3.259 0.494 7.407 0.294 3.740 P 0.626 0.010 0.711 0.001 0.885 0.001 0.622 ＜0.01 0.769 ＜0.001 与同组治疗前比较，1)P＜0.05。
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表 3 两组脂代谢指标对比
μmol/L，X±S 组别 例数 TC TG LDL-C HDL-C 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 研究组 55 6.97±0.45 4.46±1.521) 2.56±0.51 1.49±0.431) 3.45±0.87 2.88±0.471) 1.07±0.21 1.36±0.181) 对照组 55 7.12±0.47 5.23±1.641) 2.50±0.46 1.82±0.831) 3.51±0.83 3.10±0.521) 1.09±0.20 1.28±0.221) t 1.658 2.554 0.542 2.636 0.370 2.351 0.511 1.997 P 0.100 0.012 0.589 0.010 0.712 0.021 0.610 0.048 与同组治疗前对比，1)P＜0.05。
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表 4 两组肠道微生态比较
IgCFU/g，X±S 组别 例数 双歧杆菌 乳酸杆菌 肠杆菌 肠球菌 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 治疗前 治疗3个月 研究组 55 6.75±0.67 8.67±0.711) 6.56±0.59 8.69±0.621) 9.18±1.21 7.25±1.021) 8.49±0.78 6.57±0.691) 对照组 55 6.68±0.72 7.76±0.831) 6.65±0.64 7.82±0.661) 9.25±1.06 8.36±1.111) 8.53±0.72 7.21±0.741) t 0.524 6.285 0.772 7.063 0.276 5.486 0.210 4.619 P 0.601 ＜0.001 0.442 ＜0.001 0.783 ＜0.001 0.834 ＜0.001 与同组治疗前对比，1)P＜0.05。
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