桃核承气汤加减结肠水疗对痰热瘀结型重度非酒精性脂肪肝炎症因子及胰岛素抵抗的影响

目的:明确桃核承气汤加减结肠水疗对痰热瘀结型重度非酒精性脂肪肝(NAFLD)的临床疗效及作用机制。方法:100例痰热瘀结型重度NAFLD患者,均口服山楂消脂胶囊,将患者按随机表随机分配至接受桃核承气汤加减结肠水疗的观察组,单纯口服山楂消脂胶囊的对照组,每组各50例,观察时间为4周。检测患者治疗前后的肝功能丙氨酸氨基转氨酶(ALT),天冬氨酸氨基转氨酶(AST),γ-谷氨酸转肽酶(γ-GT)],血脂胆固醇(TCH),甘油三酯(TG)],空腹胰岛素浓度(FINS),空腹血糖(FPG),受控衰减参数(CAP),肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6),并根据FINS和FPG计算胰岛素抵抗指数(IRI),以明确痰热瘀结型重度NAFLD临床治疗效果;通过胰岛素抵抗,TNF-α和IL-6变化初步分析桃核承气汤加减结肠水疗的临床作用机制。结果:与本组治疗前比较,两组患者ALT,AST,γ-GT,TCH,TG,FPG,FINS,IRI,CAP,TNF-α和IL-6水平均显著降低(P<0.01)。治疗后与对照组比较,观察组ALT,AST,γ-GT,TCH,TG,FPG,IRI,CAP,TNF-α,IL-6水平均显著降低(P<0.01);观察组FINS水平明显降低(P<0.05)。结论:桃核承气汤加减结肠水疗是治疗痰热瘀结型重度NAFLD的有效方法,其作用机制可能主要在于降低IRI,血清TNF-α和IL-6水平,但其疗程设置、疗效机制及远期疗效等方面均有待进一步探讨。

Effect of Modified Taohe Chengqitang Combined with Colon Hydrotherapy on Inflammatory Factors and Insulin Resistance in Patients with Severe Nonalcoholic Fatty Liver Disease

Objective:To define the clinical efficacy of modified Taohe Chengqitang combined with colon hydrotherapy in patients with severe nonalcoholic fatty liver disease(NAFLD)accompanied by phlegm-heat stagnation syndrome and its mechanism.Method:Totally 100 patients with severe NAFLD by phlegm-heat stagnation syndrome were enrolled in the study.They were all given Shanzha Xiaozhi capsule.According to the random number table,the patients were randomly divided into the observation group(50 patients,colon hydrotherapy combined with traditional Chinese medicine)and the control group(50 patients,Shanzha Xiaozhi capsule alone).The observation period was 4 weeks.The therapeutic effect of colon hydrotherapy was verified through determinations of the liver function,blood lipid,insulin resistance index(IRI),controlled attenuation parameter(CAP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)before and after treatment.The mechanism of colon hydrotherapy combined with modified Taohe Chengqitang was preliminarily analyzed based on changes of IR,TNF-αand IL-6.Result:Alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptadase(γ-GT),total cholesterol(TCH),triglyceride(TG),fasting plasma glucose(FPG),fasting insulins(FINS),IRI,CAP,TNF-αand IL-6 of NAFLD patients in both of two groups were significantly lower than those before treatment(P<0.01).ALT,AST,γ-GT,TCH,TG,FPG,IRI,CAP,TNF-αand IL-6 in observation group were significantly lower than those in the control group after treatment(P<0.01).FINS in observation group was significantly lower than that in the control group(P<0.05).Conclusion:Colon hydrotherapy combined with modified Taohe Chengqitang is an effective method for treating NAFLD accompanied by phlegm-heat stagnation syndrome.Its mechanism may be mainly correlated with the reduction of IRI,serum TNF-αand IL-6.The course of colon hydrotherapy,the therapeutic mechanism and the long-term efficacy need to be further studied in the future.