摘要
目的:评价平胃安神饮联合低碳水化合物饮食(LCD)治疗代谢相关脂肪性肝病(MAFLD)的临床疗效及安全性。方法:采用前瞻性队列研究,选取肝郁脾虚、痰瘀互结证的MAFLD患者113例,根据患者意愿分为治疗组45例及对照组38例,两组患者均接受LCD饮食干预方案,治疗组患者在此治疗基础上加用平胃安神饮治疗,两组患者均干预2周。比较两组患者肝脏受控衰减参数(CAP)值、中医证候积分、肝脏功能相关指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ谷氨酰转移酶(γ-GT)、碱性磷酸酶(ALP)]、糖脂代谢相关指标[空腹血糖(FPG)、空腹血清C肽(C-P)、空腹血清胰岛素(FINS)、稳态模型评估胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)],人体质量指数(BMI),食欲VAS评分,并进行安全性评价。结果:两组患者CAP值均显著下降,治疗组患者临床总有效率为57.78%(26/45),优于对照组患者的31.58%(12/38)(P<0.05)。两组患者中医证候评分均显著改善,治疗组患者总有效率为84.44%,优于对照组患者的36.84%(P<0.01)。治疗组患者肝功能指标(ALT、AST、GGT、ALP)、糖代谢相关指标(FPG、C-肽、FINS、HOMA-IR)、TG、BMI、食欲VAS评分指标均有显著改善(P<0.01);对照组患者GGT、BMI显著降低(P<0.01),而食欲VAS评分有升高的趋势(P<0.05)。两组患者内均未出现严重不良反应。结论:平胃安神饮联合LCD可安全有效地改善MAFLD患者肝脏脂肪变程度及中医证候,降低肝酶,纠正糖脂代谢紊乱,减轻体重。抑制过亢食欲,缓解LCD伴随而来的不适可能是平胃安神饮治疗MAFLD核心价值所在。
Objective:Evaluation of the clinical efficacy and safety of Pingwei Anshen Decoction combined with a low-carbohydrate diet(LCD)in the treatment of metabolic-associated fatty liver disease(MAFLD).Methods:A prospective cohort study was conducted on 113 patients diagnosed with metabolic dysfunction-associated fatty liver disease(MAFLD)characterized by liver stagnation and spleen deficiency syndrome,as well as phlegm-stasis interaction syndrome.Based on patient preference,the participants were allocated into a treatment group(n=45)and a control group(n=38).Both groups underwent a low-carbohydrate diet(LCD)intervention,while the treatment group received additional therapy with Pingwei Anshen Decoction.The intervention lasted 2 weeks for both groups.Outcomes measured included liver controlled attenuation parameter(CAP)values,traditional Chinese medicine(TCM)syndrome scores,liver function indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(γ-GT),and alkaline phosphatase(ALP)],glycemic and lipid metabolism parameters[fasting plasma glucose(FPG),fasting serum C-peptide(C-P),fasting insulin(FINS),homeostasis model assessment of insulin resistance(HOMA-IR),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)],body mass index(BMI),appetite visual analog scale(VAS)scores,and safety profiles.Results:Both groups showed a significant decrease in CAP values.The total clinical effective rate of the treatment group was 57.78%(26/45),which was better than the control group's 31.58%(12/38),with a statistical difference(P<0.05).Both groups of TCM syndrome scores showed significant improvement,with a total effective rate of 84.44%in the treatment group,which was better than the control group's 36.84%(P<0.01).The treatment group showed significant improvements in liver function indexes(ALT,AST,GGT,ALP),glucose metabolism-related indexes(FPG,C-P,FINS,HOMA-IR),TG,BMI,and appetite VAS score indexes(P<0.01);There wa
作者
皮珊珊
叶永安
张珺洁
吴子彧
方舒瑶
杨媛媛
杜宏波
PI Shan-shan;YE Yong-an;ZHANG Jun-jie(Dongzhimen Hospital,Beijing University of Chinese Medicine.(Beijing,100700),China.)
出处
《中西医结合肝病杂志》
CAS
2024年第12期1069-1073,共5页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
基金
首都卫生发展科研专项(首发2024-2-4195)
第五批全国中医临床优秀人才研修项目(国中医药人教函[2022]1号)。
关键词
代谢相关脂肪性肝病
低碳水化合物饮食
代谢功能障碍相关脂肪性肝病
非酒精性脂肪性肝病
食欲亢进
metabolic dysfunction-associated fatty liver disease
low-carbohydrate diet
metabolic dysfunction-associated steatotic liver disease
non-alcoholic fatty liver disease
appetite
