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目的:观察美常安对非酒精性脂肪性肝病(NAFLD)患者临床症状及胰岛素抵抗(IR)的作用。方法:选取2009年4月至2013年3月我院收治的88例NAFLD患者,随机分为治疗组和对照组。对照组给予基础治疗,治疗组在对照组的基础上,加用美常安胶囊进行治疗。比较两组疗效及治疗前后两组血清谷丙转氨酶(ALT)、甘油三酯(TG)及稳态胰岛素抵抗指数(HOMA-IR)水平,并分析血浆D乳酸、TNF-α、内毒素与HOMA-IR的相关性,观察两组不良反应情况。结果:治疗组治疗有效率为52.3%,明显高于对照组的29.5%(P<0.05)。治疗后治疗组ALT、TG、HOMA-IR下降幅度,均明显优于对照组(P<0.05)。治疗后治疗组患者血浆D乳酸、TNF-α、内毒素水平明显低于对照组(P<0.05),且治疗组患者HOMA-IR与患者血浆D乳酸、血清TNF-α、内毒素水平呈正相关(r=0.352,0.44,0.48;均P<0.05)。不良反应发生率低,且两组不良反应发生率无显著差异(P>0.05)。结论:美常安治疗NAFLD疗效显著,可降低ALT、TG水平,降低肠道通透性,改善肠源性内毒素血症,改善IR,且安全性较高。
Objective: To observe the effect of Mei Chang An on clinical symptoms and insulin resistance (IR) in patients with non-alcoholic fatty liver disease (NAFLD). Methods: From April 2009 to March 2013, 88 cases of NAFLD admitted to our hospital were randomly divided into treatment group and control group. Control group given basic treatment, the treatment group in the control group based on the addition of the United States Changan capsule for treatment. Serum alanine aminotransferase (ALT), triglyceride (TG) and homeostasis index of insulin resistance (HOMA-IR) were compared between the two groups before and after treatment. Plasma D-lactate, TNF-α, -IR correlation, the two groups observed adverse reactions. Results: The effective rate of the treatment group was 52.3%, which was significantly higher than that of the control group (29.5%, P <0.05). After treatment, the decrease of ALT, TG and HOMA-IR in the treatment group was significantly better than that in the control group (P <0.05). After treatment, the levels of plasma D-lactate, TNF-α and endotoxin in the treatment group were significantly lower than those in the control group (P <0.05). HOMA-IR in the treatment group was positively correlated with plasma D-lactate, serum TNF- (r = 0.352, 0.44, 0.48; all P <0.05). The incidence of adverse reactions was low, and there was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion: The treatment of NAFLD by Meixuan’an is significant, which can reduce the levels of ALT and TG, reduce the intestinal permeability, improve the intestinal endotoxemia, improve the IR and have higher safety.