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复方嗜酸乳杆菌联合水飞蓟宾胶囊治疗非酒精性脂肪肝的临床效果

作者:未知

  [摘要]目的 探討复方嗜酸乳杆菌联合水飞蓟宾胶囊治疗非酒精性脂肪肝的临床效果。方法 选取2017年4月~2018年10月我院收治的120例非酒精性脂肪肝患者作为研究对象,按照治疗方法的不同将其分为观察组和对照组,每组各60例。观察组患者采用复方嗜酸乳杆菌联合水飞蓟宾胶囊治疗,对照组单独使用水飞蓟宾胶囊治疗,两组均连续治疗12周。比较分析两组患者治疗前后的生化指标[总胆固醇(TC)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转酞酶(GGT)],并检测治疗前后的脂肪肝等级,评估两种方法治疗非酒精性脂肪肝的临床效果。结果 两组患者治疗前的各项生化指标水平比较,差异无统计学意义(P>0.5);两组患者治疗后的各项生化指标水平均明显低于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后的各项生化指标水平均明显低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗的总有效率为91.67%,明显高于对照组的76.67%,差异有统计学意义(P<0.05)。两组患者治疗前的脂肪肝严重程度比较,差异无统计学意义(P>0.05);两组患者治疗后的脂肪肝严重程度均轻于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后的脂肪肝严重程度明显轻于对照组,差异有统计学意义(P<0.05)。结论 复方嗜酸乳杆菌联合水飞蓟宾胶囊治疗非酒精性脂肪肝安全有效,能够明显改善患者的肝功能,有望成为预防和治疗非酒精性脂肪肝的新方法。
  [关键词]复方嗜酸乳杆菌;水飞蓟宾;非酒精性脂肪肝;临床疗效
  [中图分类号] R975 [文献标识码] A [文章编号] 1674-4721(2019)5(c)-0068-04
  Clinical effect of Compound Lactobacillus acidophilus combined with Silibinin Capsules in the treatment of non-alcoholic fatty liver disease
  ZHANG Li-li CHEN Yan YAO Wei-min GUO Jian-wen YU Xian-yi MA Jian-min
  Department of Infectious Diseases, Nanhai District People′s Hospital in Foshan City, Guangdong Province, Foshan 528200, China
  [Abstract] Objective To investigate the clinical effect of Compound Lactobacillus acidophilus combined with Silibinin Capsules in the treatment of non-alcoholic fatty liver disease (NAFLD). Methods A total of 120 patients with NAFLD admitted to our hospital from April 2017 to October 2018 were selected as the study subjects. The enrolled patients were divided into observation group and control group according to different treatment methods, with 60 cases in each group. In the observation group, the Compound Lactobacillus acidophilus combined with Silibinin Capsules was adopted, and in the control group, patients were treated with Silibinin Capsules alone. Both groups were treated continuously for 12 weeks. The biochemical indicators (total cholesterol [TC], alanine aminotransferase [ALT], aspartate aminotransferase [AST], γ-glutamyltransferase [GGT]) of the two groups before and after treatment were compared and the levels of fatty liver before and after treatment were measured in order to evaluate the clinical effect of the two methods in the treatment of NAFLD. Results There were no significant differences in biochemical indicators between the two groups before treatment (P>0.05). The levels of biochemical indicators in the two groups after treatment were significantly lower than those before treatment, and the differences were statistically significant (P<0.05). The levels of biochemical indicators in the observation group after treatment were significantly lower than those in the control group, and the differences were statistically significant (P<0.05). The total effective rate of the treatment in the observation group was 91.67%, which was significantly higher than that in the control group (76.67%), and the difference was statistically significant (P<0.05). There was no significant difference in the severity of fatty liver between the two groups before treatment (P>0.05). The severity of fatty liver after treatment in both groups was lighter than that before treatment, and the difference was statistically significant (P<0.05). The severity of fatty liver after treatment in the observation group was significantly lighter than that in the control group, and the difference was statistically significant (P<0.05). Conclusion Compound Lactobacillus acidophilus combined with Silibinin Capsules is safe and effective in the treatment of NAFLD, which can markedly improve the liver function of patients. It is expected to be a new method for the prevention and treatment of NAFLD.   [Key words] Compound Lactobacillus acidophilus; Silibinin; Non-alcoholic fatty liver disease; Clinical efficacy
  非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)是指排除过量饮酒及外病毒性肝炎,药物性肝病等明显的肝损因素所导致的过量脂肪沉积肝组织为主要特征的临床病理综合征[1-2]。NAFLD的发病机制尚不明确,多涉及氧化应激、内毒素、三磷酸腺苷(ATP)耗竭、胰岛素抵抗等,与肥胖、代谢综合征类疾病有密切的关系[3]。患病者多无自觉症状,部分患者表现出易疲乏、血脂紊乱、肝脾肿大、体重超重等体征,若未得到及时治疗,有机会发展成脂肪性肝炎、肝纤维化、肝硬化等严重疾病[4-6]。近年来,越来越多的报道指出肠道微生态失衡在NAFLD的发病过程中起着重要作用[7]。治疗NAFLD的药物种类有很多,但均无特殊疗效,有研究提示,益生菌可以通过调节肠道微生态有效地改善NAFLD[8]。本研究选取我院收治的120例NAFLD患者作为研究对象,旨在评估复方嗜酸乳杆菌联合水飞蓟宾胶囊治疗NAFLD的临床效果,现报道如下。
  1资料与方法
  1.1一般资料
  选取2017年4月~2018年10月我院收治的120例NAFLD患者作为研究对象,按照治疗方法的不同将其分为观察组和对照组,每组各60例。纳入标准:所有患者均经相关检查确诊为NAFLD,并符合《非酒精性脂肪性肝病诊疗指南》(中华医学会肝脏病学分会脂肪肝和酒精性肝病学组2010年修订)的诊断标准;所有患者均同意配合本研究,且签订同意书。排除标准:对相关药物过敏者;伴有心、脑、肾等重大疾病者;伴肝脏恶性肿瘤疾病者;妊娠期妇女。两组患者的一般资料[性别、年龄、病程、体重指数(BMI)]比较,差异无统计学意义(P>0.05)(表1),具有可比性。本研究通过我院医学伦理委员会批准。
  1.2方法
  对照组患者给予水飞蓟宾胶囊(天津天士力圣特制药有限公司,国药准字H20040299,规格:35 mg×10粒×2板)治疗,3次/d,口服,每次70 mg。观察组患者在对照组的基础上给予复方嗜酸乳杆菌(通化金马药业集团股份有限公司,国药准字H10940114,规格:0.5 g×6粒×4板,)治疗,3次/d,口服,每次1.0 g。两组患者的疗程均为12周。
  1.3观察指标及评价标准
  ①临床疗效[9]:根据治疗后的临床症状、生化指标及超声检查将NAFLD患者的临床疗效分为显效、有效、无效,具体如下。显效:治疗后患者的临床症状消失,生化指标正常,超声检查提示正常;有效:治疗后患者的临床症状好转,生化指标有明显改善,超声检查明显改善;无效:治疗后患者的临床症状未改善甚至加重,生化指标明显异常未改善,超声检查明显异常未改善。总有效率=(显效+有效)例数/总例数×100.00%。②治疗前后肝功能生化指标:总胆固醇(TC)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转酞酶(GGT)。③治疗前后患者的脂肪肝严重等級:根据B超检查分为无脂肪肝、轻度脂肪肝、中度脂肪肝、重度脂肪肝。其中脂肪含量≤5%为无脂肪肝,5%<脂肪含量≤10%为轻度脂肪肝,10%<脂肪含量≤25%为中度脂肪肝,脂肪含量>25%为重度脂肪肝[10]。
  1.4统计学方法
  采用SPSS 18.0统计学软件进行数据分析,计量资料用均数±标准差(x±s)表示,两组间比较采用t检验;计数资料采用率表示,组间比较采用χ2检验;等级资料采用秩和检验,以P<0.05为差异有统计学意义。
  2结果
  2.1两组患者治疗前后各项生化指标水平的比较
  两组患者治疗前的各项生化指标水平比较,差异无统计学意义(P>0.5);两组患者治疗后的各项生化指标水平均明显低于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后的各项生化指标水平均明显低于对照组,差异有统计学意义(P<0.05)(表2)。
  2.2两组患者临床治疗治疗总有效率的比较
  观察组患者治疗的总有效率为91.67%,明显高于对照组的76.67%,差异有统计学意义(P<0.05)(表3)。
  2.3两组患者治疗前后脂肪肝严重程度的比较
  两组患者治疗前的脂肪肝严重程度比较,差异无统计学意义(P>0.05);两组患者治疗后的脂肪肝严重程度均轻于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后的脂肪肝严重程度明显轻于对照组,差异有统计学意义(P<0.05)(表4)。
  3讨论
  随着社会经济的发展,人们的膳食结构有了很大的改变,这促使NAFLD的发病率逐年上升,已成为临床常见的肝疾病,严重影响人们的身心健康[11]。NAFLD的发生多涉及氧化应激、内毒素、ATP耗竭、胰岛素抵抗等,其中肠道微生态失衡是影响NAFLD发病的重要因素之一[12]。因此,恢复肠道微生态平衡是综合防治NAFLD的重要过程,且已有大量的研究指出,足量的益生菌能够通过抑制病菌增殖,改善肠道菌群结构,调整肠道微生态系统,从而有效防止NAFLD的发生[13-14]。复方嗜酸乳杆菌片是一种价格低廉、安全的益生菌复方片剂,包含中国株嗜酸乳杆菌、日本嗜酸乳杆菌、粪链球菌及枯草杆菌,可改善肠道菌群的结构,平衡肠道微生态[15]。
  水飞蓟宾胶囊能够清除自由基,保护线粒体,影响真菌毒素对肝组织的伤害,增强肝组织的抵抗力,促进肝细胞修复,改善肝脏脂肪变。本研究选取120例NAFLD患者作为研究对象,进行分组,采用复方嗜酸乳杆菌联合水飞蓟宾及单独使用水飞蓟宾的方法分别治疗NAFLD患者,结果显示,采用复方嗜酸乳杆菌联合水飞蓟宾治疗后的患者各项生化指标均优于单独使用水飞蓟宾治疗的患者(P<0.05);而且采用复方嗜酸乳杆菌联合水飞蓟宾治疗的总有效率为91.67%,明显高于单独使用水飞蓟宾治疗的76.67%(P<0.05);另外,采用复方嗜酸乳杆菌联合水飞蓟宾治疗后FibroTouch检测患者脂肪肝等级分布情况明显优于单独使用水飞蓟宾治疗(P<0.05)。其缘由是肝脏与肠道菌群和肠源性物质有着密切的联系,若菌群失调,肠道微生态系统失衡,会损害黏膜屏障功能,使细菌向门脉循环转移从而损伤肝脏,复方嗜酸乳杆菌片可改善肠道菌群的结构,平衡肠道微生态,联合水飞蓟宾更有利于患者恢复[16-17]。   综上所述,复方嗜酸乳杆菌联合水飞蓟宾胶囊治疗NAFLD,安全有效,能够明显改善患者的肝功能,有望成为预防和治疗NAFLD的新方法。
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  (收稿日期:2019-01-02 本文编辑:任秀兰)
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