摘要目的 探讨复方甘草酸苷联合葛根素对非酒精性脂肪性肝病(NAFLD)患者血清瘦素水平及胰岛素抵抗指数的影响.方法 将120例NAFLD患者应用计算机随机分为4组,基础治疗组、复方甘草酸苷组、葛根素组、联合治疗组各30例.基础治疗组采用基础护肝疗法,给予维生素、肝泰乐、多种氨基酸等治疗;复方甘草酸苷组应用复方甘草酸苷60ml入液静脉滴注;葛根素组应用葛根素注射液400mg入液静脉滴注;联合治疗组给予复方甘草酸苷60ml及葛根素400 mg静脉滴注.4组患者疗程均为4周.检测治疗4周前后患者血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆固醇、甘油三酯、瘦素、空腹血糖及胰岛素,并计算胰岛素抵抗指数,应用德国西门子双源CT仪行肝脏CT检查.结果 基础治疗组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为(83.08±15.68)、(43.32±11.72) U/L,(52.12±15.62)、(36.08 ±7.28) U/L,(6.20±1.30)、(5.60±0.70)mmol/L,(2.70±0.50)、(2.10±0.40) mmol/L,(14.63±3.26)、(7.61±2.46) μg/L,7.9±1.8、7.0±1.2,组内比较差异均有统计学意义(t值分别为12.828、4.244、16.648、21.442、3.341、16.152,P均＜0.01);复方甘草酸苷组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为(83.06±14.38)、(43.28±11.06) U/L,(51.68±15.48)、(37.28±7.22) U/L,(6.30±1.50)、(5.70±0.80) mmol/L,(2.60±0.40)、(2.20±0.50) mmol/L,(15.13±3.87)、(7.89 ±2.26) μg/L,(7.8±2.2)、(7.1±1.6),组内比较差异均有统计学意义(t值分别为8.893、4.225、16.520、24.708、6.353、21.137,P均＜0.01);葛根素组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为(82.68±14.36)、(44.26±9.68) U/L,(50.06±15.23)、(36.86±6.88) U/L,(6.20±1.60)、(5.60±0.70) mmol/L,(2.70±0.52)、(2.26±0.48) mmol/L,(15.68±3.26)、(6.89±2.18)μ∥L,7.7±2.8、7.0±1.8,组内比较差异均有统计学意义(t值分别为7.087、8.138、18.159、7.244、7.470、32.283,P均＜0.01);联合治疗组治疗前、后血清ALT、AST、总胆固醇、甘油三酯、瘦素及胰岛素抵抗指数分别为(84.62±14.88)、(22.28±9.38) U/L,(49.12±16.56)、(28.48±9.06) U/L,(5.70±1.60)、(5.00±0.60) mmol/L,(2.78±0.50)、(1.70 ±0.40) mmol/L,(14.78±3.68)、(4.63±2.36) μg/L,7.6±2.1、6.2±1.6,组内比较差异均有统计学意义(t值分别为14.255、11.272、8.371、9.941、8.102、37.626,P均＜0.01).4组治疗前各指标比较差异均无统计学意义(P均＞0.05),治疗后联合治疗组低于其他3组(P均＜0.05),基础治疗组、复方甘草酸苷组、葛根素组之间比较差异均无统计学意义(P均＞0.05).结论 复方甘草酸苷联合葛根素治疗NAFLD通过降低患者血清瘦素水平、改善胰岛素抵抗,增加肝细胞对胰岛素的敏感性,从而调节血脂代谢,达到治疗NAFLD的目的.

abstractsObjective To investigate the effect of Glycyrrhizin combined with puerarin on serum Leptin and insulin resistance in non-alcoholic fatty liver disease(NAFLD) patients.Methods One hundred and twenty patients with NAFLD were randomized into 4 groups,which were control group,compound Glycyrrhizin group,puerarin group,combined group,and each group was 30 cases.Patients in control group were received the regular liver protecting therapy including vitamins,amino acids,glucurolactone,in compound Glycyrrhizin group were given 60 ml compound glycyrrhizin solution (iv),in puerarin group were given puerarin at dose of 400 mg by intravenous infusion,and in combined group were given both compound glycyrrhizin and puerarin combination.All treatment period was 4 weeks.The levels of serum serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total cholesterol (TC),triglyceride (TG),leptin (LP),fasting blood glucose (FBG) and insulin(INS) were measured,and the insulin resistance index(IRI) was calculated.The liver CT image of patients were performed by Germany Siemens dual source CT instrument.Results The levels of serum ALT,AST,TC,TG,LP and IRI in control group at before and after treatment were ((83.08 ± 115.68) U/L vs.(43.32 ±11.72) U/L,(52.12±15.62) U/Lvs.(36.08 ±7.28) U/L,(6.20±1.30) mmol/Lvs.(5.60 ±0.70) mmol/L,(2.70 ±0.50) mmol/L vs.(2.10 ±0.40) mmol/L,(14.63 ±3.26) μg/L vs.(7.61 ± 2.46) μg/L,(7.9 ± 1.8) vs.(7.0 ± 1.2)),and the difference were statistically significant (t =12.828,4.244,16.648,21.442,3.341,16.152 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and IRI in compound glycyrrhizin group after treatment were ((43.28 ± 11.06) U/L,(37.28 ± 7.22) U/L,(5.70± 0.80) mmol/L,(2.20 ± 0.50) mmol/L,(7.89 ± 2.26) μg/L,(7.1 ± 1.6) respectively,significant different from before treatment ((83.06 ± 14.38) U/L,(51.68 ± 15.48) U/L,(6.30 ± 1.50) mmol/L,(2.60 ± 0.40) mmol/L,(15.13 ± 3.87) μg/L,(7.8 ± 2.2) respectively,t =8.893,4.225,16.520,24.708,6.353,21.137 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in puerarin group after treatment were (44.26 ± 9.68) U/L,(36.86 ± 6.88) U/L,(5.60 ± 0.70) mmol/L,(2.26 ± 0.48) mmol/L,(6.89 ± 2.18) μg/L,(7.0 ± 1.8) respectively,significant different from that before treatment ((82.68±14.36) U/L,(50.06±15.23) U/L,(6.20±1.60) mmol/L,(2.70±0.52) mmol/L,(15.68 ±3.26)μg/L,(7.7 ±2.8) respectively,t =7.087,8.138,18.159,7.244,7.470,32.283 respectively,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI in combined treatment group after treatment were (22.28 ± 9.38)U/L,(28.48 ± 9.06) U/L,(5.00 ± 0.60) mmol/L,(1.70 ± 0.40) mmol/L,(4.63 ± 2.36) μg/L,(6.20± 1.6) respectively,significantly different from that before treatment ((84.62 ± 14.88) U/L,(49.12 ± 16.56)U/L,(5.70 ± 1.60) mmol/L,(2.78 ± 0.50) mmol/L,(14.78 ± 3.68) μg/L,(7.6 ± 2.1),t =14.255,11.272,8.371,9.941,8.102,37.626,P ＜ 0.01).The levels of serum ALT,AST,TC,TG,LP and ISI of patient were no significant difference before treatment,but after treatment,these indexes in combined therapy group were the lowest among 4 groups (P ＜ 0.05).And there were no significant difference among control group,compound glycyrrhizin group,puerarin group (P ＞ 0.05).Conclusion Compound glycyrrhizin combined with puerarin is proved to be an effect treatment method for NAFLD through decreasing serum leptin,improving insulin resistance.