肝脂方治疗慢乙肝合并代谢相关脂肪性肝病患者临床疗效评价

肝脏 ›› 2025, Vol. 30 ›› Issue (10): 1389-1392.

肝脂方治疗慢乙肝合并代谢相关脂肪性肝病患者临床疗效评价

于笑笑, 周龙, 沈应秋, 王开霞, 汪涛, 刘成海, 屈莉红, 张锋镝

200120 上海同济大学附属东方医院感染科(于笑笑,周龙,沈应秋,王开霞,汪涛,屈莉红,张锋镝);201203 上海上海中医药大学附属曙光医院肝病研究所(刘成海)

收稿日期:2024-10-10 出版日期:2025-10-31 发布日期:2025-12-16
基金资助:
浦东新区卫生计生科研面上项目(PW2021A-4);浦东新区国家中医药发展改革试验区建设项目(PDZY-2024-0702);综合医院中西医协同引导项目(ZXXT-202316)

Clinical efficacy of Ganzhi Formula in treating patients with chronic hepatitis B and metabolic-associated fatty liver disease

YU Xiao-xiao¹, ZHOU Long¹, SHEN Ying-qiu¹, WANG Kai-xia¹, WANG Tao¹, LIU Cheng-hai², QU Li-hong¹, ZHANG Feng-di¹

1. Department of Infectious Disease, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China;
2. Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese medicine (TCM), Shanghai 201203, China

Received:2024-10-10 Online:2025-10-31 Published:2025-12-16

摘要/Abstract

摘要： 目的探讨肝脂方联合核苷类药物治疗慢性乙型肝炎(CHB)合并代谢相关脂肪性肝病(MAFLD)的临床疗效。方法选择2022年1月至2024年7月同济大学附属东方医院收治的CHB合并MAFLD患者84例。随机分为观察组和对照组,每组42例。对照组给予核苷类药物和易善复,观察组在对照组基础上予以肝脂方,两组患者均用药12周。观察治疗前后患者FibroTouch脂肪衰减(CAP)值、血清酶、血脂等变化情况以及中医证候积分、生活质量评分、APRI、FIB-4、FAST、Agile评分。结果治疗12周后,观察组CAP值显示有效率52.4%(22/42),对照组为31.0%(13/42),差异有统计学意义(χ²=3.967,P=0.046)。观察组中医证候评分和生活质量评分有效率为83.3%(35/42)和54.8%(23/42),对照组为40.4%(17/42)和9.5%(4/42),差异有统计学意义(χ²=19.184、19.704,P<0.001)。观察组FIB-4评分较对照组改善显著(1.23±0.49)分比(0.93±0.44)分,差异有统计学意义(P=0.004)。观察组LDL水平较对照组显著降低,为2.95(2.54, 3.17)mmol/L比3.15 (2.67, 3.73)mmol/L,(P=0.046)。两组治疗前后肝功能差异无统计学意义(P>0.05)。结论肝脂方联合核苷类药物治疗能够显著改善CHB合并MAFLD患者的CAP值、中医证候和血脂水平,具有较好的临床应用价值。

关键词: 肝脂方, 慢性乙型肝炎, 代谢相关脂肪性肝病, 临床疗效

Abstract: Objective To explore the efficacy of Ganzhi Formula in treatment of patients with CHB and MAFLD. Methods A total of 84 patients from the department of Liver Disease of Dongfang Hospital, Tongji University, who met the inclusion criteria CHB combined with MAFLD, were divided into the observation group and the control group with 42 cases in each group. The control group received NAs and polyene phosphatidyl choline, while the observation group received Ganzhi Formula based on the control group. Both groups received treatment for a total of 12 weeks. Liver imaging (FibroTouch liver stiffness LSM value, CAP value), liver serum enzymes, cholesterol levels, APRI, FIB-4, FAST, Agile, Chinese medicine syndrome, and other changes were collected. Results Following 12 weeks of treatment, the observation group's CAP efficiency was 52.4% (22/42) while the control group's was 31.0% (13/42). This difference was statistically significant (P=0.046). Compared to the control group, the observation group's effective rates of TCM evidence score and quality of life score were considerably higher at 83.3% (35/42) and 54.8% (23/42) compared to 40.4% (17/42) and 9.5% (4/42) in the control group (P<0.001). The FIB-4 score was improved in the observation group (1.23±0.49 vs 0.93±0.44,P=0.004). The levels of LDL in observation group was significantly lower than that of the control group [2.95(2.54, 3.17) vs 3.15 (2.67, 3.73), P=0.046]. There was no significant difference in liver function transaminases between the two groups before and after treatment (P>0.05). Conclusion Ganzhi Formula combined with NAs could significantly improve the CAP value, TCM evidence score, and blood lipid level of patients with CHB and MAFLD, suggesting its clinical application value.

Key words: Ganzhi Formula, Chronic viral hepatitis B, Metabolic-associated fatty liver disease, Clinical efficacy

于笑笑, 周龙, 沈应秋, 王开霞, 汪涛, 刘成海, 屈莉红, 张锋镝. 肝脂方治疗慢乙肝合并代谢相关脂肪性肝病患者临床疗效评价[J]. 肝脏, 2025, 30(10): 1389-1392.

YU Xiao-xiao, ZHOU Long, SHEN Ying-qiu, WANG Kai-xia, WANG Tao, LIU Cheng-hai, QU Li-hong, ZHANG Feng-di. Clinical efficacy of Ganzhi Formula in treating patients with chronic hepatitis B and metabolic-associated fatty liver disease[J]. Chinese Hepatolgy, 2025, 30(10): 1389-1392.

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参考文献

[1] Pattyn J, Hendrickx G, Vorsters A, et al. Hepatitis B vaccines[J]. J Infect Dis, 2021, 30; 224(12 Suppl 2): S343-S351.
[2] Harrison S A, Allen A M, Dubourg J, et al. Challenges and opportunities in NASH drug development[J]. Nat Med, 2023, 29(3): 562-573.
[3] 刘成海. 病证结合中药为主治疗脂肪肝[J]. 药品评价, 2009, 6(02): 77-78.
[4] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J].中华临床感染病杂志, 2022, 15(6):401-427.
[5] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957.
[6] 中华中医药学会肝胆病专业委员会, 中国民族医药学会肝病专业委员会. 慢性乙型肝炎中医诊疗指南(2018年版)[J]. 临床肝胆病杂志, 2018, 34(12): 2520-2525.
[7] 中华中医药学会脾胃病分会. 非酒精性脂肪性肝病中医诊疗专家共识(2023)[J]. 临床肝胆病杂志, 2017, 33(12): 2270-2274.
[8] 王伟,缪海江,王新宇. 木香流气饮联合多烯磷脂酰胆碱胶囊对非酒精性脂肪肝肝郁脾虚证患者的效果观察[J]. 深圳中西医结合杂志, 2024, 34(06): 46-49.
[9] 丁宇晴,王涵,田婷,等. 慢性乙型肝炎合并脂肪肝人群疾病预后的流行病学研究[J]. 南京医科大学学报(自然科学版), 2022, 42(02): 258-263.
[10] 钟镇康,周晓玲,张志杰,等. 加味济生肾气汤联合穴位注射丹参注射液治疗慢性乙型肝炎肝纤维化患者的临床观察[J]. 中西医结合肝病杂志, 2023, 33(03): 242-246.
[11] 孔德松,张自力,张峰,等. 川芎嗪联合丹皮酚对CCl₄致大鼠肝纤维化的抑制作用及其机制研究[J]. 中国药理学通报, 2016, 32(12): 1741-1746.
[12] 常啸,李家斌. 川芎嗪联合干扰素γ治疗慢性乙肝患者对肝纤维化进程的影响[J]. 海南医学院学报, 2016, 22(24): 2999-3002.
[13] 刘磊,刘宝花,王培玉. 茯苓薏仁粉对痰湿质血脂异常影响的人群干预研究[J]. 中华健康管理学杂志, 2016,10(5): 386-389.
[14] 苗华,张旭. 茯苓结合有氧运动对大鼠基于代谢组学表征的血脂紊乱相关指标的影响[J]. 中国运动医学杂志, 2013, 32(11): 1013-1017.

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