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摘要：
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摘要：目的 探讨三仁汤合茵陈五苓散加减联合多烯磷脂酰胆碱治疗湿热蕴结型非酒
精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）的临床疗效以及其对患者
肝纤维化和血清白细胞介素（interleukin，IL）-1β、内脂素、血红素氧合酶1（heme
oxygenase-1，HO-1）水平的影响。方法 选择运城市中医医院2019年1月至2022年1月收
治的120例NAFLD湿热蕴结证患者为研究对象，采用随机数字表法分成观察组与对照
组，每组60例。观察组采用三仁汤合茵陈五苓散加减联合多烯磷脂酰胆碱治疗，对照
组单用多烯磷脂酰胆碱治疗。均连续治疗12周后观察两组临床疗效。治疗前后采用全
自动生化分析仪检测血脂 [甘油三酯（triglyceride，TG）、总胆固醇（total cholesterol，
TC）、低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）、高密度
脂蛋白胆固醇（high density lipoprotein cholesterol，HDL-C）] 和肝功能指标 [丙氨酸
氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate
aminotransferase，AST）、γ-谷氨酰转肽酶（gamma-glutamyltransferase，GGT）]，采用
放射免疫法检测肝纤维化指标 [Ⅲ型前胶原（type Ⅲ procollagen，PC-Ⅲ）、层粘连蛋白
（laminin，LN）、透明质酸（hyaluronic acid，HA）]，并于治疗前后进行瞬时弹性超声
成像检查检测肝脏硬度（liver stiffness measurement，LSM）值，采用酶联免疫法测定血
清IL-1β、内脂素和HO-1水平。记录两组患者不良反应。结果 观察组总有效率为95.00%
（57/60），显著高于对照组的78.33%（47/60），差异有统计学意义（χ2
= 7.212，
P = 0.007）。观察组和对照组治疗后血清TG [（1.91 ± 0.35）mmol/L vs（3.26 ± 0.48）mmol/L；
（2.44 ± 0.42）mmol/L vs（3.24 ± 0.51）mmol/L]、TC [（4.32 ± 0.75）mmol/L vs（6.83 ±
1.23）mmol/L；（5.46 ± 0.86）mmol/L vs（6.77 ± 1.18）mmol/L]、LDL-C [（2.52 ±
0.34）mmol/L vs（3.72 ± 0.58）mmol/L；（2.89 ± 0.42）mmol/L vs（3.68 ± 0.64）mmol/L]、
ALT [（46.56 ± 7.03）U/L vs（67.27 ± 8.13）U/L；（55.42 ± 7.34）U/L vs（68.62 ±
7.95）U/L]、AST [（69.23 ± 8.25）U/L vs（94.21 ± 10.24）U/L；（81.23 ± 8.32）U/L vs
（93.62 ± 9.86）U/L]、GGT [（62.15 ± 8.28）U/L vs（81.23 ± 11.23）U/L；（71.45 ± 9.23）U/L
vs（80.56 ± 10.85）U/L] 水平均较治疗前显著降低（P均＜ 0.05），血清HDL-C [（1.65 ±
0.23）mmol/L vs（1.13 ± 0.14）mmol/L；（1.33 ± 0.20）mmol/L vs（1.15 ± 0.17）mmol/L] 浓
度均较治疗前显著升高，且均以观察组改善更显著（P均＜ 0.05）。观察组和对照组
治疗后血清PC-Ⅲ [（118.34 ± 15.95）μg/L vs（216.74 ± 25.24）μg/L；（155.38 ± 18.48）μg/L vs
（215.57 ± 23.09）μg/L]、LN [（93.45 ± 17.34）μg/ml vs（185.76 ± 23.55）μg/ml；
（125.31 ± 20.35）μg/ml vs（183.48 ± 22.84）μg/ml]、HA [（110.38 ± 22.45）mg/ml vs
（268.45 ± 31.24）mg/ml；（161.23 ± 26.34）mg/ml vs（267.16 ± 30.45）mg/ml] 水平
和LSM值 [（6.53 ± 1.02）kPa vs（8.13 ± 1.44）kPa；（7.37 ± 1.15）kPa vs（8.07 ± 1.34）kPa]
均较治疗前显著降低，且均以观察组下降更显著（P均＜ 0.05）。观察组和对照组患
者治疗后血清IL-1β [（17.45 ± 3.61）pg/ml vs（30.74 ± 5.67）pg/ml；（24.29 ± 4.25）pg/ml vs
（29.86 ± 6.22）pg/ml]、HO-1 [（5.87 ± 0.42）ng/ml vs（3.68 ± 0.31）ng/ml；（4.56 ±
0.35）ng/ml vs（3.72 ± 0.29）ng/ml] 水平均较治疗前显著下降，血清内脂素 [（10.23 ±
1.77）mg/L vs（16.67 ± 2.04）mg/L；（13.22 ± 1.56）mg/L vs（16.58 ± 1.82）mg/L] 水
平均较治疗前显著升高，且观察组改善更显著（P均＜ 0.05）。所有对象均未见明显
不良反应。结论 三仁汤合茵陈五苓散加减联合多烯磷脂酰胆碱治疗NAFLD湿热蕴结证
可安全有效调节患者血清IL-1β、内脂素和HO-1表达水平，促进病情缓解，改善血脂水
平，减轻肝纤维化，促进肝功能恢复。
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Abstract: Objective To investigate the clinical efficacy of Sanren decoction combined with
Yinchen Wuling powder and polyene phosphatidylcholine on the treatment of non-alcoholic
fatty liver disease (NAFLD) (dampness-heat retention syndrome) and its effects on liver fibrosis
and serum levels of interleukin-1β (IL-1β), visfatin and heme oxygenase 1 (HO-1). Methods
A total of 120 patients with dampness and heat accumulation syndrome of NAFLD who were
admitted to Yuncheng Hospital of Traditional Chinese Medicine from January 2019 to January
2022 were selected and divided into observation group and control group by random number
table method, 60 cases in each group. Patients in observation group were treated with Sanren
decoction plus Yinchen Wuling powder combined wtih polyene phosphatidylcholine, and
patients in control group were treated with polyene phosphatidylcholine alone. After 12 weeks of
continuous treatment, the clinical efficacy of the two groups were observed. Blood lipid indexes
[triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high
density lipoprotein cholesterol (HDL-C)] and liver function indexes [alanine aminotransferase
(ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT)] were detected
by automatic biochemical analyzer before and after treatment. Liver fibrosis indexes [type Ⅲ
procollagen (PC-Ⅲ), laminin (LN), hyaluronic acid (HA)] were detected by radioimmunoassay,
and liver stiffness measurement (LSM) values were detected by transient elastic ultrasonography
before and after treatment. Serum levels of IL-1β, visfatin and HO-1 were determined by
enzyme-linked immunoassay. The adverse reactions of patients in two groups were recorded.
Results The total effective rate of patients in observation group was 95.00% (57/60), which were
significantly higher than that of control group [78.33% (47/60)], the difference was statistically
significant (χ
2
= 7.212, P = 0.007). The levels of serum TG [(1.91 ± 0.35) mmol/L vs (3.26 ± 0.48)
mmol/L; (2.44 ± 0.42) mmol/L vs (3.24 ± 0.51) mmol/L], TC [(4.32 ± 0.75) mmol/L vs (6.83 ±
1.23) mmol/L; (5.46 ± 0.86) mmol/L vs (6.77 ± 1.18)mmol/L], LDL-C [(2.52 ± 0.34) mmol/L
vs (3.72 ± 0.58) mmol/L; (2.89 ± 0.42) mmol/L vs (3.68 ± 0.64) mmol/L], ALT [(46.56 ± 7.03) U/L
vs (67.27 ± 8.13) U/L; (55.42 ± 7.34) U/L vs (68.62 ± 7.95) U/L], AST [(69.23 ± 8.25) U/L vs
(94.21 ± 10.24) U/L; (81.23 ± 8.32) U/L vs (93.62 ± 9.86) U/L] and GGT [(62.15 ± 8.28) U/L
vs (81.23 ± 11.23) U/L; (71.45 ± 9.23) U/L vs (80.56 ± 10.85) U/L] of patients in observation
group and control group after treatment decreased significantly compared with those before
treatment, and the level of serum HDL-C [(1.65 ± 0.23) mmol/L vs (1.13 ± 0.14) mmol/L;
(1.33 ± 0.20) mmol/L vs (1.15 ± 0.17) mmol/L] increased significantly, and the improvement
in observation group were more significant (all P ＜ 0.05). The serum levels of PC-Ⅲ [(118.34 ±
15.95) μg/L vs (216.74 ± 25.24) μg/L; (155.38 ± 18.48) μg/L vs (215.57 ± 23.09) μg/L], LN
[(93.45 ± 17.34) μg/ml vs (185.76 ± 23.55) μg/ml; (125.31 ± 20.35) μg/ml vs (183.48 ±
22.84) μg/ml], HA [(110.38 ± 22.45) mg/ml vs (268.45 ± 31.24) mg/ml; (161.23 ± 26.34) mg/ml
vs (267.16 ± 30.45) mg/ml] and LSM [(6.53 ± 1.02) kPa vs (8.13 ± 1.44) kPa; (7.37 ± 1.15) kPa vs
(8.07 ± 1.34) kPa] of patients in observation group and control group decreased significantly
after treatment compared with those before treatment, and the decrease was more significant
in observation group (all P ＜ 0.05). Serum IL-1β [(17.45 ± 3.61) pg/ml vs (30.74 ± 5.67) pg/ml;
(24.29 ± 4.25) pg/ml vs (29.86 ± 6.22) pg/ml] and HO-1 [(5.87 ± 0.42) ng/ml vs (3.68 ± 0.31) ng/ml;
(4.56 ± 0.35) ng/ml vs (3.72 ± 0.29) ng/ml] levels in observation group and control group
after treatment decreased significantly compared with those before treatment, serum levels
of visfatin [(10.23 ± 1.77) mg/L vs (16.67 ± 2.04) mg/L; (13.22 ± 1.56) mg/L vs (16.58 ±
1.82) mg/L] increased significantly and and the improvement in observation group were
more significant (all P ＜ 0.05). There were no obvious adverse reactions observed in all
subjects. Conclusions Sanren decoction combined with Yinchen Wuling powder and polyene
phosphatidylcholine in the treatment of NAFLD damp-heat accumulation syndrome can safely
and effectively regulate serum IL-1β, visfatin and HO-1 expression levels, promote disease
remission, improve blood lipid indicators, reduce liver fibrosis and promote liver function
recovery.
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