目的 探讨三七脂肝丸联合复方蛋氨酸胆碱片治疗酒精性脂肪肝的临床疗效。方法 选择2018年10月—2019年12月在郑州大学第一附属医院治疗170例酒精性脂肪肝患者，根据住院序号分成对照组（85例）和治疗组（85例）。对照组口服复方蛋氨酸胆碱片，3片/次，3次/d；治疗组在对照组基础上口服三七脂肝丸，5 g/次，3次/d。两组均治疗2个月。观察两组患者临床疗效，比较治疗前后两组患者临床症状改善时间，肝功指标丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、三酰甘油（TG）和胆固醇（TC），肝纤维化指标透明质酸（HA）、Ⅲ型前胶原N端肽（PCⅢ）、Ⅳ型胶原（Ⅳ-C）和层粘连蛋白（LN），血清学指标过氧化酶体增殖体激活受体γ（PPARγ）、瘦素（Leptin）、脂联素（APN）、转化生长因子β（TGF-β）和白细胞介素-18（IL-18）水平。结果 经治疗，对照组和治疗组总有效率分别为84.71%、97.65%（P<0.05）。经治疗，治疗组肝区不适、黄疸、痞满、腹胀症状消失时间均明显短于对照组（P<0.05）。经治疗，两组血清AST、ALT、TC、TG、HA、LN、PCⅢ、IV-C水平均显著下降（P<0.05），并以治疗组最显著（P<0.05）。经治疗，两组血清PPARγ、Leptin、APN、TGF-β、IL-18水平均明显改善（P<0.05），并以治疗组改善最明显（P<0.05）。结论 三七脂肝丸联合复方蛋氨酸胆碱治疗酒精性脂肪肝可有效改善患者临床症状，促进肝功能和肝纤维化指标改善，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Sanqi Zhigan Pills combined with compound methionine choline tablets in treatment of alcoholic fatty liver. Methods Patients (170 cases) with alcoholic fatty liver in the First Affiliated Hospital of Zhengzhou University from October 2018 to December 2019 were divided into control (85 cases) and treatment (85 cases) groups based on hospitalization serial numbers. Patients in the control group were po administered with Compound Methionine and Choline Bitartrate Tablets, 3 tablets/time, three times daily. Patients in the treatment group were po administered with Sanqi Zhigan Pills on the basis of the control group, 5 g/time, three times daily. Patients in two groups were treated for 2 months. After treatment, the clinical efficacy was evaluated, and the disappearance time of clinical symptoms, the liver function indexes of AST, ALT, TC, and TG, the liver fibrosis indexes of HA, LN, PCⅢ and CIV, the serological indexes of PPARγ, Leptin, TGF-β, IL-18, and APN in two groups before and after treatment were compared. Results After treatment, the effective rates of control group and treatment group were 84.71% and 97.65% respectively (P<0.05). After treatment, the disappearance time of liver discomfort, jaundice, puffiness and abdominal distension in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, the serum levels of AST, ALT, TC, TG, HA, LN, PCⅢ, and IV-C were significantly decreased in two groups (P<0.05), especially in the treatment group (P<0.05). After treatment, the levels of serum PPAR γ, Leptin, APN, TGF-β, and IL-18 were significantly improved in two groups (P<0.05), especially in the treatment group (P<0.05).Conclusion Sanqi Zhigan Pills combined with compound methionine choline tablets in treatment of alcoholic fatty liver can effectively improve the clinical symptoms, promote the improvement of liver function and liver fibrosis indexes, which has a certain clinical application value.

R977

国家自然科学基金资助项目（U1904143）