目的 探讨大黄利胆胶囊联合水飞蓟宾葡甲胺片治疗非酒精性脂肪性肝病患者的临床疗效。方法 选取2019年6月-2020年3月在许昌市中心医院治疗的非酒精性脂肪性肝病患者124例，随机分为对照组和治疗组，每组各62例。对照组口服水飞蓟宾葡甲胺片，100 mg/次，3次/d。治疗组在对照组的基础上口服大黄利胆胶囊，2粒/次，3次/d。两组患者均连续治疗12周。观察两组患者临床疗效，同时比较治疗前后两组患者肝功能、血脂水平、肝纤维化指标、炎性因子单核细胞趋化蛋白-1（MCP-1）、白细胞介素-17A（IL-17A）和IL-10水平及脂质过氧化损伤产物水平。结果 治疗后，对照组总有效率为75.81%，显著低于治疗组的90.32%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者丙氨酸氨基转移酶（ALT）、天氨酸氨基转移酶（AST）、谷氨酰转移酶（GGT）、血清总胆固醇（TC）、血清三酰甘油（TG）、透明质酸（HA）、层黏连蛋白（LN）、IV型胶原蛋白（IV-C）、丙二醛（MDA）和8-异前列腺素F2α（8-iso-PGF2α）水平均显著降低（P<0.05），且治疗组降低更为明显（P<0.05）。治疗后，两组MCP-1、IL-17A均显著降低，IL-10水平显著升高（P<0.05），且治疗组患者MCP-1、IL-17A、IL-10水平改善程度更为明显（P<0.05）。结论 大黄利胆胶囊联合水飞蓟宾葡甲胺片可显著改善非酒精性脂肪性肝病患者的肝功能、血脂、肝纤维化指标，有效抑制炎性反应，减轻脂质过氧化损伤，疗效较佳，安全性高。

Objective To investigate the clinical effect of Dahuang Lidan Capsules combined with silybin meglumine in treatment of nonalcoholic fatty liver disease. Methods Patients (124 cases) with nonalcoholic fatty liver disease in Xuchang Central Hospital from June 2019 to March 2020 were randomly divided into control and treatment groups, and each group had 62 cases. Patients in the control group were po administered with Silibin Meglumine Tablets, 100 mg/time, three times daily. Patients in the treatment group were po administered with Dahuang Lidan Capsules on the basis of the control group, 2 grains/time, three times daily. After treatment, the clinical efficacy was evaluated, and the liver function and blood lipid levels, liver fibrosis indexes, inflammatory factors of MCP-1, IL-17A and IL-10 levels, the levels of lipid peroxidation damage products in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 75.81%, which was significantly lower than 90.32% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the levels of ALT, AST, GGT, TC, TG, HA, LN, IV-C, MDA and 8-iso-PGF2α in two groups were significantly decreased (P<0.05), and the indexes in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the MCP-1 and IL-17A levels in two groups were significantly decreased (P<0.05), but the IL-10 levels were significantly increased (P<0.05), and the improvement of MCP-1, IL-17A and IL-10 in the treatment group were significantly better than those in the control group (P<0.05). Conclusion Dahuang Lidan Capsules combined with silybin meglumine in treatment of nonalcoholic fatty liver disease can significantly improve liver function, blood lipid, liver fibrosis indexes, effectively control inflammatory reaction, reduce lipid peroxidation damage, with better clinical efficacy and higher safety.

R975