【目的】探讨二黄祛脂颗粒联合水飞蓟宾胶囊对非酒精性脂肪肝 （NAFLD） 患者脂肪肝指数、炎症因子及自噬相关基因 水平的影响。 【方法】将126例痰瘀互结型NAFLD患者随机分为对照组和观察组，每组各63例。对照组给予水飞蓟宾胶囊口 服治疗，观察组在对照组的基础上给予二黄祛脂颗粒口服治疗，疗程为3个月。观察2组患者治疗前后脂肪肝指数、炎症因 子[白细胞介素6 （IL-6） 、肿瘤坏死因子α （TNF-α） ]、肝功能及血脂指标[丙氨酸氨基转移酶 （ALT） 、天冬氨酸氨基转移酶 （AST） 、γ谷氨酰转肽酶 （GGT） 、总胆固醇 （TC） 、甘油三酯 （TG） 、高密度脂蛋白胆固醇 （HDL-C） 、低密度脂蛋白胆固醇 （LDL-C） ]、自噬相关基因[自噬相关基因7 （ATG7） 、肌球蛋白样BCL2结合蛋白 （Beclin 1） ]水平的变化情况，并评价2组患者 的临床疗效和安全性。 【结果】（1） 疗效方面，治疗3个月后，观察组的总有效率为90.48% （57/63） ，对照组为71.43% （45/63） ， 组间比较 （χ2 检验） ，观察组的疗效明显优于对照组 （P＜0.01） 。 （2） 脂肪肝指数方面，治疗后，2组患者的脂肪肝指数均较治疗 前明显降低 （P＜0.05） ，且观察组对脂肪肝指数的降低幅度明显优于对照组 （P＜0.01） 。 （3） 炎症因子方面，治疗后，2组患者 血清IL-6、TNF-α水平均较治疗前明显降低 （P＜0.05） ，且观察组对血清IL-6、TNF-α水平的降低幅度均明显优于对照组 （P＜0.05） 。 （4） 肝功能方面，治疗后，2组患者血清ALT、AST、GGT水平均较治疗前明显降低 （P＜0.05） ，且观察组对血清 ALT、AST、GGT水平的降低幅度均明显优于对照组 （P＜0.05） 。 （5） 血脂方面，治疗后，2组患者血清TG、TC、LDL-C水平 均较治疗前明显降低 （P＜0.05） ，血清HDL-C水平均较治疗前明显升高 （P＜0.05） ，且观察组对血清TG、TC、LDL-C水平的 降低幅度及对血清HDL-C水平的升高幅度均明显优于对照组 （P＜0.05） 。 （6） 自噬相关基因方面，治疗后，2组患者的血清 ATG7、Beclin 1水平均较治疗前明显升高 （P＜0.05） ，且观察组对血清ATG7、Beclin 1水平的升高幅度均明显优于对照组 （P＜0.05） 。 （7） 安全性方面，用药过程中2组患者均未见肝、肾功能损害或严重不良反应。 【结论】二黄祛脂颗粒联合水飞蓟 宾胶囊治疗痰瘀互结型NAFLD患者疗效确切，有助于缓解脂肪肝症状，降低炎症因子水平，改善肝功能及血脂水平，调节 自噬相关基因表达。

Abstract：Objective To investigate the effects of Erhuang Quzhi Granules combined with Silibinin Capsules on fatty liver index，inflammatory factors and autophagy-related gene levels in patients with nonalcoholic fatty liver disease （NAFLD） . Methods A total of 126 patients with NAFLD of phlegm blended with blood stasis type were randomly divided into control group and observation group，with 63 cases in each group. The control group was treated with oral use of Silibinin Capsules，and the observation group was treated with oral use of Erhuang Quzhi Granules on the basis of treatment for the control group. The course of treatment lasted for 3 months. Before and after treatment，the two groups were observed in the changes of fatty liver index，and the levels of inflammatory factors of interleukin 6 （IL-6） and tumor necrosis factor alpha （TNF-α） ，liver function and blood lipid indicators of alanine aminotransferase （ALT） ，aspartate aminotransferase （AST） ，γ-glutamyl transpeptidase （GGT） ，total cholesterol （TC） ，triglyceride （TG） ，high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C） ，and autophagy-related genes of autophagy-related gene 7 （ATG7） and myosin-like BCL2 binding protein （Beclin 1） . After treatment，the clinical efficacy and safety of the two groups were evaluated. Results （1） After 3 months of treatment，the total effective rate of the observation group was 90.48%（57/63）， and that of the control group was 71.43%（45/63） . The intergroup comparison （tested by chi-square test） showed that the efficacy of the observation group was significantly superior to that of the control group （P＜0.01） . （2） After treatment，the fatty liver index of the two groups was significantly decreased compared with that before treatment （P＜0.05） ，and the decrease of fatty liver index in the observation group was significantly superior to that in the control group （P＜0.01） . （3） After treatment，the serum levels of inflammatory factors of IL-6 and TNF-α in the two groups were significantly lower than those before treatment （P＜0.05），and the decrease of serum IL-6 and TNF-α levels in the observation group was significantly superior to that in the control group （P＜0.05） . （4） After treatment，the serum levels of liver function indicators of ALT，AST and GGT in the two groups were significantly lower than those before treatment（P＜0.05），and the decrease of serum ALT，AST and GGT levels in the observation group was significantly superior to that in the control group （P＜0.05） . （5） After treatment，the serum levels of blood lipids of TG，TC and LDL-C in the two groups were significantly lower than those before treatment （P＜0.05），and the serum HDL-C level was significantly higher than that before treatment （P＜0.05） . The decrease of serum TG，TC and LDL-C levels and the increase of serum HDL-C level in the observation group were significantly superior to those in the control group （P＜0.05） . （6） After treatment，the serum levels of autophagy- related genes of ATG7 and Beclin 1 in the two groups were significantly higher than those before treatment （P＜ 0.05） ，and the increase of serum ATG7 and Beclin 1 levels in the observation group was significantly superior to that in the control group （P＜0.05） . （7）During the medication，no liver or kidney function damage or serious adverse reactions were found in the two groups. Conclusion Erhuang Quzhi Granules combined with Silibinin Capsules are effective for the treatment of NAFLD patients with phlegm blended with blood stasis type，which is helpful to relieve the symptoms of fatty liver，reduce the levels of inflammatory factors，improve liver function and blood lipid levels，and regulate the expression of autophagy-related genes.

R259.755

国家自然科学基金资助项目 （编号：81802062）