【目的】 探讨清热渗湿降浊法联合水飞蓟宾葡甲胺片治疗丙氨酸氨基转移酶（ALT）异常的湿热蕴结型非酒精性脂肪性肝 炎（NASH）患者的临床疗效。【方法】 采用回顾性研究方法，根据用药情况将80例ALT异常的湿热蕴结型NASH患者分为对照 组和观察组，每组各40例。对照组给予水飞蓟宾葡甲胺片治疗，观察组在对照组的基础上联合清热渗湿降浊法治疗，疗程 为 12 周。观察 2 组患者治疗前后肝功能指标[丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶 （GGT）]、血脂指标[总胆固醇（CHOL）、甘油三酯（TRIG）]以及肝脂肪度的变化情况，并评价 2组患者的临床疗效及安全性。 【结果】（1）经治疗12周后，观察组的总有效率为95.00%（38/40），对照组为77.50%（31/40）；组间比较，观察组的疗效明显 优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2 组患者的肝功能指标 ALT、AST、GGT 水平均较治疗前明显下降 （P＜0.05），且观察组对肝功能指标 ALT、AST、GGT水平的下降作用均明显优于对照组（P＜0.05）。（3）治疗后，2组患者的 血脂指标CHOL、TRIG水平均较治疗前明显下降（P＜0.05），且观察组对血脂指标CHOL、TRIG水平的下降作用均明显优于 对照组（P＜0.05）。（4）治疗后，2组患者的肝脂肪度均较治疗前明显下降（P＜0.05），且观察组对肝脂肪度的下降作用明显优 于对照组（P＜0.05）。（5）治疗过程中，2组患者均未发生明显不良反应，具有较高的安全性。【结论】 清热渗湿降浊法联合水 飞蓟宾葡甲胺片治疗ALT异常的湿热蕴结型NASH患者疗效确切，联合清热渗湿降浊法治疗能显著提高临床疗效。

Objective To investigate the clinical efficacy of therapy of clearing heat，percolating dampness and lowering turbidity combined with Silibin Meglumine Tablets in the treatment of non-alcoholic steatohepatitis （NASH）patients with abnormal alanine aminotransferase（ALT）level of damp-heat accumulation type. Methods A retrospective study was conducted. According to the medication， 80 patients with NASH with abnormal ALT level of damp-heat accumulation type were divided into control group and observation group，with 40 cases in each group. The control group was treated with Silibin Meglumine Tablets，and the observation group was treated with therapy of clearing heat， percolating dampness and lowering turbidity on the basis of treatment for the control group. The course of treatment covered 12 weeks. The changes of liver function indicators of ALT， aspartate aminotransferase（AST），and gamma glutamyl transpeptidase（GGT），blood lipid indicators of total cholesterol （CHOL）and triglyceride（TRIG），and the degree of hepatic steatosis in the two groups were observed before and after treatment. After treatment，the clinical efficacy and safety of the two groups were evaluated. Results（1）After 12 weeks of treatment，the total effective rate of the observation group was 95.00%（38/40），and that of the control group was 77.50%（31/40）. The curative effect of the observation group was significantly superior to that of the control group，and the difference was statistically significant（P＜0.05）.（2）After treatment，the levels of ALT， AST and GGT in the two groups were significantly lower than those before treatment（P＜0.05），and the decrease of ALT，AST and GGT in the observation group was significantly superior to that in the control group（P＜0.05）. （3）After treatment，the levels of CHOL and TRIG in the two groups were significantly lower than those before treatment（P＜0.05），and the decrease of CHOL and TRIG in the observation group was significantly superior to that in the control group（P＜0.05）.（4）After treatment，the degree of hepatic steatosis in the two groups was significantly lower than that before treatment（P＜0.05），and the decrease of the degree of hepatic steatosis in the observation group was significantly superior to that in the control group（P＜0.05）.（5）During the treatment，no obvious adverse reactions occurred in the two groups，indicating high safety. Conclusion The therapy of clearing heat，percolating dampness and lowering turbidity combined with Silibin Meglumine Tablets exerts certain effect in the treatment of NASH patients with abnormal ALT level of damp-heat accumulation type，and the therapy can significantly enhance the clinical efficacy of Silibin Meglumine Tablets alone for NASH.

R259.755

深圳市科技创新委员会博士基础启动项目（编号：20210795132528002）