| Part 1 Clinical researchObjective:The clinical practice of traditional Chinese medicine in treating NAFLD suggests that TCM treatment of NAFLD can not only improve the main clinical symptoms,main syndromes and quality of life,but also reduce the degree of hepatic steatosis,which is worthy of further study.At present,the evaluation scheme of NAFLD clinical research is based on the objective indexes such as imaging,and the subjective feelings of patients are less related to the quality of life,which is not enough to reflect the advantages and characteristics of TCM treatment.This study begins with the outcome index of patient report to evaluate the clinical effect of regulating liver and live-spleen in treating NAFLD and expounding the therapeutic effect of traditional Chinese medicine on NAFLD.and has the advantages of good effect and function.Method:Methods from June 2016 to January 2017,a total of 60 outpatients in digestive department of Beijing Chinese Medicine Hospital affiliated to Capital Medical University were randomly divided into treatment group and control group.The treatment group was given the combination of regulating the liver and regulating the spleen to cooperate with the lifestyle intervention,while the control group only received life style intervention,the treatment course lasted for 12 weeks.Two groups were compared before and after treatment,PRO scale,TCM syndrome and TCM symptom scores.Result:(1)The scores of TCM PRO scale:compared with before treatment,the PRO scores and the three dimension scores of the two groups were significantly increased after treatment,and the difference was statistically significant(P<0.05).Compared with the control group,the total score of PRO and the scores of physiological,psychological and therapeutic dimensions in the treatment group were significantly higher than those in the control group(P<0.05).(2)The total integral of TCM syndromes:compared with before treatment,the total integral of TCM syndromes in the two groups was obviously reduced after treatment,and the difference was statistically significant(P<0.05).Compared with the control group,the total score of TCM syndromes in the treatment group was significantly lower than that in the control group(P<0.05).(3)The main symptom scores of the two groups were significantly lower than that before treatment(P<0.05,P<0.05),and the symptoms of the two groups were significantly lower than those before treatment(P<0.05,P<0.05,P<0.05,P<0.05).Compared with the control group,the scores of major symptoms in the treatment group were significantly decreased after treatment,and the difference was statistically significant(P<0.05).(4)Comparison of syndromes efficacy:before and after treatment,the total effective rate of the treatment group was significantly higher than that of the control group,the difference was statistically significant(P<0.01).Conclusion:(1)The method of regulating liver and regulating spleen combined with lifestyle intervention can effectively improve the traditional Chinese medicine syndromes of NAFLD and pro,the curative effect is outstanding,and it is suitable for clinical popularization.(2)To evaluate the clinical efficacy of NAFLD by PRO scale of TCM can reflect the whole concept of TCM and the method of differentiation and treatment according to people's conditions,and highlight the characteristics of TCM treatment.Part 2 Experimental studyObjective:At present,the prevention and treatment of fatty liver with traditional Chinese medicine has its own characteristics and advantages,which shows good prospects.But because of its unclear curative effect mechanism,it has become a bottleneck restricting the application and development of TCM clinical popularization.This study clarifies the mechanism of regulating liver and spleen treating NAFLD from the angle of "intestinal liver axis",and deepens the transmission of spleen to liver disease and the treatment of liver and spleen in traditional Chinese medicine.Theoretical understanding promotes the clinical application of TCM regulating liver and regulating spleen in the prevention and treatment of nonalcoholic fatty liver disease.Method:50 male SD rats(SPF grade)were randomly divided into 10 control group,10 model group and 30 treatment group(10 liver and spleen group,10 liver regulating group and 10 liepi group).The rats in the control group were fed with normal diet,and the rats in the model group and the treatment group were all given the NAFLD model with high glucose and high-fat diet for 4 weeks.At the same time,the treatment group was given 2ml/100g/d(5 times as much as the adult dose)according to the requirement of different drugs,while the control group was given the same amount of normal saline.At the end of fourth weeks,animals were sacrificed,and blood,liver and intestinal specimens were collected.The levels of serum ALT,AST,GGT and ALP were measured by automatic biochemistry analyzer.The degree of steatosis was observed by HE staining and oil red staining,and the expression of tight junction protein ZO-1 and Occludin was observed by immunohistochemistry.Results:(1)Serum liver function:compared with the model group,the activities of ALT and AST in the liver regulating spleen group and the spleen governing group were all decreased,the difference was statistically significant(P<0.05).There was no significant difference between the liver control group and the model group.Compared with the liver regulating spleen group,there was no significant difference between the spleen and spleen group(P>0.05).Compared with the model group,the activity of GGT in the liver regulating spleen group,the regulating liver group and the spleen regulating group all decreased,and the difference was statistically significant(P<0.05).Compared with the liver regulating spleen group,the activity of liver regulating group and spleen spleen group were higher,and the difference was statistically significant(P<0.05).(2)hepatic histology:HE staining:liver tissues of model group almost all showed lipid droplet hepatocytes,which belonged to severe steatosis.There were different degrees of improvement in the liver tissue fatty degeneration in the treatment group and the model group.Among them,the improvement of the liver and spleen group was the most obvious,and the total number of listead hepatocytes was less than 1/3.The total number of hepatocytes in liver regulating group is about 1/2.The number of hepatocytes in Lipi group is more than 2/3.Oil red staining:a little dot red fat staining was seen in the liver cells of the control group,and diffuse red lipid droplets in the hepatocytes of the model group.Compared with the model group,the lipid droplets in the treatment group decreased,and the liver regulating spleen group decreased significantly.(3)intestinal tight junction protein:the expression of ZO-1 and Occludin protein in the control group is continuous and uniform,and the color is deep.Compared with the control group,the two kinds of protein expression in the model group were very few,scattered and light.Compared with the model group,the expression of liver regulating spleen group was more continuous,and the color was deeper.The expression level of liver regulating group was a little more,less continuous and slightly darker.The expression of the spleen group was smaller than that in the model group.Conclusion:(1)The method of regulating liver and regulating spleen can improve the liver function,steatosis of liver tissue and permeability of intestinal mucosa in rats with non-alcoholic fatty liver,which is superior to the method of regulating liver and regulating spleen.(2)The method of regulating liver and regulating spleen can improve the destruction of intestinal tight junction in NAFLD rats and can protect the intestinal mucosal barrier,thus slowing down the occurrence and development of liver injury.(3)It deepens the mechanism of regulating liver and regulating spleen to prevent and cure non-alcoholic fatty liver. |
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