Dong Can, Zhang Cai-Rong, Xue Bo-Yu, Miu Wei-Feng, Fang Nan-Yuan, Li Kang, Ou Zeng-Jian, Xu Yu-Qi
Department of Acupuncture and Moxibustion, Nanjing Hospital of TCM Affiliated to Nanjing University of Chinese Medicine, Nanjing 210012, Jiangsu Province, China.
First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210046, Jiangsu Province.
Zhongguo Zhen Jiu. 2020 Feb 12;40(2):129-34. doi: 10.13703/j.0255-2930.20190201-k00034.
To observe the effect of electroacupuncture (EA) combined with lifestyle control on hepatic fat status, hepatic enzymology, glycolipid metabolism and anthropological parameters in patients with obese nonalcoholic fatty liver disease(NAFLD).
A total of 90 patients with obese NAFLD were randomized into an observation group (45 cases, 4 cases dropped off) and a control group (45 cases, 1 case dropped off). Lifestyle control was implemented in the control group. On the basis of the treatment in the control group, acupuncture was applied at Zhongwan (CV 12), Quchi (LI 11), Shuifen (CV 9), Huaroumen (ST 24), Daheng (SP 15), Guanyuan (CV 4), Qihai (CV 6), etc. EA was provided at Huaroumen (ST 24) and Daheng (SP 15) with dilatational wave, 2 Hz/100 Hz in frequency, 30 min each time, once every other day, 3 times a week. The treatment for 12 weeks was required in both of the two groups. Hepatic fat status [controlled attenuation parameter (CAP) and liver stiffness measurement (LSM)], hepatic enzymology [alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transferase (GGT)], glycolipid metabolism and insulin sensitivity [fasting plasma glucose (FPG), fasting serum lisulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C)] and anthropological parameters [body weight (BW), body mass index (BMI), fat percentage (FP), waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR)] in the two groups were observed before and after treatment.
①Compared before treatment, hepatic CAP, LSM, serum ALT, AST and GGT after treatment were obviously reduced in the two groups (<0.05, <0.01). After treatment, CAP and ALT in the observation group were lower than the control group (<0.05). ②Compared before treatment, FINS, HOMA-IR, LDL-C, TC and TG after treatment were obviously reduced in the two groups (<0.05, <0.01),while the levels of HDL-C were increased (<0.05). Compared before treatment, FPG after treatment in the observation group was reduced (<0.05). Compared with the control group, FINS, HOMA-IR, TC and TG in the observation group were lower than those in the control group after treatment (<0.05). ③Compared before treatment, BW BMI, FP, WC, HC, WHR after treatment were obviously reduced in the two groups (<0.01). After treatment, WC and WHR in the observation group were lower than the control group (<0.05).
Electroacupuncture combined with lifestyle control can effectively treat obese nonalcoholic fatty liver disease, and present better therapeutic effect on hepatic fat status, glycolipid metabolism, insulin resistance, WC and WHR.
观察电针联合生活方式干预对肥胖型非酒精性脂肪性肝病（NAFLD）患者肝脏脂肪状态、肝酶学、糖脂代谢及人体学参数的影响。
将90例肥胖型NAFLD患者随机分为观察组（45例，脱落4例）和对照组（45例，脱落1例）。对照组给予生活方式干预。观察组在对照组治疗基础上，针刺中脘（CV12）、曲池（LI11）、水分（CV9）、滑肉门（ST24）、大横（SP15）、关元（CV4）、气海（CV6）等穴位。于滑肉门（ST24）、大横（SP15）行电针治疗，采用疏密波，频率2Hz/100Hz，每次30分钟，隔日1次，每周3次。两组均治疗12周。观察两组治疗前后肝脏脂肪状态[受控衰减参数（CAP）和肝脏硬度值（LSM）]、肝酶学[丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和γ-谷氨酰转移酶（GGT）]、糖脂代谢及胰岛素敏感性[空腹血糖（FPG）、空腹血清胰岛素（FINS）、胰岛素抵抗稳态模型评估（HOMA-IR）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）]以及人体学参数[体重（BW）、体重指数（BMI）、脂肪百分比（FP）、腰围（WC）、臀围（HC）和腰臀比（WHR）]。
①与治疗前比较，两组治疗后肝脏CAP、LSM、血清ALT、AST及GGT均明显降低（<0.05，<0.01）。治疗后，观察组CAP及ALT低于对照组（<0.05）。②与治疗前比较，两组治疗后FINS、HOMA-IR、LDL-C、TC及TG均明显降低（<0.05，<0.01），HDL-C水平升高（<0.05）。观察组治疗后FPG较治疗前降低（<0.05）。与对照组比较，观察组治疗后FINS、HOMA-IR、TC及TG低于对照组（<0.05）。③与治疗前比较，两组治疗后BW、BMI、FP、WC、HC、WHR均明显降低（<0.01）。治疗后，观察组WC及WHR低于对照组（<0.05）。
电针联合生活方式干预能有效治疗肥胖型非酒精性脂肪性肝病，在改善肝脏脂肪状态、糖脂代谢、胰岛素抵抗、WC及WHR方面疗效更佳。
