【作者】 李万辉；

【导师】 杨牧祥；

【作者基本信息】 河北医科大学 ， 中西医结合临床， 2005， 硕士

【摘要】 目的:非酒精性脂肪肝为临床常见病,它是由多种疾病和病因引起的肝脏脂肪变。非酒精性脂肪肝的发病机制目前尚不十分清楚,其诱发因素较多且互为因果,相互作用,一般认为以脂肪代谢异常、氧应激、脂质过氧化损伤、游离脂肪酸的作用以及缺氧和肝微循环障碍为主,上述诸因素可能在非酒精性脂肪肝的发生发展的不同时期起到一定作用。流行病学调查显示:非酒精性脂肪肝发病率为5.2%～11.4%。若不予以积极治疗,约25%的非酒精性脂肪肝患者可发展为肝纤维化,约10%的严重患者可演变成肝硬化。近年来,随着人民生活习惯、饮食结构改变,非酒精性脂肪肝的检出率日趋增多,在部分地区其已成为仅次于病毒性肝炎的第二大肝病。国内外研究表明与非酒精性脂肪肝最相关的致病因素是高脂血症。长期的高脂肪高热量饮食是肥胖症及其相关疾病——高脂血症、非酒精性脂肪肝等的重要成因。因此,高脂饮食与高脂血症和非酒精性脂肪肝密切相关。非酒精性脂肪肝在传统医学中无相应的病名,依据中医基本理论和长期临床观察认为本病主要是由于肝气郁滞,失其柔顺条达之性,气病及血,血脉瘀阻;过食肥甘,或饮食不化,使脾失健运,聚湿为痰,终致气、食、瘀、痰、湿交结于胁下而发病。越鞠丸(香附、苍术、川芎、栀子、神曲)出自《丹溪心法》,为金元时期著名医家朱丹溪创立的六郁更多还原

【Abstract】 Objective:Fatty liver one of clinical familiar diseases, it cause from various diseases. The mechanism of the fatty liver is not quite clarity now, its factors are more and interacted, generally thinking the abnormality of lipid metabolizes , oxygen stress, lipid peroxdative injury , free fat acid , short of oxygen and obstacle of hepatic circulation were regarded as the mostly factor, which should play a certain rode during the development period of fatty liver. Epidemiology inquisition shows:The fatty liver outbreak rate is 5.2% ～11.4%. If not given the positive treatment, about 25% fatty liver sufferer can develop to the hepatic fibrosis, roughly 10% serious sufferer can turn into hepatocirrhosis. In recent years, changes along with the living habit and food construction, move and move people were diagnosed fatty liver, in some regions it had become the second hepatic disease only next to virus hepatitis. The domestic and international research show that hyperlipidemia is the most related with fatty liver. Because the long period of high fat diet is always deal to fat and hyperlipidemia. Therefore, the high fat diet is the most important reason of fatty liver. The nonalcoholic fatty liver has no homologous name in Chinese Tradtional Medicine, according to the basic theories in Chinese medicine with long-term clinical observes to think that this disease primarily is owing to the partiality of fatty food, or wine which caused dysfunction of the spleen in transportation, production of and phlegm, soon caused QI movement lose its harmonious way, circulation become blocked and finally the phlegm, moistness and blood stasis stagnates the liver. YueJuWan (Nutgrass galingale rhizome, Chinese atractylodes, Szechwan lovge rhizome,Cape jasmine, Hawthorn fruit) comes from the DANXI’s personal Comprehension, which was used to cure depression syndrome by Zhu danxi. There is move same characteristics between of the pathogenesis of Fatty liver and therapy range of Yuejuwan. So this experiment commences from the " depression syndrome ", use Yuejuwan as the medicine give the model of nonalcoholic fatty liver rats, in order to get the first step study of the fatty liver’s prevention and cure function by observing the effect of YueJuWan on the nonalcoholic fatty liver rats . Method:50 healthy SD rats , which weight 180～200g, were separated into 5 groups averagely in random , (1)Normal Control Group (which were abbreviated to “NCG”in the following);(2) pathologic Control Group(PCG);(3)Yuejuwan High-dose Group(YHG) ; (1)Yuejuwan Low-dose Group (YLG);(4)Dongbaogantai Control Group(DCG) and fed in the house of bright and dark 12 hours, not limit to eating anddrinking, we feed base food with NCG, the others high-fat-diet. At the same time, all groups rats were poured 2ml liquid into stomach 1 time a day, NCG and PCG:Saline;YHG:poured Yuejuwan 3.34g/100g weight into stomach(20 times as much as clinical adult dosage);YLG:poured Yuejuwan 1.67g/100g weight into stomach(10 times as much as clinical adult dosage);DCG:poured Dongbaogantai 7.20g/100g weight into stomach(20 times as much as clinical adult dosage). The experiment lasts 8 weeks. The 8 weekends, kill the animal, get serum, blood plasma and hepatic tissue,make pathology slices. Detect serum and hepatic tissue TC,TG,HDL-C,LDL-C,ApoA1, ApoB100 and serum liver function AST,ALT contents;Serum ET-1, NO, TXB2, 6-Keto-PGF1αcontents and observe pathomor -phology change of hepatic tissue. Result : ①The influence of Yuejuwan to the pathomorphology of hepatic tissue. The observation of naked eye:The shape of liver is integrated, fresh red, capsule smooth and glossy in NCG. The PCG’s liver was soft, slicing greasy which volume and weight of increases, envelope strain, edge bluntness , There was significant difference compared with NCG ( P<0.01).The YHG and YLG have no significant difference in volume, weight, quality, color with NCG but have significant difference with PCG (P<0.05). The observation of microscope:The liver tissue in NCG is complete and clear, hepatic lobufe’s construction is normal, the liver cell arrangesorderly around the central vein ,The liver blood sinusoid arranges in good order, no inflammation ,The same size and circle liver cell uncleus was clear, located the centre of polygonal cell, cytoplasm is abundant and afterbirth liquid is well-distributed. The hepatic construction disappears in PCG rat, hepatic lobule’s boundary is not clear and arranges disorderly,mostly liver sinusoids disappears, There are many and different size lipid droplet vacuoles(fatty degeneration) in the expanded livers cell. This shows that:There was worse and worst fatty degeneration in most livers cell. In YHG and YLG, lipid droplet vacuoles almost disappears, the construction of hepatic lobule and liver blood sinusoid is clear . the cell arranges orderly,construction is normal, the reborn liver cell appears in some liver cells. The hepatic lobule ’s construction in DCG is clear, liver blood sinusoid expand lightly,fatty degeneration lighten there are still lipid droplet vacuoles. Each group have an improvement in fatty degeneration compared with PCG, but YHG and YLG were better than DCG. ②The effect on serum and hepatic lipid contents and liver function of rat by Yuejuwan. the result manifested that the contents of serum and hepatic lipid TC(7.34±0.54/5.09±0.99),TG(1.47±0.14/3.65±0.73), LDL-C(4.88±0.67/3.32±0.83) and serum ApoB100(0.67 ±0.59) in PCG increase sharply than NCG TC(1.75 ±0.17/1.08 ±0.48), TG ( 0.91 ±0.11/0.77 ±0.14),LDL-C(0.31±0.08/0.38±0.28)and serum ApoB10(00.02±0.01)( P<0.05 or P<0.01),The PCG HDL-C(0.69±0.13/0.18±0.06),ApoA1 (0.04±0.02) reduce obviously than NCG HDL-C(1.09 ±0.12/0.30 ±0.07) and ApoA1(0.11 ±0.03) ( P<0.05 or P<0.01). The serum liver function ALT, AST(53.25±7.38 and 55.76±6.72) in PCG increase obviously than NCG(34.63±3.16 and 43.41±2.29) ( P<0.05).Through given medicine ,the content of serum and livers tissue TC, TG, LDL-C and serum ApoB100 in YHG(2.07 ±0.28/3.05±0.57,0.55±0.10/2.12 ±0.78,1.35 ±0.34/1.77 ±0.29,0.14 ±0.02) and YLG(2.41±0.23/3.34±0.46 ,0.52±0.09/2.52±0.55,1.42±0.22/2.43±0.44,0.20 ±0.11) and DCG(3.25±0.31/2.53±0.59,0.81 ±0.11/3.29 ±0.88,1.57 ±0.38/1.55 ±0.31,0.29 ±0.14) reduce sharply ( P<0.05 or P<0.01),the content of serum and livers tissue HDL-C and serum ApoA1 in YHG(1.93±0.18/0.37 ±0.10,0.17 ±0.06) and YLG(1.37 ±0.27/0.33 ±0.13,0.14±0.02)and DCG(1.01±0.16/0.39±0.17,0.16±0.04) increase obviously( P<0.05 or P<0.01).the liver function ALT, AST content in YHG(35.38 ±6.52,45.76 ±3.59)and YLG(35.50±8.11, 47.51±3.66) and DCG (42.50±5.68, 48.92±3.20)reduce obviously( P<0.05 or P<0.01), among them the function of lower the content of serum and livers tissue TC, TG, LDL-C and serum ApoB100 and heighten the content of serum and livers tissue HDL-C and serum ApoA1 in YHG is better than that of in YLG and DCG(P<0.05).③The effect on serum ET-1,NO,and TXB2,6-Keto-PGF1αcontent of rat by Yuejuwan. the result manifested that the content of serum ET-1(168.43±15.70),NO(144.01±30.92)and ET-1/ NO (2.01±0.81)inPCG are increase significantly than NCG(128.14±9.96, 104.44±41.45,1.32±0.78)(P<0.05), Through given medicine ,the content of serum ET-1,No and ET-1/ NO in each given-medicine group reduce sharply (P<0.05 or P<0.01), the function of lower the content of serum ET-1,NO and adjust ET-1/ NO proportion in YHG(134.10±9.36,105.78±31.06,1.27±0.63) is more obvious than that in YLG (145.87±10.61,123.11±35.82,1.18 ±0.65) and DCG (145.19 ±11.76,130.67 ±31.62,1.09±0.58) ( P<0.05). the content of serum TXB2, 6-Keto-PGF1αand TXB2/6-Keto-PGF1α(393.25±21.84 ,374.97±12.18,1.05 ±0.49 ) ,are increase significantly than NCG(221.96 ±12.01,290.85 ±26.82,0.76 ±0.27)( P<0.05), Through given medicine ,the content of serum TXB2, 6-Keto-PGF1αand TXB2/6-Keto-PGF1αin each treat group reduce sharply (P<0.05 or P<0.01), the function of lower the content of serum TXB2, 6-Keto-PGF1 αand adjust TXB2/6-Keto-PGF1αproportion in YHG (233.85±44.86, 289.53±57.85,0.80±0.09) is more obvious than that in YLG (264.30±45.29,311.46 ±56.28,0.84 ±0.11) and DCG (295.16 ±25.52,309.90±23.47,0.95±0.27) ( P<0.05). Conclusion:This research use Yuejuwan as medicine, with the method of Activating QI and Eliminating phlegm, promoting blood circulation for removing blood stasis, treat the nonalcoholic fatty liver rat begin with the view of Depression Syndrome. The result manifested that in Yuejuwan can improve the lipid metabolism in serum and hepatic tissue, correct liver更多还原