【作者】 姚宗良；

【导师】 王斌；

【作者基本信息】 青岛大学 ， 病原生物学， 2006， 硕士

【摘要】 目的探讨血脂康联合有氧运动治疗对非酒精性脂肪肝患者血清中TNF-α、TGF-β1水平的影响。通过观察对比血脂康合有氧运动治疗前后非酒精性脂肪肝患者血清中TNF-α、TGF-β1的变化，分析脂肪肝的临床变化及其转归，为临床脂肪肝患者的病情恢复提供辅助诊断，为判断肝脏纤维化轻重提供帮助，为临床治疗脂肪肝提供依据。方法选择非酒精性脂肪肝60例，分为Ⅰ组(血脂康组，15例)、Ⅱ组(有氧运动组，15例)、Ⅲ组(血脂康联合有氧运动组，15例)和对照组(未用血脂康及未运动组，15例)，4周为1疗程，观察对比各组3个疗程及6个疗程前后血脂变化及肝功能和体重及症状体征的变化，采用双夹心ELISA法测定血清TNF-α、TGF-β1，同时利用生化分析仪检测血甘油三酯(TG)、胆固醇(TG)、高密度脂蛋白胆固醇(HDL-C)及丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)的浓度，并利用B型超声判断脂肪肝的轻重及其转归。结果(1)治疗3个疗程与治疗前各组TNF-α、TGF-β1的结果进行纵向比较结果：血脂康组TNF-α差异有统计学意义(t=2.46／P＜0.05)，而TGF-β1无统计学意义(t=1.40／P＞0.05)；运动组TNF-α、TGF-β1差异有统计学意义(t=2.14，t=2.20／P＜0.05)；血脂康运动组TNF-α、TGF-β1差异有统计学意义(t=2.51，P＜0.05／t=3.44，P＜0.01)；而对照组前后无统计学意义(t=0.04，t=0.07／P＞0.05)(2)治疗6个疗程时各组TNF-α、TGF-β1的结果与试验前进行纵向比较结果：血脂康组TNF-α、TGF-β1差异有统计学意义(t=3.72，t=2.86／P＜0.01)；运动组TNF-α、TGF-β1差异有统计学意义(t=4.23，t=3.34／P＜0.01)；血脂康运动组TNF-α、TGF-β1差异有显著统计学意义(t=7.38，t=3.36／P＜0.01)；而对照组前后无统计学意义(t=0.055，t=0.173／P＞0.05)。(3)治疗3个疗程后各组TC、TG、HDL-C、及BMI的结果：血脂康组和对照组比较，3个疗程时TC、TG差异有统计学意义(t=2.53，t=2.99，P＜0.01)；运动组和对照组比较TG、和BMI差异有统计学意义(t=2.70，P＜0.05／t=3.52，P＜0.01)；血脂康运动组与对照组比较TC、TG、BMI差异有统计学意义(t=3.02，t=3.22，t=6.68，P＜0.01)；而HDL-C治疗组与对照组比较差异无统计学意义(t=0.45，t=0.51，t=0.79，／P＞0.05)。(4)治疗6个疗程各组TC、TG、HDL-C及BMI的结果：血脂康组与对照组比较，TC、BMI 1及TG差异有统计学意义(t=2.08，t=2.06，P＜0.05／t=3.59，P＜0.01)；运动组和对照组比较HDL-C和其他比较项目差异均有统计学意义(t=2.17，P＜0.05／t＞2.763，P＜0.01)；血脂康运动组和对照组比较，HDL-C与其他比较项目差异均有统计学意义(t=2.30，P＜0.05／t＞2.763，P＜0.01)。(5)肝功治疗前与治疗后比较结果：治疗前肝功都有不同程度的损害，经治疗后各组(包括对照组)丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)均有改善，血脂康组和运动组及血脂康运动组差异有统计学意义(其中AST项t=3.27，t=5.83，t=7.23／P＜0.01)，而对照组无统计学意义(AST项t=1.0g／P＞0.05)。(6)在6个疗程时B超声像图表现各组在6个疗程后各项观察指标较前都有不同程度的改变，但血脂康运动组改善的人数优于其它组，在改善肝实质回声强度、前场回声、肝脏大小以及肝内管道结构变细或不清方面与其他组比较差异有统计学意义(x~2=7.35，P＜0.05／x~2=5.17，P＜0.01)。结论(1)血脂康、有氧运动以及血脂康联合运动治疗能够对非酒精性脂肪肝起到一定的缓解作用，患者血清内TNF-α和TGF-β1水平有不同程度的降低，同时TC、TG、ALT、AST的也有了不同程度的下降、HDL-C的不同程度的升高，B超声像图也明显好转。进一步验证了TNF-α与肝脏的损害有关，TGF-β1与肝脏纤维化有关。(2)单用血脂康对降低血脂具有一定的作用，特别对TG较高的脂肪肝患者作用相对较好，但治疗中对TNF-α、TGF-β1和BMI的影响与其他组比较相对较小。(3)单用运动治疗，在治疗过程中对血脂的降低相对缓慢，但在降低TNF-α、TGF-β1和BMI方面相对较好。(4)血脂康联合有氧运动治疗非酒精性脂肪肝既能降低血脂，又能降低血清TNF-α、TGF-β1的水平，因此建议临床患者应当注意应用血脂康联合有氧运动来治疗或改善肝功能，达到对脂肪肝的缓解和治疗的目的。更多还原

【Abstract】 Objectives: Discuss the influence of Xuezhikang associated aerobic movement in the serum ofTNF-αand TGF-β1 of the non-alcoholic fatty liver patients, apply immunologic methods to examinethe level of tumor necrosis factor alpha (TNF-α) and Transforming growth factor beta-I(TGF-β1) inthe serum of the non-alcoholic fatty liver patients, through observing and comparing the changes ofTNF-αand TGF-β1 in the serum of the non-alcoholic fatty liver patients before and after thexuezhikang associated aerobic movement, analyses the clinical changes and turning back of fatty liver.Offer help for the recovery of clinical fatty liver patient, supply methods for judging the seriousness ofliver fibrosis, provide basis for clinical treatment of fatty liver.Method: Select 60 examples of non-alcoholic fatty liver, divided them into groupⅠ(Xuezhikanggroup, 15 examples), groupⅡ(aerobic movement group, 15 examples), groupⅢ(Xuezhikangassociated aerobic movement group, 15 examples)and comparing group( unused Xuezhikang andunder moved group, 15 examples), four weeks is one course of treatment, observe and contrast eachgroup around the 3rd and 6th course, finding the change of blood fat、liver function、weight andsymptom body solicit, use the enzyme-linked immunosorbent assay(ELISA) to measure the serum ofTNF-αand TGF-β1 of the non-alcoholic fatty liver patient, at the same time, biochemically analyzeblood triglyceride(TG), cholesterol(TG), high density lipoprotein cholesterol(HDL-C), ALTand AST et al, and use B ultrasound to jude the seriousness of the fat liver and the recovery.Results: (1) Longitudinally compare TNF-αan TGF-β1 in each group (the groups after three coursesof treatment and the ones before treatment)Xuezhikang group after 3 course of treatments withexperiment former TNF-αdiscrepancy has statistics significance (t=2.46/P＜0.05), but TGF-β1 doesn’tsee statistics significance (t=1.40/P＞0.05); aerobic movement group TNF-αand TGF—β1 in the 3around discrepancies of course of treatment has statistics significance (t=2.14,t=2.20/P＜0.05); Xuezhikang associated aerobic movement group TNF-αand TGF-β1in the 3 arounddiscrepancies of course of treatment have statistics significance (t=2.51,P＜0.05/t=3.44,P＜0.01),butcomparing group doesn’t have any statistics significance(t=0.04,t=0.07/P＞0.05)(2) Longitudinally compare TNF-αan TGF-β1 in each group (the groups after six courses oftreatment and the ones before treatment)Xuezhikang group 6 course of treatments with experimentmore former comparison TNF-αand TGF-β1 discrepancies have statistics significance(t=3.72, t=2.86/P＜0.01); aerobic movement group TNF-αand TGF-β1 in the 6 around discrepancies of course of treatment have statistics significance (t=4.23, t=3.34/P＜0.01),Xuezhikang associated aerobic movement group TNF-αand TGF-β1 in the 6 around discrepancies ofcourse of treatment have apparently statistics significance (t=7.38t=3.36/P＜0.01); but comparinggroup doesn’t have anystatistics significance (t=0.055, t=0. 173/P＞0.05).(3) After three test courses of treatment, the result of TC、TG、HDL-C and BMI by statisticshandling: Xuezhikang Group compared with comparing group, TC, TG’s discrepancy has statisticssignificance (t=2.53,t=2.99,P＜0.01), aerobic movement group and comparing group’s comparison, TG,BMI discrepancies have statistics significance (t=2.70, P＜0.05/t=352,P＜0.01); Xuezhikang associatedaerobic movement group compared with comparing group exclude HDL-C outside every indexdiscrepancy have statistics significance(t=3.02, t=3.22, t=6.68,P＜0.01), but HDL-C tests group withcompare group’s comparison doesn’t see any statistics significance(t=0.45,t=0.51, t=0.79,/P＞0.05).(4) After six test courses of treatment, TC、TG、HDL-Cand BMI by statisticshandling: Xuezhikang Group compared with comparing group, TC、TG BMIdiscrepancy has statisticssignificance (t=2.08,t=2.06, P＜0.05/t=3.57,P＜0.01), aerobic movement group compared withcomparing group, HDL-C and Other projects’ discrepancies have statistics significance (t=2.17,P＜0.05/t＞2.763,P＜0.01); Xuezhikang associated aerobic movement group compared with comparing groupHDL-C discrepancy and other projects’ discrepancies have statistics significance(t=2.30,P＜0.05/t＞2.763,P＜0.01).(5) The comparing result of liver function before and after treatment: liver function haveinfringement of different level, after treatment each group (including comparing group) ALT and ASThave improvement, Xuezhikang group and aerobic associated movement group and Xuezhikangassociated aerobic movement group 6 course of treatment with experiment more former comparisondiscrepancy have statistics significance (AST t=3.27,t=5.83,t=7.23/P＜0.01). But comparing group, it isaround to do not have statistics significance (AST t=1.09/P＞0.05).(6) The result of B ultrasonic picture after 6 course of treatment: the observation index of eachgroup has changes of different degrees after 6 course of treatmens, but Xuezhikang aerobic associatedmovement group works better than other groups,compared with other groups in the aspect ofimproving liver substance echo strength and former site echo and reducing liver size and improvingthe liver road structure of inner tube have statistics significance (X~2=7.35, P＜0.05/X~2=5.17, P＜0.01).Conclusions: (1) Xuezhikang,aerobic movement and Xuezhikang aerobic associatedmovement, Both of them can reduce the serum of TNF-αand TGF-β1 of the non-alcoholic fatty liverpatients with different levels, this is appearancely consistent with TC, TG, ALT and AST’s drop andHDL-C go up, the result of conclusion appearance coincide with result of B ultrasonic, It have furtherverified that TNF-αand TGF-β1 the infringement with liver and liver fiberosis. (2) Only use Xuezhikang to reduce the blood fat have certain role, It is relatively bette forTGof the special higher patient role of fatty liver than TC, but it less influence for treatment of TNF-α,TGF-βand BMI.(3) Only aerobic associated movement, in treatment course, the reduction for blood fat isrelatively slow, but It is reducing TNF-β, TGF-β1 and BMI aspect relative better.(4)Xuezhikang aerobic associated movement can reduce the blood fat of the non-alcoholicfatty liver, can again reduce the level of serum TNF-α, TGF-β1, therefore we suggest that clinicalpatient must pay attention to apply Xuezhikang aerobic associated movement, they treats or improvesliver function, reach the purpose for treatment and the alleviation of fatty liver.更多还原