2026 年第 9 期 第 21 卷

祛湿活血膏调节代谢相关脂肪性肝病患者瘦素和脂联素及炎性因子的临床研究

Clinical study on Qushi Huoxue ointment regulating leptin, adiponectin and inflammatory factors in patients with metabolic associated fatty liver disease

作者：唐艳芳1农佳昕2林海1刘容1王凯萌1刘旭东1

英文作者：Tang Yanfang1 Nong Jiaxin2 Lin Hai1 Liu Rong1 Wang Kaimeng1 Liu Xudong1

单位：1广西中医药大学第二附属医院（广西中医药大学附属瑞康医院）肝病科，南宁530011；2广西中医药大学研究生学院，南宁530001

英文单位：1Department of Hepatology The Second Affiliated Hospital of Guangxi University of Chinese Medicine (Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine) Nanning 530011 China; 2Graduate School Guangxi University of Chinese Medicine Nanning 530001 China

关键词：代谢相关脂肪性肝病；祛湿活血膏；瘦素；脂联素

英文关键词：Metabolicassociatedfattyliverdisease;QushiHuoxueointment;Leptin;Adiponectin

• 摘要：

• 目的 探讨祛湿活血膏对代谢相关脂肪性肝病（MAFLD）患者肝脏脂肪衰减值、肝功能、脂代谢及脂肪细胞因子、炎性因子的调节作用。方法 选取2024年1月至2025年12月在广西中医药大学第二附属医院接受治疗的MAFLD患者91例，采用随机数字表法分为对照组（44例）和观察组（47例）。对照组在常规治疗基础上予双环醇片口服治疗，观察组在对照组基础上予祛湿活血膏口服治疗。检测2组治疗前后肝功能、脂代谢相关指标、炎性因子、肝脏脂肪衰减值及肝脏硬度，同时评价中医证候疗效。结果 治疗后，2组γ-谷氨酰转移酶、丙氨酸转氨酶、天冬氨酸转氨酶水平均低于治疗前，且观察组均低于对照组［（26±10）U/L比（35±8）U/L、（30±9）U/L比（35±11）U/L、（20±9）U/L比（25±12）U/L］（均P＜0.05）。治疗后，2组总胆固醇、甘油三酯、低密度脂蛋白胆固醇、瘦素水平均低于治疗前，且观察组均低于对照组［（4.0±1.4）mmol/L比（4.8±1.1）mmol/L、1.76（1.67,1.85）mmol/L比2.05（1.48,2.65）mmol/L、（2.5±0.9）mmol/L比（2.9±1.0）mmol/L、（3.3±2.9）μg/L比（4.6±2.4）μg/L］；2组高密度脂蛋白胆固醇、脂联素水平均高于治疗前，且观察组均高于对照组［（1.34±0.38）mmol/L比（1.17±0.33）mmol/L、（8.6±2.4）mg/L比（6.4±3.5）mg/L］（均P＜0.05）。治疗后，2组脂肪衰减、肝脏硬度水平均低于治疗前，且观察组均低于对照组［（222±26）dB/m比（242±30）dB/m、（7.3±2.9）kPa比（8.6±2.4）kPa］（均P＜0.05）。治疗后，2组白细胞介素6和高敏C反应蛋白水平均低于治疗前，且观察组均低于对照组［（13±6）ng/L比（15±5）ng/L、（2.5±1.8）mg/L比（4.5±3.0）mg/L］（均P＜0.05）。治疗后，2组空腹胰岛素、胰岛素抵抗指数水平均低于治疗前，且观察组均低于对照组［（9.7±2.6）mIU/L比（11.0±3.6）mIU/L、（2.3±0.6）比（2.8±1.2）］（均P＜0.05）。观察组总有效率高于对照组［95.7%（45/47）比81.8%（36/44）］（χ2=4.506，P=0.034）。结论 祛湿活血膏治疗MAFLD，可有效降低肝脏脂肪衰减值、改善肝脏硬度，修复肝功能、调节脂代谢紊乱，同时通过下调炎性因子与瘦素水平、升高脂联素水平缓解胰岛素抵抗，提升中医证候疗效。

• Objective To explore the regulatory effect of Qushi Huoxue ointment on liver fat attenuation value, liver function, lipid metabolism, adipocytokines and inflammatory factors in patients with metabolic associated fatty liver disease (MAFLD). Methods A total of 91 MAFLD patients treated in The Second Affiliated Hospital of Guangxi University of Chinese Medicine from January 2024 to December 2025 were enrolled and divided into control group (44 cases) and observation group (47 cases) by random number table method. The control group was treated with bicyclol tablets orally on the basis of routine treatment, and the observation group was given oral Qushi Huoxue ointment additionally on the basis of the control group. Liver function, lipid metabolism related indicators, inflammatory factors, liver fat attenuation value and liver stiffness were detected before and after treatment in both groups, and the efficacy of traditional Chinese medicine syndromes was evaluated simultaneously. Results After treatment, the levels of gamma-glutamyl transferase, alanine transaminase and aspartate transaminase in both groups were lower than those before treatment, and the above indexes in the observation group were lower than those in the control group ［（26±10）U/L vs （35±8）U/L,（30±9）U/L vs （35±11）U/L,（20±9）U/L vs （25±12）U/L］(all P＜0.05). After treatment, the levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol and leptin in both groups decreased compared with baseline and were further lower in the observation group ［（4.0±1.4）mmol/L vs （4.8±1.1）mmol/L, 1.76（1.67.1.85）mmol/L vs 2.05（1.48,2.65）mmol/L,（2.5±0.9）mmol/L vs （2.9±1.0）mmol/L,（3.3±2.9）μg/L vs （4.6±2.4）μg/L］; the levels of high-density lipoprotein cholesterol and adiponectin in both groups increased after treatment and were higher in the observation group ［（1.34±0.38）mmol/L vs （1.17±0.33）mmol/L, （8.6±2.4）mg/L vs （6.4±3.5）mg/L］(all P＜0.05). After treatment, liver fat attenuation and liver stiffness in both groups were decreased, and were lower in the observation group than in the control group ［（222±26）dB/m vs （242±30）dB/m, （7.3±2.9）kPa vs （8.6±2.4）kPa］(all P＜0.05). The levels of interleukin-6 and high-sensitivity C-reactive protein in both groups were reduced after treatment, with lower levels in the observation group ［（13±6）ng/L vs （15±5）ng/L,（2.5±1.8）mg/L vs （4.5±3.0）mg/L］(all P＜0.05). Fasting insulin and homeostasis model assessment of insulin resistance in both groups declined after treatment, and were lower in the observation group ［（9.7±2.6）mIU/L vs （11.0±3.6）mIU/L,（2.3±0.6） vs （2.8±1.2）］(all P＜0.05). The total effective rate of the observation group was higher than that of the control group ［95.7% (45/47) vs 81.8% (36/44)］(χ2=4.506, P=0.034). Conclusions For patients with MAFLD, Qushi Huoxue ointment can effectively reduce liver fat attenuation value, improve liver stiffness, repair liver function and regulate lipid metabolism disorder. Meanwhile, it can alleviate insulin resistance by down-regulating inflammatory factors and leptin levels and up-regulating adiponectin level, and improve the therapeutic effect of traditional Chinese medicine syndromes.