| There are three parts in this dissertation:literature research,clinical research and animal experiment,mainly describe the situations of modern medicine and TCM on the nonalcoholic fatty liver and the experimental study.The goal of this dissertation is trying to find the characteristics of young patients with nonalcoholic fatty liver and explore the mechanism of Chaiqi Decoction on nonalcoholic fatty liver disease.1?Literature reviewThe epidemiology,etiology,diagnosis,and other chronic diseases related,lifestyle and nutritional intervention of NAFLD were summed up based on the nearly ten years literature form the Pubmed.To summarize and evaluate the relevant literature of TCM treatment of nonalcoholic fatty liver disease in recent three years and all these papers were collected from CNKI.2?Clinical research(1)Clinical characteristics and risk factors of nonalcoholic fatty liver disease in young adultsObjective:To investigate the characteristics and risk factors of nonalcoholic fatty liver disease in young adults.Methods:A total of 264 NAFLD cases were collected from Dongfang Hospital which affiliated to Beijing University of Chinese Medicine between June 2014 to September 2015,age between 18 to 45.At the same time,according to the age and gender,110 cases of healthy people as the control group were collected in the same hospital.Compare the height and weight,personal history,liver function,blood lipids,combined diseases in both two groups.Results:The BMI index in NAFLD youth adult group was significantly higher than the control group.There are obvious differences in the biochemical indexes of two groups in ALT,AST,TC,TG,FBG and UA,the case group were higher than that of the control group;but the difference lever of HDL and LDL between the two groups have no statistic meaning.Male patients were significantly more than female patients,the ratio of male to female is 2.94:1.The highest proportion of patients was at the age of 40 to 45 years old,the proportion of patients younger than 30 years old was the lowest.In each age group,male patients were significantly higher than women.More than half of the cases had abnormal TG levels in the blood.A total of 95 cases,accounting for 35.98%of NAFLD patients combined type 2 diabetes;followed by hypertension and coronary heart disease,accounted for 26.89%and 3.79%;chronic renal insufficiency with only 5 cases.Conclusion:The proportions of NAFLD were different in different ages,higher age had the higher proportion.Abnormal blood lipid may be the risk factor of young NAFLD;BMI is closely related with the young NAFLD,one reason of the number of female patients was significantly lower than male is women taking more cares about their body figures.(2)TCM syndromes in young patients with nonalcoholic fatty liver diseaseObjective:To explore the TCM syndromes in young patients with nonalcoholic fatty liver disease and its related characteristics.Methods:264 NAFLD cases were collected from Dongfang Hospital which affiliated to Beijing University of Chinese Medicine between June 2014 to September 2015,age between 18 to 45.According to the data,the TCM syndrome,the characteristics of tongue and pulse,the relationship between TCM syndrome type and related biochemical indexes were analyzed.Results:The phlegm and blood stasis type took the most place,followed by liver and spleen deficiency,dampness and heat,phlegm dampness and liver Qi stagnation.But there was no significant difference between the TCM syndrome type and gender,age,level of blood lipid,uric acid,BMI index,liver function.There was significant difference in FBG level among the different syndrome types.Conclusion:Based on the different study population,gender,age and region factors,the study results are various.This study mainly focus on the young people,although the TCM syndrome of phlegm and blood stasis take the most place,the most basic pathogenesis is fatty liver stagnation and spleen deficiency.3?Experimental research(1)The mechanism of Chaiqi Decoction on the biochemical and inflammatory factors in rats with nonalcoholic fatty liver diseaseObjective:To study the effect of Chai Qi Decoction on the biochemical and inflammatory factors in rats with nonalcoholic fatty liver disease.Methods:To establish the fatty liver model,the rats were fed by high fat diet and drug intervention by Chaiqi Decoction and rosiglitazone.At the end of eighth weeks,the level of serum ALT,AST,TG,TC,HDL,LDL,FIN,FBG and inflammatory factor TNF-a,IL-6,ICAM,VCAM were detected.Results:The levels of serum ALT,AST,TG,TC and LDL-C in model group were significantly higher than those in normal group(P<0.05).The TG,HDL-C and LDL-C levels in Chaiqi Decoction group are significantly improved compared with the model group(P<0.05),but the level of TC had no significant difference(P>0.05).Rosiglitazone significantly inhibited TG,TC and LDL-C content(P<0.05),but HDL-C had no obvious change compared with model group(P>0.05).There were no significant differences in the indexes between the Chai Qi Decoction group and the rosiglitazone group.The FBG and FINS in model group were significantly higher than those in normal group(P<0.05),and the FBG level was significantly lower in Chaiqi group than model group(P<0.05).The IRI in the model group was higher than that the normal group,the IRI values in the two treatment groups was lower than the model group,and there was statistical difference.The levels of TNF-??IL-6?sICAM-1?sVCAM-1 in model group were significantly increased compared with the normal group.These four inflammatory factors were lower in two treatment groups than in the model group(P<0.05).Conclusion:Chaiqi Decoction can inhibit the increase of serum lipid and the level of liver enzymes in fatty liver rats,improve insulin resistance and inhibit the increase of serum inflammatory factors.(2)The effect of Chaiqi Decoction on the expression of liver protein in rats with nonalcoholic fatty liver diseaseObjective:To explore the mechanism of Chaiqi Decoction on rats with nonalcoholic fatty liver disease.Methods:The rats fed with high fat diet to establish the fatty liver model and had drug intervention by Chaiqi Decoction and rosiglitazone.After eighth weeks,the liver tissue was HE stained;SOD,MDA,GSH-Px and TG levels were detected in the liver;the expression of LXRa,SREBP-lc and FAS were detected by immunohistochemistry,Western Blot and PCR.Results:Under the light microscope,the structure of liver tissue in the normal group is complete and clear.Liver cells in the model group filled with a large number of different sizes of round lipid droplets,and the structure is unclear,hepatic cords disorders.The structures in liver of Chaiqi Decoction group and rosiglitazone group were better than the model group.The SOD and GSH-Px content were decreased in the liver tissue of model group,MDA and TG were significantly increased(P<0.05).Chaiqi Decoction and rosiglitazone can increase SOD and GSH-Px content,and decreased MDA and TG content;Chaiqi Decoction have more advantages than rosiglitazone in improving SOD and GSH-Px(P<0.05).The expression of LXRa,SREBP-1c and FAS of the model group were increased,and the expression of the two treatment groups was decreased after the intervention.Conclusion:Chaiqi decoction can improve the pathological morphology of liver tissue of NAFLD rats,and can regulate the role of fatty liver through the regulation of LXRa-SREBP-1c-FAS signaling pathway. |
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