目的 分析高原地区非酒精性脂肪性肝病(NAFLD)的综合治疗效果.方法 选择在高原地区居住满5年、确诊为NAFLD并排除其他肝病及合并症的患者190例,随机分为治疗组(97例)和对照组(93例).治疗组在心理、行为及生活方式干预的基础上给予辛伐他汀、二甲双胍及维生素E口服,对照组在心理、行为及生活方式干预的基础上仅给予辛伐他汀口服.比较两组患者治疗后的疗效及血糖、血脂、肝功能等的变化.结果 治疗后治疗组患者的疗效显著优于对照组,差异有统计学意义(P＜0.01).两组治疗后血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、体质指数及腰围/臀围比值均较治疗前显著降低,但治疗组降低更明显(P＜0.01).治疗组治疗后收缩压及舒张压较对照组及治疗前显著降低(P＜0.01),而对照组仅舒张压显著降低(P＜0.01).对照组不降低血糖水平,而治疗组治疗后空腹血糖较治疗前及治疗后的对照组均显著降低(P＜0.01).两组治疗后均能显著改善血脂,但治疗组改善更明显(P＜0.01).结论 在心理、行为及生活方式干预的基础上联用辛伐他汀、二甲双胍及维生素E等的综合治疗是治疗高原地区NAFLD的有效方法.%Objective To investigate the effects of comprehensive treatment in non - alcoholic fatty disease ( NAFLD ) in the plateau region.Methods A total of 190 NAFLD patients who have lived in the plateau region for over 5 years and were confirmed of non alcoholic fatty liver disease without other liver diseases and complications were randomized is into the treatment group ( 97 cases ) and the control group ( 93 cases ).mental The treatment group received additional treatment of oral metformin and vitamin E besides simvastatin administration and the supportive treatment in the control group.Levels of blood glucose and blood lipids, as well as liver functions were compared between the two groups.Results Effective rate of the treatment group ( 92.78％ ) is significantly higher than that of the control group ( 76.34％ ) ( P ＜0.01 ).ALT, AST, and y - GT levels , as well as body mass index ( BMI) and Waist to hip ratio were significantly reduced after treatment in both groups, with the treatment group lower than the control group ( P ＜0.01 ).Both systolic blood pressure and diastolic blood pressure were significantly reduced in the treatment group ( P ＜0.01 ), while in the control group only reduced diastolic blood pressures were noticed ( P ＜ 0.01 ).Levels of blood glucose were reduced in the treatmeng group but not in the control group ( P ＜ 0.01 ).Levels of blood lipids were reduced in both groups after treatment, with more obvious improvement in the treatmeng group ( P ＜0.01 ).Conclusion Combination of simvastatin, metformin and vitamin E supplemented by supportive treatment is among the effective methods in treating NAFLD in plateau regions.
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