目的 通过观察健脾祛痰方对脾虚痰浊型血脂异常患者的血脂水平、中医证候积分的影响，分析正常与高脂人群、中药治疗前后患者肠道菌群的结构变化，以明确健脾祛痰方降脂的临床疗效，探索健脾祛痰法降脂的作用机制。方法 在辽宁中医药大学附属医院纳入正常及脾虚痰浊血脂异常受试者共计180例，按照就诊顺序随机分为正常组、模型组、健脾祛痰方组，每组60例。所有组别均予健康宣教，健脾祛痰方组予健脾祛痰方颗粒剂冲服，治疗疗程为2个月。采用全自动分析仪检测所有受试者血清胆固醇(Total Cholesterol，TC)、甘油三酯(Triglyceride，TG)、低密度脂蛋白胆固醇(Low Density Lipoprotein，LDL-C)、高密度脂蛋白胆固醇(High Density Lipoprotein，HDL-C)水平，用中医证候积分量表评定患者中医证候疗效，酶联免疫吸附测定法测定受试者血清人成纤维细胞生长因子19(FGF19)的表达水平，16SrRNA高通量测序技术检测受试者粪便标本肠道菌群的结构变化。结果 脾虚痰浊型血脂异常患者经健脾祛痰方治疗后血脂水平，中医证候积分较治疗前明显改善，血清中FGF19含量明显降低;健脾祛痰方组血脂疗效、中医证候积分总有效率显著优于模型组。高脂人群菌群多样性和物种丰度与正常人群相比明显减弱。有益菌减少，肠杆菌过生长，肠道菌群结构被破坏。健脾祛痰方组患者用药后样本间差异明显，各分类水平物种组成比例发生变化，编码胆盐水解酶(Bile Salt Hydrolase，BSH)相关微生物丰度降低。用药后肠道中的有害菌肠杆菌目(Enterobacteriales)减少，肠道菌群平衡有所恢复。结论 健脾祛痰法能够显著降低血脂异常患者TC、TG、LDL-C水平，改善中医证候，其机制可能通过调节肠道菌群和胆汁酸代谢抑制FXR信号传导通路以降脂。
Study on Clinical Efficacy of Jianpi Qutan Recipe(健脾祛痰方)in Treating Dyslipidemia and Its Influence on Gut Microbiota
Objective To observe the effect of Jianpi Qutan Recipe(健脾祛痰方)on blood lipid levels and TCM syndrome scores in patients with spleen deficiency and phlegm-turbid type of dyslipidemia and analyze the structure changes of intestinal flora in normal and high-fat populations and patients before and after TCM treatment.To clarify the clinical efficacy of Jianpi Qutan Recipe for lowering the blood lipids and explore the mechanism of the spleen-invigorating and phlegm-reducing method for lowering the blood lipids.Methods A total of 180 subjects with normal and dyslipidemia due to spleen deficiency and phlegm-turbid were enrolled in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine.They were ran-domly divided into normal group,model group and Jianpi Qutan Recipe group according to the order of treatment,with 60 cases in each group.All the groups were given health education,and the Jianpi Qutan Recipe group was given Jianpi Qutan Recipe Gran-ules,and the course of treatment was 2 months.The serum levels of cholesterol(TC),triglyceride(TG),low-density lipoprotein(LDL-C)and high-density lipoprotein(HDL-C)of all subjects were detected by an automatic analyzer,and the TCM symp-tom score scale was used to detect the levels of all subjects.The efficacy of TCM syndromes was evaluated,the expression level of serum FGF19 was determined by enzyme-linked immunosorbent assay,and the structural changes of intestinal flora in stool sam-ples were detected by 16SrRNA high-throughput sequencing technology.Results The blood lipid levels and TCM syndrome scores of patients with dyslipidemia due to spleen deficiency and phlegm-turbid were significantly improved compared with those before treatment,and the serum FGF19 content was significantly decreased.The total effective rate was significantly better than that of the model group.The bacterial diversity and species abundance of the high-fat population were significantly weakened compared with those of the normal population.Beneficial bacteria were reduced,enterobacters were overgrown and the structure of intestinal flora was destroyed.There were significant differences among the samples in the Jianpi Qutan Recipe group after medi-cation,the species composition ratio of each classification level changed,and the abundance of microorganisms encoding bile salt hydrolase(BSH)decreased.After the medication,the harmful bacteria Enterobacteriales in the intestine decreased,and the bal-ance of intestinal flora was restored.Conclusion The method of strengthening spleen and removing phlegm can significantly re-duce the levels of TC,TG and LDL in patients with dyslipidemia and improve the TCM syndromes.
strengthening spleen and removing phlegm therapycholesterolgut microbiotabile acidFXR metabolic pathway
万方数据
维普
