Fatty liver in patients with drug treatment
Although most patients with simple fatty liver by dietary restraint, increase exercise, and get rid of bad habits and other non-drug treatment, can effectively prevent and control obesity, and alcoholism and its related fatty liver, however, lifestyle changes are not universal, some patients tend to need to increase the disease-related drugs used to promote recovery.
Drug treatment for the metabolic syndrome
Metabolic syndrome is a type 2 diabetes and cardiovascular disease risk factors, early diagnosis and early intervention in metabolic syndrome, contribute to steatohepatitis, type 2 diabetes and cardiovascular and cerebrovascular disease prevention and treatment. Finland and the United States based on the results of diabetes prevention study, in the treatment of metabolic syndrome, recommended an intervention is as follows: moderate caloric restriction (in the first year of weight loss of 5% ~ 10%); moderate increase in physical activity; changes in diet group points (low fat, moderate carbohydrate, high protein). To full life after treatment is still not enough to make the various components of metabolic syndrome in normal or high risk of combined cardiovascular disease, you need to use drug therapy for secondary intervention. Specific measures include:
(1) weight loss: For obesity, especially visceral obesity in patients treated in June if the underlying weight loss and waist circumference reduction was not obvious, or body mass index (BMI)> 27kg/m2 merger lipids, blood glucose, blood pressure and other indicators of two or more abnormal could be considered even used of sibutramine or orlistat and other weight-loss drugs, but the weekly weight loss should not exceed 1.2kg (no more than a week for children 0.5kg).
(2), lipid: lipid disorders after basic treatment and (or) application of weight-loss hypoglycemic drugs 3 to 6 months, and continued to show a mixed hyperlipidemia or hyperlipidemia merging two or more risk factors are required to consider raising with fibrates, statins or other lipid-lowering drug probucol to lower blood triglycerides and low-density lipoprotein cholesterol levels.
(3) step-down: According to the latest U.S. guidelines recommend treatment of hypertension, blood pressure ≥ 140/90 mmHg should receive antihypertensive drug treatment, if patients with diabetes, then, when blood pressure ≥ 130/80 mmHg or antihypertensive drug treatment should begin.
(4) to improve insulin resistance and lowering blood glucose: At present, the academic community to improve insulin resistance, delaying the onset of type 2 diabetes and reduce cardiovascular risk in drugs is a growing interest. American Diabetes intervention research projects show that people with metabolic syndrome using metformin can prevent or delay diabetes; In addition, recent research has also confirmed that thiazolidinediones, TZDs have reduced impaired glucose tolerance and insulin resistance in the role of risk of diabetes onset. Likewise, similar studies also confirmed that acarbose, and orlistat may also delay the progress of impaired glucose tolerance group with type 2 diabetes. However, at present there is no data indicate that thiazolidinediones, TZDs can reduce the metabolic syndrome, impaired glucose tolerance and diabetes, cardiovascular disease risk groups. To this end, the merger with type 2 diabetes, impaired glucose tolerance, fasting hyperglycemia, as well as visceral obesity in patients with fatty liver may consider the application of metformin and rosiglitazone and other thiazolidinediones, TZDs to improve insulin resistance and hyperglycemia.
Drug treatment for fatty liver disease
Liver drugs as adjuvant therapy is mainly used for the following types of fatty liver in patients with: (1) accompanied by abnormal liver function in patients with fatty liver; (2) the merger of metabolic syndrome in patients with fatty liver; (3) of fatty liver biopsy confirmed hepatitis, especially the progress of liver fibrosis in patients with the merger; (4) basic treatment for six months is still the basis of ineffective or that therapy might be induced and lead to liver deterioration in patients with fatty liver; (5) there is chronic liver disease related to disorders such as implicit endogenous fatty liver patients. (6), alcoholic fatty liver alcohol remains a month after liver ailments and liver function damage resulting.
Liver drug use main objective was to: ① fat, reduce fat synthesis in liver cells and promote their excretion, so that the liver steatosis to reduce or dissipated; ② liver cell membrane stability, improve anti-oxidation and liver cell detoxification ability, so that liver function of Health of indexes returned to normal; ③ anti-inflammatory, to avoid the activation of inflammatory cells, inhibit inflammatory factor activity, to reduce liver cell necrosis and apoptosis, thus contributing to progress in prevention and treatment of liver fibrosis; ④ balanced treatment of the primary disease, improve glucose and lipid metabolism disorders, to reduce metabolic syndrome and its related incidents.
Existing studies have shown that the majority of Liver drug and symptomatic treatment only play a supporting role, and some empirical applications of drugs, the lack of a firm basis for clinical pharmacology. If a variety of fatty liver disease pathogenesis and drug therapy have a deeper understanding of the rational use of medicines to achieve targeted, you can better improve the quality of treatment. So far there is no convincing in view of randomized controlled trials to establish that a particularly effective drugs can be recommended for all patients with fatty liver. Chinese medicine to prevent fatty liver disease is often played by the combined effect of traditional Chinese medicine is rich in many active ingredients, from the multi-link, multi-target regulate the body’s physiological reaction tends to balance, to become the basis for an integrated mechanism. It is this unparalleled superiority, so that traditional Chinese medicine for the treatment of fatty liver and liver fibrosis in new hope. Side effects of traditional Chinese medicine’s biggest advantage is relatively small, and therefore has a wide range of applications and development prospects.
As the etiology and pathogenesis of fatty liver mechanism is relatively complicated, many issues are still being studied. Most drugs used to treat fatty liver, almost all physiological and biochemical processes in the liver, based on the findings of animal experiments by the choice, the purpose is to promote and accelerate the liver lipid metabolism in the liver fat transfer, the so-called The “fat-free drugs.” Has yet to find a cure for fatty liver effects of drugs, Liver drug in the treatment of fatty liver only play a supporting role, can cause fatty liver, type, stage and its complications the appropriate choice rational use of medicines.
For example, diabetes mellitus and hyperlipidemia of fatty liver could try polyene phosphatidylcholine (Essentiale), silymarin, vitamin E, lipid shell capsules; merger cholecystitis, cholelithiasis, gallbladder cholesterol crystals, as well as cholestasis fatty the liver, can be a trial of ursodeoxycholic acid, bile Tablet (constipation are particularly appropriate where), etc. drugs; not alcohol fatty liver is preferred polyene phosphatidylcholine (Essentiale); combined with progressive liver fibrosis in the fat liver, could be considered compound was added Biejiaruangan tablets, capsules, etc. Fuzheng Huayu anti-fibrosis. Generally choose a ~ two kinds of Liver drug treatment for more than six months, or to the normalization of biochemical markers of liver function and (or) imaging examination showed fatty liver receded far. In principle, with or without the use of Schisandra class alone can only reduce serum aminotransferase various Chinese and Western medicine, may be implicitly covered by the condition and ease the implementation of basic treatment of liver diseases leading to the deterioration.
What are the issues of drug treatment needs attention
Should be emphasized that removal of the cause and the importance of comprehensive treatment. So far, no effects of drug prevention and treatment of fatty liver, in fact, in the future will not necessarily find such a panacea. Therefore, patients with fatty liver do not respond to drug treatment to the dream, if only to place their hopes on drugs, without attention to other treatment methods, certainly not to achieve a satisfactory effect, and may trigger drug-induced diseases. For the majority of fatty liver is better than cure, so deal with obesity, alcoholism, fatty liver in high-risk populations such as health missionary and intervention to reduce the incidence of fatty liver-related diseases, to prevent the prevalence of fatty liver.
Because patients with fatty liver is often associated with other systemic diseases, these diseases, prevention and treatment of fatty liver than is sometimes more important in considering the diagnosis and treatment of fatty liver program, there should be the overall point of view, according to fatty liver in patients with sub-type and stage and its associated disease state and severity of the development of specific treatment programs. In the course of drug treatment need to be alert to lose weight, lipid-lowering and the treatment of hypertension and diabetes drugs, liver and kidney toxicity, so these drugs need to be in the doctor’s advice and the relevant indicators to monitor use.
Across the country related to prescription medicine, Chinese medicine, as well as Chinese and Western medicine combined approach to combating fatty liver in rats and a number of clinical studies, which may lack treatment well, but the exact efficacy and safety of clinical trials to be further verified. At home and abroad also do not have a curative effect, allows a variety of fatty liver completely reversed the traditional Chinese medicine prescriptions. Some in the ad presented the so-called traditional Chinese medicine treatment of fatty liver effects is not reliable, and these prescriptions were not to undergo a rigorous clinical trial validation. In addition, long-term high-dose and take herbal medicine, especially Chinese herbal compound, can lead to liver and kidney dysfunction such as drug-induced disease, should not have the patients to “traditional Chinese medicine drug-free” misled.
Fatty liver is a chronic disease, and recurrent high, therefore, fatty liver patients need long-term acceptance of diet, exercise, behavior modification and other mainly the comprehensive treatment, but mostly short-term drug therapy, treatment is generally 6 months to 2 years, if necessary, based on clinical symptoms and laboratory test results “on demand” in order to consolidate the curative effect and prevent disease recurrence and to minimize drug-induced diseases.