糖皮质激素联合腺苷蛋氨酸、熊去氧胆酸治疗药物性急性重度胆汁淤积性肝病的临床疗效
Clinical efficacy of glucocorticoid combined with S-adenosyl-L-methionine and ursodeoxycholic acid in the treatment of acute severe drug-induced cholestatic liver disease induced by drugs
余海忠 1李虎业 1夏文英 1李进财 1徐尚胜2
作者信息
- 1. 青海省第四人民医院药剂科,西宁 810000
- 2. 青海省第四人民医院外科二病区,西宁 810000
- 折叠
摘要
目的 探讨糖皮质激素联合腺苷蛋氨酸(S-adenosyl-L-methionine,SAMe)、熊去氧胆酸(Ursodeoxycholic acid,UDCA)治疗药物性急性重度胆汁淤积性肝病(Drug-induced cholestatic liver disease,DICLD)的效果.方法 选取2018年1月至2022年12月青海省第四人民医院收治的106例急性重度DICLD患者,采用随机数字表法将其分为两组,各53例.对照组给予SAMe、UDCA治疗,观察组给予SAMe、UDCA联合糖皮质激素(甲泼尼龙)治疗.治疗2周后检测并比较两组患者肝功能指标[碱性磷酸酶(Alkaline phosphatase,ALP)、总胆汁酸(Total bile acid,TBA)、γ-谷氨酰转移酶(γ-glutamyltransferase,y-GT)及血清胆红素(Total bilirubin,TBil)]、生化指标[前白蛋白(Prealbumin,PA)、白蛋白(Albumin,ALB)]及免疫功能指标[可溶性黏附分子1(Soluble vascular cell adhesion molecule-1,sVCAM-1)、干扰素 γ(Interferon-y,IFN-γ)]水平并评估两组患者临床疗效.采用Spearman相关性建议分析临床疗效与生化、免疫功能指标的相关性,并观察两组治疗方案的安全性.结果 观察组治疗总有效率为90.57％,高于对照组的73.58％(P＜0.05).治疗后,两组 ALP、TBA、γ-GT、TBil、PA、ALB、sVCAM-1、IFN-γ 水平均较治疗前降低(P＜0.05),且观察组 ALP、TBA、γ-GT、TBil、PA、ALB、sVCAM-1、IFN-γ 水平均低于对照组(P＜0.05).Spearman相关性分析显示,患者临床疗效与PA、ALB水平呈正相关,与sVCAM-1、IFN-γ水平呈负相关(P均＜0.05).观察组、对照组药物不良反应率分别为18.87％、11.32％,两组比较差异无统计学意义(P＞0.05).结论 糖皮质激素联合SAMe、UDCA能够提高急性重度DICLD患者疗效,改善肝功能及炎症因子水平,提高机体免疫功能,且安全性良好.
Abstract
Objective To explore the effect of glucocorticoid combined with S-adenosyl-L-methionine(SAMe)and ursodeoxycholic acid(UDCA)in the treatment of drug-induced acute severe drug-induced cholestatic liver disease(DICLD).Methods A total of 106 patients with DICLD treated in the hospital from January 2018 to December 2022 were selected.The patients were divided into 2 groups with 53 cases each by random number table method.The control group was treated with SAMe and UDCA,and the ob-servation group was treated with glucocorticoid(methylprednisolone)combined with SAMe and UDCA.Liver function indexes[(alkaline phosphatase(ALP),total bile acid(TBA),γ-glutamyltransferase(γ-GT),serum bilirubin(TBil)],biochemical indexes[prealbumin(PA)and albumin(ALB)]and immune function indicators[soluble adhesion molecule 1(sVCAM-1)and interferon-y(IFN-y)]were detected af-ter 2 weeks of the treatment.After two weeks of treatment,the clinical efficacy of the two groups was e-valuated.Spearman correlation test was used to analyze the correlation between clinical efficacy and bio-chemical and immune function indexes,and the safety of the two groups of treatment schemes was ob-served.Results The total effective rate was 90.57％in the observation group and 73.58％in the control group(P＜0.05).After the treatment,the levels of ALP,TBA,y-GT,TBil,PA,ALB,sVCAM-1 and IFN-y in both groups were lower than those before the treatment(P＜0.05),the levels of ALP,TBA,γ-GT,TBil,PA,ALB,sVCAM-1 and IFN-γ in the observation group were lower than those in the control group(P＜0.05).Spearman correlation analysis showed that the clinical efficacy was positively correla-ted with the levels of PA and ALB,and negatively correlated with the levels of sVCAM-1 and IFN-γ(all P＜0.05).There was no significant difference in adverse drug reactions between the 2 groups(18.87％vs 11.32％,P＞0.05).Conclusion Glucocorticoids combined with SAMe and UDCA can improve the efficacy of DICLD patients,improve the levels of liver function and inflammatory factors,and enhance the body's immune function,with good safety.
关键词
胆汁淤积性肝病/甲泼尼龙/腺苷蛋氨酸/熊去氧胆酸/疗效Key words
cholestatic liver disease/methylprednisolone/S-adenosyl-L-methionine(SAMe)/ursodeoxy-cholic acid(UDCA)/curative effect引用本文复制引用
基金项目
青海省卫健委指导性课题项目(2021-wjzdx-75)
出版年
2024
NETL
NSTL
万方数据