地塞米松联合丁二磺酸腺苷蛋氨酸和多烯磷脂酰胆碱治疗淤胆性肝炎的疗效及其影响因素  

The clinical study and related factors analysis of adenosine methionine and polyene phosphatidylcholine combined with dexamethasone in treatment of acute viral cholestatic hepatitis

作　　者：袁桂才[1] 陈爱珍[1] 王伟新[1] 胡子毅[2] 王成英 YUAN Gui-cai;CHEN Ai-zhen;WANG Wei-xin;HU Zi-yi;WANG Cheng-ying(Department of Infection,the Second Affiliated Hospital of Yichun College,Yichun 336000,Jiangxi,China;不详)

机构地区：[1]宜春学院第二附属医院感染科,江西宜春336000 [2]江西中医药大学附属医院急诊科,江西南昌330006 [3]南昌大学第一附属医院感染科,江西南昌330019

出　　处：《广东医学》2020年第8期813-817,共5页Guangdong Medical Journal

基　　金：江西省自然科学基金项目(20182BAB215037)。

摘　　要：目的分析地塞米松联合丁二磺酸腺苷蛋氨酸、多烯磷脂酰胆碱治疗淤胆性肝炎的安全性、疗效及相关影响因素。方法选取215例淤胆性肝炎患者作为研究对象,根据随机数字表法分为对照组和观察组,分别为107例和108例。其中对照组给予常规保肝治疗(丁二磺酸腺苷蛋氨酸+多烯磷脂酰胆碱),观察组在对照组基础上间歇联用小剂量地塞米松。观察并比较两组患者治疗前后肝功能[血清总蛋白(TP)、γ-谷胺酰转肽酶(GGT)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、总胆红素(Tbil)、总胆汁酸(TBA)]和血脂水平[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)]、疗效及不良反应。采用t检验和或χ^2检验分析不同疗效组差异性指标,后采用logistic回归分析探讨淤胆性肝炎的独立危险因素。结果治疗前,两组患者肝功能和血脂水平差异无统计学意义(P>0.05);治疗后,观察组肝功能和血脂水平明显低于对照组,差异有统计学意义(均P<0.05)。观察组有效者(86例,79.68%)明显高于对照组(64例,9.81%),差异有统计学意义(χ^2=0.002,P<0.05);但两组不良反应差别不大(χ^2=0.091,P>0.05)。经单因素及多因素分析后得知,病毒类型、治疗前TBA和合并糖尿病是影响淤胆性肝炎患者预后的独立危险因素(P<0.05)。结论与传统护肝治疗比较,联用地塞米松后可明显提高淤胆性肝炎的有效率,且安全性良好,其中治疗前TBA、病毒感染类型和合并糖尿病是影响淤胆性肝炎的独立危险因素。Objective To investigate the safety,efficacy and related influencing factors of adenosine methionine and polyene phosphatidylcholine combined with dexamethasone in treating acute virus cholestatic hepatitis.Methods A total of 215 patients with acute viral cholestatic hepatitis were enrolled.According to the random digital table method,the patients were divided into the control group(n=107)and the observation group(n=108).The control group was given with routine liver preservation(Ademetionine succinate plus polyene phosphatidylcholine),the experimental group was given with small dose of dexamethasone on the basis of conventional treatment.The liver function indexes,including serum total protein,gamma-glutamyl transaminopeptidase,glutamic-pyruvic transaminase,alkaline phosphatase,total bilirubin and total bile acid;blood lipid levels,including total cholesterol,triglyceride,low density lipoprotein cholesterol;efficacy and adverse reactions were observed and compared before and after treatment in the two groups.The t-test and chi-square test were used to analyze the differences between different therapeutic groups.The logistic regression analysis was used to explore the independent risk factors of acute viral cholestatic hepatitis.Results Before treatment,there was no significant difference in liver function and blood lipid level between the two groups(P>0.05).After treatment,the liver function indexes,including TP,GGT,ALT,ALP,TBil and TBA,and blood lipid level,including TC,TG and LDL-C,of the observation group were significantly lower than those in the control group(P<0.05).The effective rate of the observation group(86 cases,79.68%)was significantly higher than that of the control group(64 cases,9.81%,χ^2=0.002,P<0.05);but there was no significant difference between two groups in adverse reaction(χ^2=0.091,P>0.05).The univariate and multivariate analysis showed that the type of virus,TBA of pre-treatment and diabetes mellitus were independent risk factors that affected the prognosis of patients with acute viral

关 键 词：淤胆性肝炎 丁二磺酸腺苷蛋氨酸 多烯磷脂酰胆碱 地塞米松 

分 类 号：R575.1[医药卫生—消化系统] R587.1[医药卫生—内科学]