燃煤污染型砷中毒慢性肝损伤患者临床特征及谷胱甘肽治疗情况分析  

Clinical characteristics and glutathione treatment of chronic liver injury in patients with coal-burning-borne arsenism

作　　者：郭芳 董肖肖 刘兴园 李超[1] 董春花[1] Guo Fang;Dong Xiaoxiao;Liu Xingyuan;Li Chao;Dong Chunhua(Emergency Department of Binzhou People's Hospital,Shandong,Binzhou 256600,China)

机构地区：[1]山东省滨州市人民医院急诊科,256600

出　　处：《中华地方病学杂志》2020年第10期746-750,共5页Chinese Journal of Endemiology

摘　　要：目的探讨燃煤污染型砷中毒(简称燃煤型砷中毒)慢性肝损伤患者临床特征及谷胱甘肽的治疗效果。方法2017年3月至2018年12月,以滨州市人民医院收治的71例燃煤型砷中毒肝损伤患者为研究对象,采用抽签法分为观察组(37例)和对照组(34例)。两组患者均给予常规治疗,包括静脉滴注复合氨基酸、口服B族维生素等,并静脉滴注5.0 g溶于250 ml 5%葡萄糖的维生素C混合液,1次/d,治疗4周(1个疗程);观察组同时静脉滴注1.8 g溶于250 ml 5%葡萄糖的谷胱甘肽,1次/d,治疗4周(1个疗程)。观察患者临床特征,并比较两组患者治疗前后肝功能指标[丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转氨酶(AST)、总胆红质(TBIL)、直接胆红素(DBIL)]及血清抗氧化指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]变化情况,以及临床疗效。结果71例燃煤型砷中毒肝损伤患者,心电图检查异常率为64.79%(46/71),胸部X线检查异常率为26.76%(19/71)。治疗后两组患者肝功能指标ALT、AST、TBIL、DBIL低于治疗前[观察组治疗前:(131.82±25.62)、(109.84±26.28)U/L,(81.47±20.93)、(57.38±15.25)μmol/L;观察组治疗后:(58.93±12.03)、(51.20±10.57)U/L,(25.66±7.94)、(16.49±4.92)μmol/L;对照组治疗前:(128.95±31.20)、(107.39±29.81)U/L,(83.21±17.95)、(55.39±16.30)μmol/L;对照组治疗后:(76.42±15.73)、(74.33±14.80)U/L,(36.72±9.32)、(23.74±7.35)μmol/L,P均<0.05],且治疗后观察组患者各肝功能指标明显低于对照组(P均<0.05)。治疗后两组患者血清抗氧化指标MDA、SOD、GSH-Px明显高于治疗前[观察组治疗前:(25.47±3.98)μmol/L,(85.72±23.54)、(1729.84±379.50)U/L;观察组治疗后:(46.31±7.49)μmol/L,(122.31±28.53)、(2410.29±512.31)U/L;对照组治疗前:(26.02±4.11)μmol/L,(84.95±21.03)、(1749.52±405.28)U/L;对照组治疗后:(38.92±6.27)μmol/L,(103.12±25.68)、(2097.42±478.52)U/L,P均<0.05],且治疗后观察组患者各血清抗氧�Objective To investigate and analyze the clinical characteristics of chronic liver injury and glutathione treatment in patients with coal-burning-borne arsenism.Methods A total of 71 patients with liver injury caused by coal-burning-borne arsenism admitted to Binzhou People's Hospital from March 2017 to December 2018 were randomly divided into observation group(37 cases)and control group(34 cases)by lottery.Both groups of patients were given routine treatment,including intravenous infusion of compound amino acids,oral administration of B vitamins,etc.,and intravenous infusion of 5.0 g of vitamin C mixture dissolved in 250 ml of 5%glucose,once a day,treatment for 4 weeks.In addition,the observation group was given an intravenous infusiondrip of 1.8 g of glutathione dissolved in 250 ml of 5%glucose,once a day,for 4 weeks.The clinical characteristics of the patients were observed,and the changes of liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL)],serum antioxidant indexes[malondialdehyde(MDA),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)],and clinical efficacy before and after the treatment were compared between the two groups.Results In 71 coal-burning-borne arsenism patients with liver injury,the abnormal rate of electrocardiogram(ECG)examination was 64.79%(46/71),and the abnormal rate of chest X-ray examination was 26.76%(19/71).After treatment,the liver function indexes ALT,AST,TBIL and DBIL decreased in both groups[observation group before treatment:(131.82±25.62),(109.84±26.28)U/L,(81.47±20.93),(57.38±15.25)μmol/L;observation group after treatment:(58.93±12.03),(51.20±10.57)U/L,(25.66±7.94),(16.49±4.92)μmol/L;control group before treatment:(128.95±31.20),(107.39±29.81)U/L,(83.21±17.95),(55.39±16.30)μmol/L;control group after treatment:(76.42±15.73),(74.33±14.80)U/L,(36.72±9.32),(23.74±7.35)μmol/L,P<0.05],and the liver function indexes in the observation group were significantly lower than those in the contr

关 键 词：砷中毒 燃煤型 慢性肝损伤 谷胱甘肽 

分 类 号：R599.1[医药卫生—内科学]