中药复方联合腺苷蛋氨酸治疗肝内胆汁淤积性病毒性肝炎32例

肝内胆汁淤积性黄疸是由感染、药物、免疫损伤等多种原因造成的一种临床综合征,它可以引起肝细胞死亡而加重肝损伤,临床病程长达数月至半年,有时甚至发展为重型肝炎。目前尚缺乏特效疗法,我们用中药复方联合腺苷蛋氨酸治疗肝内胆汁淤积性病毒性肝炎取得了较好的疗效,现报道如下。 1 对象和方法 1.1 病例选择 选取2000年1月～2003年2月本院住院治疗的淤胆型肝炎和急、慢性肝炎合并肝内胆汁淤积患者83例,随机分为A组(中药复方联合腺苷蛋氨酸治疗组)32例、B组(腺苷蛋氨酸治疗组)28例、C组(门冬氨酸钾镁     

腺苷蛋氨酸联合熊去氧胆酸治疗淤胆型病毒性肝炎的疗效观察

目的 观察腺苷蛋氨酸联合熊去氧胆酸治疗肝内胆汁淤积性病毒性肝炎的临床疗效.方法 选择急性淤胆型肝炎和慢性淤胆型肝炎患者132例,随机分为治疗组和对照组,每组各66例.治疗组给与腺苷蛋氨酸冻干粉针剂1000 mg加入5%葡萄糖液250 ml中静脉滴注,1次/d,熊去氧胆酸(尤思弗)250mg,2次/d口服,疗程均为4周.对照组采用f-J4氨酸钾镁针剂30 ml加入5%葡萄糖液250 ml中静脉滴注,1次/d,疗程4周.观察症状、体征,并分别于2、4周复查肝功能,观察丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、血清总胆红素(STB)、血清结合胆红素(SCB)变化.结果 两组治疗4周后乏力、腹胀、恶心、呕吐、肝区痛等症状均基本消失;治疗组的皮肤瘙痒的有效率、肝肿大回缩有效率以及肝功能主要指标下降幅度显著高于对照组,两组比较差异有统计学意义.结论 腺苷蛋氨酸和熊去氧胆酸联合治疗无明显的毒副反应,其安全性和耐受性较好,是治疗淤胆型病毒性肝炎的有效方法.     

丁二磺酸腺苷蛋氨酸治疗胆汁淤积性肝炎的临床疗效

目的探讨丁二磺酸腺苷蛋氨酸治疗胆汁淤积性肝炎的疗效、疗程及安全性。方法收集2006至2010年我院感染科收治的90例病毒性肝炎所致肝内胆汁淤积症患者,分为腺苷蛋氨酸组（治疗组）与常规保肝药组（对照组）,比较二组治疗前后症状体征和生化指标的变化,记录不良反应。结果疗程2周时,治疗组总胆红素下降幅度大于对照组,但两者之间差异无统计学意义（P＞0．05）;治疗组血清ALT、GGT较基线下降幅度大于对照组（P＜0．001）。疗程4周时,治疗组总胆红素、ALT、GGT较基线下降幅度均大于对照组（P＜0．001）。且患者耐受性良好,无严重不良反应发生。结论腺苷蛋氨酸至少4周疗程的治疗对肝内胆汁淤积患者肝功能改善有确切疗效,且安全性好。     

S-腺苷蛋氨酸联合血栓通治疗胆汁淤积性肝炎的临床疗效

目的评估S-腺苷蛋氨酸联合血栓通治疗胆汁淤积性肝炎的效果及不良反应。方法 54例胆汁淤积性肝炎患者被随机分为治疗组(30例)和对照组(24例)。两组均予常规保肝治疗。对照组给予S-腺苷蛋氨酸针剂1.0 g/d静脉滴注;治疗组在对照组基础上加用血栓通针剂0.5 g/d静脉滴注,疗程均为4周。比较两组治疗前后症状、生化指标(ALT、TBil、γ-GT、ALP、TBA)变化及不良反应。结果治疗组治疗后TBil、γ-GT、ALP及TBA下降程度高于对照组(P0.05);其皮肤瘙痒和灰白便的改善也优于对照组(P0.05);治疗组总有效率为83.3%,高于对照组的58.3%(P0.05)。两组患者耐受性良好,无严重不良反应发生。结论S-腺苷蛋氨酸联合血栓通治疗胆汁淤积性肝炎效果理想,副作用小,值得临床推广。     

腺苷蛋氨酸治疗药物性淤胆型肝炎疗效观察

目的探讨腺苷蛋氨酸对药物性淤胆型肝炎的疗效。方法将88例药物性淤疸型肝炎随机分为治疗组46和对照组42例,治疗组在一般保肝治疗基础上加用腺苷蛋氨酸1000毫克溶于5%葡萄糖液250毫升每日1次静点,对照组仅给予一般保肝治疗,疗程均4周。结果治疗2周时,治疗组有效率明显高于对照组,两组间的差异有统计学意义（P〈0.05）。治疗4周时,治疗组与对照组的有效率差异无统计学意义（P〉0.05）,但两组的临床治愈率的差异有统计学意义（P〈0.05）。结论腺苷蛋氨酸在治疗药物性淤胆型肝炎上有较好疗效,能较早促进损伤的肝细胞修复、再生以缓解症状、体征及肝功恢复,是目前较理想的治疗药物性淤胆型肝炎的药物。     

S-腺苷蛋氨酸治疗慢性乙型肝炎肝内胆汁淤积的临床观察

近年来我们应用孓腺苷蛋氨酸治疗慢性乙型肝炎合并肝内胆汁淤积，并用门冬氨酸钾镁作为对照组。     

腺苷蛋氨酸联合前列地尔治疗戊型肝炎导致的肝内胆汁淤积的疗效观察

腺苷蛋氨酸是临床上治疗病毒性肝炎导致的肝内胆汁淤积较理想的药物之一.自2002年4月以来,我们采用腺苷蛋氨酸联合前列地尔治疗戊型病毒性肝炎导致的肝内胆汁淤积,取得良好疗效.     

对病毒性淤胆型肝炎临床表现及其诊断问题的一些新认识

病毒性肝炎是引起肝内胆汁淤积的主要病因之一。临床上多数急性病毒性淤胆型肝炎为自限性疾病,预后良好。但慢性肝炎、肝硬化所致的慢性病毒性淤胆型肝炎及病程日久的急性病毒性淤胆型肝炎常有重度黄疸。黄疸持续不退或进行性加深,常可致胆汁性肝硬化或肝细胞发生液化和凝固性坏死而演变成重症肝炎。     

熊去氧胆酸联合 S-腺苷蛋氨酸治疗药物性胆汁淤积型肝损伤

目的：评价熊去氧胆酸联合 S-腺苷蛋氨酸治疗药物性胆汁淤积型肝损伤的疗效。方法回顾性分析69例药物诱导胆汁淤积型肝损伤患者的使用损肝药物种类,诊断分型采用药物性肝损伤国际共识的量化评分系统。根据不同治疗方案分成2组,治疗组37例,采用熊去氧胆酸联合 S-腺苷蛋氨酸治疗;对照组32例,采用其他护肝药物。对两组患者临床表现和肝功能改善进行对比分析。结果两组经治疗后临床症状、体征和肝脏生化指标较治疗前有显著改善,但治疗组在皮肤瘙痒改善和皮肤黄染消退更好,治疗2周皮肤瘙痒改善率为93．9％,皮肤黄染消退率4周达78．4％,分别高于对照组75．9％和59．4％（分别 P ＝0．011,P ＝0．037）,血清 TBil、ALP、γ-GT 和 TBA 水平下降优于对照组（分别P ＜0．01,P ＜0．05,P ＜0．01,P ＜0．01）。结论熊去氧胆酸和 S-腺苷蛋氨酸是治疗药物诱导胆汁淤积型肝损伤的有效药物,两药联合治疗效果更佳。     

S-腺苷蛋氨酸治疗急性胆汁淤积性肝炎的疗效

目的评估S-腺苷蛋氨酸治疗急性胆汁淤积性肝炎的效果及不良反应。方法选择76例急性胆汁淤积性肝炎患者,分为治疗组（47例）和对照组（29例）进行临床对比观察。对照组给予甘草酸二铵和茵栀黄治疗,静脉注射4周;治疗组在上述治疗基础上加用S-腺苷蛋氨酸,1000mg/d,静脉注射4周。分别在不同时间点（第2、4、6周）针对临床症状、生化指标（TBil、ALT、AST、ALP、GGT）及不良反应进行观察。结果与治疗前TBil水平比较,治疗第2、4、6周时的TBil降幅率治疗组分别为46%、77%、92%,对照组分别为37%、60%、90%,差异均有统计学意义（P〈0.05）。两组临床症状均有改善,皮肤瘙痒改善率治疗组为70.0%,对照组为45.0%,差异有统计学意义（P〈0.05）。结论 S-腺苷蛋氨酸退黄疸速度快,尤以前4周下降速度快,同时对改善胆汁淤积性肝炎患者的皮肤瘙痒有显著疗效,且无明显不良反应。     

门冬氨酸钾镁对冠状动脉造影术后患者钾离子水平及QTc间期的影响

目的 探讨术前应用门冬氨酸钾镁对冠状动脉造影患者术后血清钾离子水平以及QTc间期的影响。方法 入选2019年1月～2020年11月于天津市人民医院心内科住院行冠状动脉造影检查的患者共282例,分为门冬氨酸钾镁组（n=138）与氯化钾组（n=144）。门冬氨酸钾镁治疗组患者术前应用门冬氨酸钾镁30 ml静脉输液治疗,常规氯化钾组患者术前应用氯化钾0.5 g静脉输液治疗。记录两组患者术前及术后血清钾离子、钠离子、氯离子、血清肌酐、红细胞、血红蛋白、红细胞压积和QTc间期等指标,并比较手术前后各项指标的变化。计算两组患者Gensini评分,评估患者发生QTc间期与冠脉病变及电解质的相关性。结果 在门冬氨酸钾镁治疗组,血清钾离子、血红蛋白、红细胞计数、血小板计数及红细胞压积均较术前降低（均P<0.01）,而血清钠离子、氯离子、血清肌酐以及QTc间期较术前升高（均P<0.01）;血小板容积与术前比较差异无统计学意义。在氯化钾组,血清钾离子、血红蛋白、红细胞计数、红细胞压积、血小板均较术前降低（均P<0.01）,血清钠离子、氯离子及QTc间期较术前有所升高（均P<0.01）...     

消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的临床疗效

目的评价消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的临床疗效。方法慢性乙型肝炎(湿热瘀阻型)轻度黄疸患者68例,随机数字表简单随机分组,消黄方组38例,熊去氧胆酸(UDCA)组30例。两组基础治疗方案为拉米夫定100 mg,每天1次,口服(或替比夫定600 mg,每天1次,口服);复方甘草酸苷60 ml,每天1次,静滴;还原型谷胱甘肽1.2 g,每天1次,静滴。UDCA组加UDCA 250 mg,每天3次,口服;消黄方组加消黄方100 ml,每天2次,口服。疗程4周。治疗前后观察两组中医证候、肝功能、肝纤维化指标及APRI指数变化。结果 (1)与UDCA组相比,消黄方治疗慢性乙型肝炎(湿热瘀阻型)轻度黄疸的有效率略高(89.5%vs76.7%),但差异无统计学意义(P>0.05)。(2)与治疗前相比,消黄方在改善性乙型肝炎轻度黄疸患者肝功能及血脂水平(ALT、AST、GGT、LDH、TBil、DBil、pre-A、TBA、TC、apo-A、HDL等)方面差异有统计学意义(P<0.01或P<0.05)。与UDCA组相比,消黄方可有效降低TBil、DBil、TBA、TC水平,提高apo-A含量(P<0.05)。(3)与治疗前相比,两组患者透明质酸(HA)均降低,差异具有统计学意义(P<0.05),消黄方对C-IV也显示出较好的改善作用(P<0.05)。(4)与治疗前相比,消黄方组可显著降低患者APRI指数(P<0.01),且与UDCA组比较差异有统计学意义(P<0.05)。结论消黄方可缓解慢性乙型肝炎(湿热瘀阻型)轻度黄疸患者临床症状,改善肝功能、肝纤维化指标,对肝内胆汁淤积性黄疸有较好的临床疗效。     

High-level expression of hepatitis B viral antigens in fibrosing cholestatic hepatitis.

The expression of hepatitis B viral antigens was quantified in liver tissue from four transplant recipients with fibrosing cholestatic hepatitis (FCH) and compared with five other transplant recipients who did not develop this syndrome and 30 patients with chronic hepatitis B virus (HBV) infection. As measured by radioimmunoassays, the liver tissue from patients with FCH had significantly greater amounts of both hepatitis B surface antigen (HBsAg) and nucleocapsid antigens than to transplant patients without this syndrome (P less than 0.01) or patients with chronic HBV infection (P less than 0.001). Intrahepatic expression of pre-S1/pre-S2 in FCH was also extensive with a distribution parallel to that of HBsAg. High-level expression of intrahepatic HBsAg and hepatitis B core antigen in the explanted liver was associated with subsequent development of FCH in the liver graft, suggesting that viral/host factors may also be important. This pattern of intrahepatic hepatitis viral antigen expression, by analogy with Chisari's transgenic mice model and Roingeard's HBV-transfected HepG2 cell model, may be the cause of direct hepatocytopathic injury in this condition.     

Nasobiliary drainage in acute cholestatic hepatitis with pruritus

Background/aimCholestatic acute viral hepatitis may have prolonged course. Pruritus is often a prominent feature and difficult to control. Sometimes it may be accompanied by severe cough. There are no reports of endoscopic nasobiliary drainage in these patients.MethodsWe prospectively evaluated the role of nasobiliary drainage in six patients with cholestatic acute viral hepatitis with intractable pruritus and accompanying severe cough in one patient in an uncontrolled study.ResultsThere were five male and one female patient with cholestatic acute viral hepatitis with intractable pruritus. One patient also had severe cough. Nasobiliary drainage relieved pruritus in all patients and patient with cough also showed marked improvement within 24 h. Nasobiliary drainage also hastened the recovery in these patients.ConclusionsShort-term nasobiliary drainage should be considered in patients with cholestatic acute viral hepatitis with intractable pruritus and cough for symptomatic relief. It may help in faster recovery in these patients. However, a larger randomized controlled study is warranted.     

A woman with recent jaundice and pruritus

A middle-aged woman suffering from jaundice and pruritus that had begun a month previously was presented to a physician.At the first assessment, laboratory findings had revealed a cholestatic pattern and serologic tests for hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis A virus (HAV) were negative. Normal findings of abdominal computed tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) ruled out extrahepatic causes of cholestasis. A liver biopsy was done and showed intrahepatic cholestasis without destruction of the bile ducts or granuloma.We assessed the intrahepatic causes of cholestasis. Finally the diagnosis was confirmed by means of a simple test.     

胆汁淤积性肝病并发皮肤瘙痒的发病机制及治疗进展

瘙痒是胆汁淤积性肝病如原发性胆汁性肝硬化、原发性硬化性胆管炎和妊娠期肝内胆汁淤积症的一个常见症状。既往研究的胆汁淤积性瘙痒的潜在致痒因子有胆盐、组胺、孕酮代谢产物、内源性阿片样物质和溶血性磷脂酸等。然而,胆汁淤积性瘙痒的确切发病机制尚不清楚,现有的止痒方法仅可使部分患者症状得到缓解,新的止痒方法已被提出和(或)正在研究中。在回顾近期关于胆汁淤积型肝病并发皮肤瘙痒的发病机制和治疗的实验和临床试验,以便提高对胆汁淤积性瘙痒的认识和治疗。     

Flucloxacillin induced delayed cholestatic hepatitis

We report four cases of severe delayed cholestatic hepatitis induced by flucloxacillin. All patients presented with deep jaundice and pruritus which developed soon after ceasing flucloxacillin. Liver function tests were abnormal in all patients with markedly elevated serum bilirubin concentration, alkaline phosphatase and aspartate transaminase levels. Extrahepatic biliary obstruction and infective hepatitis were excluded in all cases. Liver biopsies showed centrilobular cholestasis with portal and lobular inflammation and eosinophil infiltration. Although symptoms resolved within six weeks in all patients, cholestatic liver function tests have persisted in two patients for more than six months. With the increasing usage of this drug and the delayed presentation of cholestasis, flucloxacillin needs to be considered in the differential diagnosis of all patients presenting with cholestatic jaundice.     

参麦注射液合用门冬氨酸钾镁治疗难治性心力衰竭观察

目的：观察参麦注射液与门冬氨酸钾镁注射液合用治疗难治性心力衰竭的疗效。方法：160例充血性心力衰竭（CHF）患者，随机被分为治疗组和对照组。两组基础治疗相同，治疗组加用参麦注射液20ml，门冬氨酸钾镁30ml，5％葡萄糖150ml，每日静脉滴注，连用14d。结果：两组心率、血压、心电图、心功能指标均有改善，但治疗组心率、心功能改善显著（P分别〈0．05，〈0．01），且甚于对照组（P〈0．05）。治疗组的总有效率、心电图疗效优于对照组（P〈0．05），低钾血症和室性心律失常发生率显著少于对照组（P〈0．05）。结论：参麦注射液与门冬氨酸钾镁合用治疗难治性心力衰竭疗效优于常规治疗。     

Diagnostic and therapeutic approach to cholestatic liver disease.

When cholestatic liver disease is present, liver ultrasound should be performed to ascertain if cholestasis is extrahepatic or intrahepatic. If bile ducts appear dilated and the probability of interventional treatment is high, endoscopic retrograde cholagio-pancreatography (ERCP) or trans-hepatic cholangiography (THC) should be the next step. If the probability of interventional therapeutics is low, cholangio-MRI should be performed. Once bile duct dilation and space occupying lesions are excluded, a work up for intrahepatic cholestasis should be started. Some specific clinical situations may be helpful in the diagnostic strategy. If cholestasis occurs in the elderly, drug-induced cholestatic disease should be suspected, whereas if it occurs in young people with risk factors, cholestatic viral hepatitis is the most likely diagnosis. During the first trimester of pregnancy cholestasis may occur in hyperemesis gravidorum, and in the third trimester of gestation cholestasis of pregnancy should be suspected. A familial history of recurrent cholestasis points to benign recurrent intrahepatic cholestasis. The occurrence of intrahepatic cholestasis in a middle-aged woman is a frequent presentation of primary biliary cirrhosis, whereas primary sclerosing cholangitis should be suspected in young males with inflammatory bowel disease. The presence of vascular spider nevi, ascites, and a history of alcohol abuse should point to alcoholic hepatitis. Neonatal cholestasis syndromes include CMV, toxoplasma and rubinfections or metabolic defects such as cystic fibrosis, alpha1-antitrypsin deficiency, bile acid synthesis defects, or biliary atresia. The treatment of cholestasis should include a management of complications such as pruritus, osteopenia and correction of fat soluble vitamin deficiencies. When hepatocellular failure or portal hypertension-related complications occur, liver transplantation should be considered.