淤胆型肝炎

川芎嗪注射液联合肝素钠与口服熊去氧胆酸治疗慢性淤胆型肝炎疗效观察，前列地尔联合复方甘草酸苷治疗淤胆型肝炎临床观察，     

小剂量肝素、立其丁联合治疗慢性淤胆型肝炎疗效观察

探讨小剂量肝素、立其丁联合治疗慢性淤胆型肝炎的临床疗效和安全性，并与对照组(苦黄)比较疗效及肝功能指标的变化。75例入围患者随机分成治疗组(38例)和对照组(37例)，治疗组用立其丁针10mg和肝素针50mg加入10％葡萄糖液150ml中缓慢静脉滴注，每分钟20-30滴，每日一次；对照组用苦黄针40ml加入10％葡萄糖液加250ml中静脉滴注，每日一次。疗程均为5—6周。治疗组显效率59％，有效率86％，对照组显效率36％，有效率64％，两组比较有显著性差异(P＜0．05)，治疗组治疗后的STB，SCB，ALT均比对照组低，有统计学差异。提示小剂量肝素、立其丁联合治疗慢性淤胆型肝炎疗效肯定，优于苦黄，没有明显不良反应。     

多巴酚丁胺与川芎嗪治疗肺心病心力衰竭疗效观察

目的探讨多巴酚丁胺与川芎嗪治疗肺心病心力衰竭的临床疗效。方法140例患者随机分为治疗组与对照组。对照组常规治疗，给予氧疗、抗感染、改善通气功能，应用利尿剂、洋地黄以及扩血管药物。治疗组在常规治疗的基础上加用多巴酚丁胺40mg加入5％葡萄糖液250ml内静滴，每日1次，7天为一疗程，川芎嗪400mg加入5％葡萄糖注射液250ml静滴，每日1次，14天为一疗程。结果治疗组有效率为9．14％，对照组有效率为71．43％。两组比较，差异有统计学意义（P〈0．05）。结论多巴酚丁胺与川芎嗪联合治疗肺心病心力衰竭疗效显著。     

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.     

神经节苷脂联用川芎嗪治疗血管性痴呆患者的疗效

目的 观察单唾液酸四己糖神经节苷脂(GMI)联用川芎嗪治疗血管性痴呆(VD)的疗效.方法 将102例VD病人随机分为治疗组51例及对照组51例.治疗组用 GMI 40 mg加入0.9%氯化钠注射液100 ml中静滴,每日1次,川芎嗪80 mg加入0.9%氯化钠注射液250 ml中静滴,每日1次.对照组给予川芎嗪80 mg加入0.9%氯化钠注射液250 ml中静滴,每日1次.两组疗程均为21 d.观察治疗前后血液流变学指标、两组简易精神状态检查量表()MMSE积分值和ESS评分的改变.结果 治疗21 d后,两组治疗后MMSE及日常生活能力量表(ADL)较治疗前明显增高(P<0.05);治疗组与对照组MMSE及ADL比较差异有显著性,治疗组MMSE积分值比治疗前提高5.00分,治疗组疗效优于对照组(P<0.05).治疗组与对照组红细胞聚集指数及血浆黏度比较差异有显著性,治疗组疗效优于对照组(P<0.05).结论 GMI联合川芎嗪治疗VD效果显著,方法 简便,使用范围广,无明显不良反应,值得临床应用.     

川芎嗪治疗慢性乙型肝炎50例(摘要)

目的:观察川芎嗪治疗慢性乙型肝炎的疗效。方法:将1994睥3月～1996年5月在我院住院且诊断符合1990年5月第六次全国病毒性肝炎学术会议制定的诊断标准的100例慢性乙型肝炎患者随机分为治疗组和对照组各50例,治疗组用川芎嗪注射液200mg加入10％葡萄糖溶液250ml中静滴每日1次;对照组以丹参注射液20ml加入10％葡萄糖液250ml中静滴。两组患者同时采用对症支持疗法和服用中草药,均以3个月为1疗程。结果:治疗组基     

淤胆型肝炎

中西医结合治疗淤胆型肝炎35例——庄见齐等(广东汕头大学医学院第一附属医院515041)；《河北医学》，2004，10(12)：1094-1095[目的：探讨中西医结合治疗淤胆型肝炎的方法。方法：治疗组用熊去氧胆酸(IYDCA)联合中药赤芍(重用)复方辩证论治，对照组用门冬氨酸30ml，静脉滴注，每日一次。结果：中西医结合治疗35例淤胆型肝炎病人，     

利多卡因联合倍他司汀治疗椎——基底动脉缺血性眩晕40例疗效观察

目的观察利多卡因联合倍他司汀治疗椎-基底动脉缺血性眩晕的疗效。方法选择眩晕症患者80例，随机分两组各40例。对照组应用盐酸倍他啶注射液500ml，山莨菪碱针剂20mg加入5％GS液250ml静滴，每日1次，7天为1个疗程。治疗组以利多卡因100mg加入5％GS液250ml静滴，倍他司汀20mg加入5％GS液250ml静滴。每日1次，7天为1个疗程。结果两组治疗后均取得了较好的效果，但两组间比较，治疗组总有效率明显高于对照组（P〈0．05）。结论应用利多卡因联合倍他司汀治疗椎一基底动脉缺血性眩晕疗效显著，值得临床推广使用。     

腺苷蛋氨酸联合异甘草酸镁治疗瘀胆型肝炎45例

[目的]观察腺苷蛋氨酸联合异甘草酸镁治疗瘀胆型肝炎的疗效。[方法]90例患者随机分为2组各45例,治疗组采用腺苷蛋氨酸冻干粉针剂1 000 mg加入5%葡萄糖250 ml静脉滴注,1次/d,异甘草酸镁注射液100mg加入10%葡萄糖250 ml静脉滴注,1次/d;对照组采用苦黄注射液30 ml加入10%葡萄糖250 ml静脉滴注,1次/d,甘草酸二铵注射液150 mg加入10%葡萄糖250 ml静脉滴注,1次/d,疗程均为4周。观察患者治疗前后的症状和肝功能变化,并记录治疗过程中的不良反应。[结果]治疗组总有效率95.6%,优于对照组77.8%,2组比较差异有统计学意义（P〈0.05）。治疗组治疗后肝功能指标均较治疗前改善（P〈0.05）,且各指标改善情况均优于对照组（P〈0.05）。[结论]腺苷蛋氨酸联合异甘草酸镁治疗瘀胆型肝炎临床疗效明显。     

灯盏细辛注射液治疗糖尿病合并脑梗死疗效观察

目的观察灯盏细辛注射液治疗糖尿病合并脑梗死的疗效。方法60例糖尿病合并脑梗死患者随机分为治疗组和对照组。治疗组30例应用灯盏细辛注射液40ml加入生理盐水250ml中静滴。对照组30例应用川芎嗪注射液160mg加入生理盐水250ml中静滴。两组均1次／d，14天为1个疗程。结果治疗组总有效率（90％）明显高于对照组（77％），P〈0．01。治疗组用药前后血液流变学指标中血液黏度指标均有明显改善。结论灯盏细辛注射液治疗糖尿病合并脑梗死疗效确切，安全可靠。     

小剂量雷公藤多甙联合低分子肝素钠治疗慢性肾小球肾炎临床观察

目的探讨小剂量雷公藤多甙联合低分子肝素钠治疗慢性肾小球肾炎的临床疗效。方法将64例慢性肾小球肾炎患者分为3组。在常规治疗基础上，实验组予小剂培雷公藤多甙联合低分子肝素钠治疗；对照组l予小剂量雷公藤治疗；对照组Ⅱ子低分子肝素钠治疗。分别检测患者治疗前及治疗12周后肾功能、血清白蛋白、24h尿蛋白定量、尿中红细胞、肝功能、血常规及血粘度、血脂，并进行比较。结果3组患者治疗前后肾功能、血清白蛋白、尿蛋白及尿红细胞差异有统计学意义；实验组治疗后血清白蛋白、尿蛋白及尿红细胞水平与对照组l、Ⅱ治疗后差异有统计学意义。结论小剂量雷公藤多甙联合低分子肝索钠治疗慢性肾小球肾炎，疗效显著，药物毒副作用小。     

Long-term treatment of chronic hepatitis C with ursodeoxycholic acid: influence of HCV genotypes and severity of liver disease.

AIMS/BACKGROUND: Current therapy for chronic hepatitis C virus (HCV) infection is based on the administration of interferon alpha (IFN) alone or in combination with other anti-viral agents. However, such therapy is effective in only a minority of selected patients. Long-term ursodeoxycholic acid (UDCA) treatment has been reported to improve liver function and structure especially in cholestatic disorders. We investigated the effect of long-term UDCA treatment on liver function in respect to the severity of chronic liver disease and HCV genotypes. METHODS: Forty-five patients with non-cholestatic laparoscopy-biopsy proven HCV-associated chronic hepatitis (n=16) or cirrhosis (n=29) who had not responded to, or were unsuitable for IFN, were randomly assigned to receive UDCA (600 mg/day; n=23) or no therapy (n=22) for 12 months. At entry, all patients were evaluated by means of conventional and quantitative liver function tests (LFTs), including galactose elimination capacity and antipyrine clearance, HCV antibodies, HCV-RNA and HCV genotypes. LFTs were measured at 6 and at 12 months, whereas HCV-RNA was determined again after treatment. RESULTS: Baseline characteristics were comparable in the two study groups. Long-term UDCA therapy was well tolerated. Based on the analysis of variance, there was a significant decrease in serum transaminase, LDH and GGT levels in UDCA treated patients. By contrast, the activities of these enzymes increased in untreated patients, with AST levels reaching statistical significance only. Statistical analysis also showed that the improvement in biochemical markers was more pronounced in UDCA treated patients with liver cirrhosis than in those with chronic hepatitis but was similar in patients with HCV genotype 1b and non-1b. However, HCV-RNA was positive in all patients after treatment. Quantitative LFTs remained, on average, stable over the 12 months of the trial in all groups. CONCLUSIONS: Long-term UDCA treatment is well tolerated in patients with HCV-associated chronic liver disease. The effect appears to be greater in cirrhotics than in patients with chronic hepatitis but is independent of HCV genotypes. Thus, long-term UDCA treatment, despite the absence of an anti-viral effect, seems beneficial in reducing disease activity in patients with chronic hepatitis or cirrhosis who are unsuitable for IFN therapy.     

川芎嗪联合苦参素治疗慢性乙肝临床观察

观察川芎嗪联合苦参秦治疗慢性乙肝的疗效.86例患者随机分为两组,对照组(B组)36例给苦参素及常规护肝药;治疗组(A组)50例在对照组基础上联用川芎嗪(40-80)mg/日,静脉滴注,疗程均为4周.结果:治疗4周后,治疗组ALT及TBil复常率分别为92%、96%,对照组分别为55.5%,77.7%,两组间有显著性差异(P＜0.05),HBV DNA及HBeAg阴转率略高于对照组,但无统计学差异.川芎嗪联合苦参素明显改善肝功能且抑制DNA复制,是治疗慢性乙肝的有效联合.     

Ursodeoxycholic acid decreases the serum transaminase levels of chronic liver disease patients treated with glycyrrhizin

The effects of ursodeoxycholic acid (UDCA) on the liver function test values were investigated in patients with chronic hepatitis (CH) and liver cirrhosis (LC) in whom treatment with glycyrrhizin (SNMC) for more than 6 months had failed to improve serum transaminase levels. Twenty-six patients treated with Stronger neo minophagen C (SNMC), 60 ml, i.v., three times/week) for more than 6 months were given UDCA (Urso, 600 mg/day) in addition (SNMC + UDCA group) and 22 patients were given UDCA (Urso, 600 mg/day) alone (UDCA group). The mean AST, ALT, γ-GTP and total bile acid (TBA) values during the 3 months before UDCA treatment and the 3 months after the start of UDCA treatment were compared in each case. The results showed that AST, ALT and γ-GTP were improved by 28, 34 and 46%, respectively in the 24 patients with CH, type C in the SNMC + UDCA group, and 27, 30 and 39%, respectively in the 14 patients with CH, type C in the UDCA group. UDCA was also effective in improving AST and ALT in the patients in the SNMC + UDCA group who were resistant to interferon therapy. The percentages of improvement in AST, ALT and γ-GTP in the 10 LC patients were lower than in the CH patients in both SNMC + UDCA and UDCA group. In conclusion, UDCA is useful in decreasing the serum transaminase levels of patients with CH, even when they are being treated with SNMC.     

Gallstone dissolution with ursodeoxycholic acid in patients with chronic active hepatitis and two years follow-up

Chemical dissolution of cholesterol gallstones using ursodeoxycholic acid (UDCA) in six patients with histologically confirmed HBsAg-negative chronic active hepatitis was started after a minimum of one year of therapy with steroids, azathioprine, or chloroquine and a treatment-free period of 8-15 months. The treatment with UDCA lasted 3-20 months with a daily dose of 8-11 mg/kg. Four patients served as controls. A decrease in transaminases (P less than 0.05) occurred in all patients during the UDCA therapy. After completion of the treatment, the figures rose again, but did not return to the initial value. The stones dissolved in five patients. A second liver biopsy was carried out in two patients after UDCA therapy, and this showed no detectable deterioration. Four patients refused biopsy because the laboratory parameters had improved under UDCA. A stone recurred in one patient six months after the end of therapy; the others have remained free of stones for up to 24 months.     

Efficacy of ursodeoxycholic acid therapy in chronic viral hepatitis C with high serum γ-glutamyltranspeptidase levels

We administered ursodeoxycholic acid (UDCA) orally, at a daily dose of 600 mg, for 4 months to 36 patients with chronic viral hepatitis C. Another 36 patients with chronic viral hepatitis C, treated with placebo for 4 months, served as controls. None of the patients were alcoholics and none suffering from auto-immune hepatitis. Of the 36 patients in the UDCA-treated group, 13 had high levels of serum -glutamyl-transpeptidase (GGT), i.e., exceeding 150U/l (normal <50U/l). Histological examination of liver biopsy specimens obtained from 10 patients in this group before treatment suggested that damage of the interlobular bile ducts was prominent in patients with higher levels of serum GGT. After 1 month of UDCA treatment, significant decreases in the levels of serum GGT, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were observed (P<0.05 for GGT and AST), and the decreases continued for the 4-month treatment period. The reduction of GGT levels was the most prominent change in the liver function indices; the percent change in the GGT level was –25.2±4.4 (mean percent change ± SE) at 1 month and –38.0±5.0 at 4 months. A significant correlation was observed between the serum AGGT level (GGT value before treatment minus value after 3 months of treatment) and the total score for morphological injury of the bile ducts (P<0.05). These results suggested that UDCA has the potential to reverse hepatocellular damage in patients with chronic viral hepatitis C, in whom high GGT levels may be due, in part, to a damaged interlobular bile duct. UDCA may be useful for the treatment of chronic viral hepatitis C, especially in patients exhibiting a high level of GGT.     

Long-term treatment of chronic hepatitis C with ursodeoxycholic acid: influence of HCV genotypes and severity of liver disease

Abstract: Aims/Background: Current therapy for chronic hepatitis C virus (HCV) infection is based on the administration of interferon alpha (IFN) alone or in combination with other anti-viral agents. However, such therapy is effective in only a minority of selected patients. Long-term ursodeoxycholic acid (UDCA) treatment has been reported to improve liver function and structure especially in cholestatic disorders. We investigated the effect of long-term UDCA treatment on liver function in respect to the severity of chronic liver disease and HCV genotypes. Methods: Forty-five patients with non-cholestatic laparoscopy-biopsy proven HCV-associated chronic hepatitis (n=16) or cirrhosis (n=29) who had not responded to, or were unsuitable for IFN, were randomly assigned to receive UDCA (600 mg/day; n=23) or no therapy (n=22) for 12 months. At entry, all patients were evaluated by means of conventional and quantitative liver function tests (LFTs), including galactose elimination capacity and antipyrine clearance, HCV antibodies, HCV-RNA and HCV genotypes. LFTs were measured at 6 and at 12 months, whereas HCV-RNA was determined again after treatment. Results: Baseline characteristics were comparable in the two study groups. Long-term UDCA therapy was well tolerated. Based on the analysis of variance, there was a significant decrease in serum transaminase, LDH and GGT levels in UDCA treated patients. By contrast, the activities of these enzymes increased in untreated patients, with AST levels reaching statistical significance only. Statistical analysis also showed that the improvement in biochemical markers was more pronounced in UDCA treated patients with liver cirrhosis than in those with chronic hepatitis but was similar in patients with HCV genotype lb and non-1b. However, HCV-RNA was positive in all patients after treatment. Quantitative LFTs remained, on average, stable over the 12 months of the trial in all groups. Conclusions: Long-term UDCA treatment is well tolerated in patients with HCV-associated chronic liver disease. The effect appears to be greater in cirrhotics than in patients with chronic hepatitis but is independent of HCV genotypes. Thus, long-term UDCA treatment, despite the absence of an anti-viral effect, seems beneficial in reducing disease activity in patients with chronic hepatitis or cirrhosis who are unsuitable for IFN therapy.     

拉米夫定联合六味五灵片治疗e抗原阳性慢性乙型肝炎疗效观察

目的观察拉米夫定（LAM）联合六味五灵片治疗e抗原阳性慢性乙型肝炎（CHB）效果。方法 100例e抗原阳性慢性乙型肝炎患者分为治疗组50例及对照组50例。治疗组每次给予LAM100mg,每日1次;六味五灵片每次2g,每日3次。对照组每次给予LAM100mg,每日1次;护肝片每次1.4g,每日3次,两组疗程均为24周,疗程结束后继续口服LAM,并对两组ALT、HBV-M、HBV DNA载量及血清肝纤维化指标等进行观察。结果治疗结束时,治疗组显效18例、有效26例,总有效率88%;对照组显效6例、有效21例,总有效率54%。两组有效率相比P〈0.05,差异有统计学意义。两组治疗后肝纤维化各项指标比较P〈0.05,差异均有统计学意义。结论 LAM联合六味五灵片具有较好抑制乙型肝炎病毒（HBV）复制、恢复肝功能及抗纤维化的作用,是临床治疗慢性乙型肝炎值得推荐的方法。     

Ileal absorption of bile acids in patients with chronic cholestasis

The effect of cholestasis on ileal bile acid absorption is controversial in animal models (up-or down-regulation) and unknown in humans. We therefore studied values of the selena homotaurocholic acid (SeHCAT) test before and after long-term administration (>3 months, 13–15 mg/kg/day) of ursodeoxycholic acid (UDCA) in 27 patients with chronic cholestatic liver diseases (24 women, 3 men; mean age, 50 years; 24 primary biliary cirrhosis, 2 secondary biliary cirrhosis, 2 others). The control group consisted of 14 healthy volunteers. Seven-day SeHCAT percentage retention was identical in the 12 untreated cholestatic patients (serum bilirubin, 75 ± 42 µmol/L, alkaline phosphatase, 4.2 ± 1.0N; mean ± SEM) and in the control group (43.6 ± 2.9 and 43.8 ± 4.2%, respectively). In the 22 patients treated by UDCA for 38 ± 8 months, SeHCAT percentage retention was 20.3 ± 3.0%. In the seven patients with the SeHCAT test done before and after UDCA treatment (16 ± 5 months), SeHCAT percentage retention decreased significantly under UDCA therapy (42.0 ± 4.4 vs 19.4 ± 4.1%; P < 0.02). We conclude that, in patients with chronic cholestasis (1) SeHCAT percentage retention is not altered—taken together with the known defect of biliary excretion, this lack of increase in SeHCAT percentage retention argues against up-regulation of bile acid ileal transport; and (2) UDCA treatment induces a decrease in the SeHCAT percentage retention—this effect may be related primarily to a decreased bile acid ileal absorption.