特利加压素治疗失代偿期乙型肝炎肝硬化患者消退腹水的作用及对肝肾功能的影响

目的 探讨特利加压素对失代偿期乙型肝炎肝硬化患者肝肾功能的影响及对腹水的治疗作用。方法 回顾性分析2014年8月至2016年4月安徽省立医院肝脏外科收治的50例失代偿期乙型肝炎肝硬化患者，按其处置方式的不同分为特利加压素处理组（n=25）和传统处理组（n=25），比较两组患者治疗后1 d、3 d、7 d血清谷丙转氨酶、谷草转氨酶、总胆红素、碱性磷酸酶、肌酐、尿素氮等肝肾功能指标及24 h尿量和腹围的变化。结果 治疗后3 d和7 d，特利加压素治疗患者血清肌酐水平为（100.88±28.51）μmol/L和（95.28±25.34）μmol/L，显著低于传统处理组【分别为（124.34±19.88）μmol/L和（113.99±26.89）μmol/L，P＜0.05】；尿素氮水平为（10.13±4.76）μmol/L和（9.05±4.53）μmol/L，低于传统处理组【分别为（13.12±5.28）μmol/L和（12.34±5.99）μmol/L，P＜0.05】；24 h尿量为（1825.6±613.34） ml和（1990.8±731.16）ml，显著多于传统处理组【（1334.42±542.33）ml和（1421.54±698.99）ml，P＜0.05】；腹围为（91.32±7.4）cm和（91.04±7.45）cm，显著小于传统治疗组【（96.28±6.89）cm和（96.55±7.99）cm，P＜0.05】。治疗7 d后，特利加压素组患者腹水好转率为76.0%（19/25），显著高于传统治疗组的40.0%(10/25，P＜0.05）；而两组患者血清谷丙转氨酶、谷草转氨酶、总胆红素、碱性磷酸酶等肝功能指标的变化，差异无统计学意义（P＞0.05）。结论 对于失代偿期乙型肝炎肝硬化患者，特利加压素能有效改善其肾功能，减少腹水，预防肝肾综合征的发生，短期使用该药，对患者肝功能影响不大。

Therapeutic effects of terlipressin in treatment of patients with decompensated cirrhosis resulting from chronic hepatitis B

Objiective To explore the therapeutic effect of telipressin in treatment of patients with decompensated cirrhosis resulting from chronic hepatitis B. Methods 50 patients with decompensated cirrhosis resulting from chronic hepatitis B were admitted to Anhui Provincial Hospital between August 2014 and June 2016. The patients were divided into telipressin treatment group（n=25） and traditional treatment group（n=25） accordng to the different treatment approaches. The urine volume，abdominal perimeter，and the serum levels of alanine aminotransferase（ALT），AST，total bilirubin，alkaline phosphatase（ALP），creatinine， urea nitrogen on day 1，3，7 after treatment were compared between the two groups. Results On day 3 and 7 after treatment，serum levels creatinine in telipressin treatment group were（100.88±28.51） μmol/L and （95.28±25.34） μmol/L，respectively，significantly lower than those in traditional treatment group （124.34±19.88）μmol/L and （113.99±26.89） μmol/L，P＜0.05]；serum levels of urea nitrogen in telipressin treatment group were （10.13±4.76） μmol/L and（9.05±4.53） μmol/L，respectively，markedly lower than those in traditional treatment group（13.12±5.28）μmol/L and （12.34±5.99） μmol/L，P＜0.05]；urine volumes in telipressin treatment group were （1825.6±613.34） ml and （1990.8±731.16） ml，respectively，much greater than those in traditional treatment group（1334.42±542.33）ml and（1421.54±698.99） ml，P＜0.05]；abdominal perimeters in telipressin treatment group were（91.32±7.4） cm and（91.04±7.45） cm， respectively，smaller than those in traditional treatment group （96.28±6.89）cm and （96.55±7.99） cm，P＜0.05]；after seven day treatment，ascites subsided in 76.0% in telipressin treatment group （19/25），much higher than 40.0% in patients in traditional treatment group（10/25，P＜0.05）；However，serum levels of ALT，AST，ALP，total bilirubin on day 3 and 7 after treatment were not significantly different between the two groups（P＞0.05）. Conclusion Terlipressin is effective for patients with decompensated cirrhosis resulting from chronic hepatitis B. The treatment can improve renal functions and decrease ascites.