经皮经肝胆管引流术联合异甘草酸镁治疗恶性梗阻性黄疸患者肝功能损伤的疗效观察

目的：评价经皮经肝胆管引流术（ percutaneous transhepatic cholangial drainage ，PTCD）联合异甘草酸镁治疗恶性梗阻性黄疸患者肝功能损伤的临床疗效及安全性。方法2009年6月～2013年6月，恶性梗阻性黄疸120例，在PTCD术后常规护肝治疗的基础上，按就诊顺序依次分入观察组（加用异甘草酸镁100 mg/d）和对照组（加用还原型谷胱甘肽1200 mg/d）各60例。治疗7天后，比较丙氨酸氨基转移酶（ ALT）、天冬氨酸氨基转移酶（ AST）、白蛋白（ ALB）、γ-谷氨酰转肽酶（γ-GT）、碱性磷酸酶（ ALP）、总胆红素（ TBil）、直接胆红素（ DBil）及肿瘤坏死因子α（ TNF-α）、核因子κB（ NF-κB）的变化；观察与药物有关的不良反应。结果治疗1周后，观察组与对照组TBil、DBil、ALT、AST、ALP、TNF-α、NF-κB较治疗前均明显下降（P＜0.05），且观察组下降更明显（P＜0．05）。2组ALB、γ-GT治疗前后差异无显著性，2组间比较差异亦无显著性（P＞0.05）。结论恶性梗阻性黄疸患者PTCD术后异甘草酸镁治疗肝功能损伤对恢复肝功能、消退黄疸有促进作用。

Effects of PTCD Combined with Magnesium Isoglycyrrhizinate on Liver Function Damage in Patients with Malignant Obstructive Jaundice

Objective To evaluate treatment effects and safety of percutaneous transhepatic cholangial drainage （ PTCD ） combined with magnesium isoglycyrrhizinate （ MI ） therapy on liver function damage in patients with malignant obstructive jaundice . Methods One hundred and twenty cases of malignant obstructive jaundice from June 2009 to June 2013 were enrolled in the study . After PTCD, these patients were divided into either experimental group or control group according to each patient ’ s admittance sequence（60 cases in each groups ）.All the patients were given conventional hepatoprotective treatment .At the same time, the experimental group was given magnesium isoglycyrrhizinate 100 mg/d, while the control group was given reduced glutathione 1200 mg/d.After treatment for 7 days, the serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, albumin （ALB）,γ-glutamyl transpeptidase （γ-GT）, alkaline phosphatase （ALP）, total bilirubin （TBil）, direct bilirubin （D-Bil）, tumor necrosis factor-α（ TNF-α） , and nuclear factor-kappa B （ NF-κB） were detected and compared between the two groups , respectively .Adverse reactions correlated with magnesium isoglycyrrhizinate were observed . Results Adverse reactions did not occur during the treatment course.Compared with preoperation of PTCD , parameters such as serum TBil , DBil, ALT, AST, ALP, TNF-α, NF-κB in both groups were decreased obviously （P〈0.05）.Compared with the control group , the serum TBil, DBil, ALT, AST, ALP, TNF-α, NF-κB in the experimental group were decreased more dramatically （P〈0.05）.There were no significant differences in ALB and γ-GT, either before and after PTCD or between the two groups （P〉0.05）. Conclusion Treated with magnesium isoglycyrrhizinate medication combined with PTCD , patients with malignant obstructive jaundice obtain dramatic recovery of liver functions and relief of jaundice .