营养支持联合美他多辛治疗酒精性肝病患者肝功能和外周血细胞参数的变化

目的探讨营养支持联合美他多辛治疗酒精性肝病患者对肝功能、红细胞和血小板参数的影响。方法2015年5月～2017年10月我院诊治的酒精性肝病患者90例,被分为两组,每组45例,分别给予美他多辛片或美他多辛联合营养支持治疗4周,后者为给予35～40 kcat·kg^-1·d^-1的热量。结果治疗前,两组肝功能指标差异无统计学意义(P>0.05),治疗结束时,两组血清ALT、GGT和TBIL水平明显降低,ALB明显升高;治疗前,两组凝血功能指标差异无统计学意义(P>0.05),治疗后两组PT、APTT和TT均明显缩短,FIB显著升高;治疗前,两组红细胞参数和血红蛋白水平差异无统计学意义(P>0.05),治疗后两组RBC、HGB和HCT均显著上升,RDW和MCV显著下降;治疗前,两组血小板计数(PLT)、血小板平均体积(MPV)和血小板分布宽度(PDW)相比无统计学差异(P>0.05),治疗后PLT显著上升,MPV和PDW明显降低(P<0.05),联合组以上变化均显著优于对照组(P<0.05)。结论营养支持联合美他多辛治疗酒精性肝病患者能够显著改善肝功能、凝血功能、红细胞和血小板参数,提示营养支持治疗可能更重要,需要高度重视。

Impact of nutrition support and medusa administration on liver function,erythrocyte and platelet parameters in patients with alcoholic liver diseases

Objectiv To explore the impact of nutrition support and medusa administration on liver function, erythrocyte and platelet parameters in patients with alcoholic liver diseases（ALD）. Methods 90 patients with ALD were recruited in our hospital between May 2015 and October 2017,and they were divided into two groups with 45 cases in each group. All the patients were given glutathione,portuguese aldehyde lactone intravenously and 45 patients were treated with metadoxine,while another 45 were treated with combination of metadoxine and nutritional support at 35~40 kcat·kg^-1·d^-1. The regimen lasted for four weeks. Results At presentation,serum liver function and blood coagulation function index in the two groups were not statistically significantly different （P>0.05）,while serum ALT,GGT and bilirubin levels at the end of the treatment in the two groups significantly decreased and coagulation function improved;before the treatment,the red blood cell parameters,including RBC counts,HBG levels,HCT,RDW and MCV in the two groups had no statistically significantly different（P>0.05）,while at the end of the treatment,the RBC counts,HBG and HCT in the two groups were significantly increased,e.g.（3.45±0.46）×10¹²/L vs. （5.32±0.51）×10¹²/L,（90.12±3.67） g/L vs. （140.92±6.02） g/L,（0.32±0.12）% vs. （0.46±0.11） % in the combination group,and（3.44±0.42）×10¹²/L vs. （4.96±0.48）×10¹²/L,（89.92±3.54）g/L vs. （135.67±6.23） g/L,（0.32±0.10）% vs. （0.41±0.10） % in metadoxine-treated group,and MCV and RDW decreased,e.g. （19.34±1.92）% vs. （12.43±1.21）% and（109.24±6.34）fL vs. （95.19±5.92） fL in the combination,and （19.15±1.89）% vs. （14.91±1.19）% and （109.01±6.45）fL vs. （99.43±6.42）fL in the metadoxine-treated group （P<0.05）;Before the treatment,the platelet parameters,such as PLT counts,MPV and PDW had no statistically significantly different （P>0.05）,and at the end of the treatment,the platelet counts significantly increased in the two groups,e.g. （98.43±10.02）×10⁹/L vs. （219.04±9.78）×10⁹/L in the combination group,an （98.68±10.13）×10⁹/L vs. （200.43±10.24）×10⁹/L in metadoxine-treated group（P<0.05）,while the MPV and PDW decreased obviously,e.g.（12.74±2.02） fL vs.（10.76±1.13） fL and （17.93±2.01） fL vs. （14.28±1.45） fL in the combination group,and（12.84±2.11） fL vs.（11.63±1.02） fL,and （17.87±1.98） fL vs. （15.89±1.51） fL in metadoxine-treated group （P<0.05）;All the improvements above in combination group were significantly superior to those in metadoxine-treated group （P<0.05）. Conclusion The metadoxine combined with nutrition support in treatment of patients with ALD might significantly improve the liver function,erythrocyte and platelet parameters,which needs further and long-term investigation.