N-乙酰半胱氨酸治疗慢加急性肝衰竭的疗效观察

目的：观察N-乙酰半胱氨酸治疗慢加急性肝衰竭的疗效。方法：选取HBV 感染引起的慢加急性肝衰竭（早期）患者60例，随机分为治疗组和对照组，各30 例。两组在常规予以甘草酸制剂保肝、血制品支持、替比夫定抗病毒等治疗的基础上, 治疗组加用N-乙酰半胱氨酸8g慢滴qd，且两组均未给予人工肝治疗。观察两组28天后其临床症状、生化和病毒指标及12周生存情况。结果：①与治疗前相比：两组ALT、HBV-DNA、TB水平均显著下降，PTA显著上升；②治疗后治疗组PTA上升及TB下降程度较对照组差异有统计学意义；③两组均有少量的胸闷反应；治疗组恶心呕吐发生率显著高于对照组，但无显著差异。④12周生存情况比较，治疗组生存率96.7%，对照组90.0%，两组无显著差异。结论：N-乙酰半胱氨酸在替比夫定抗病毒基础上可以较好地用于乙肝病毒感染引起的慢加急性肝衰竭（早期）的治疗。

Therapeutic Effect of N-Acetylcysteine on Acute-on-chronic Liverfailure

Objective: To investigate the efficacy of N-acetylcysteine in the treatment of acute-on-chronic liver failure. Methods: Sixty patients with early stage of acute-on-chronic liver failure were randomly divided into treatment group and control group, 30 cases in each group. On the basis of routine treatment of glycyrrhizic acid preparation for liver protection, blood products support and telbivudine antiviral therapy, patients in the treatment group were given 8 g slow drops of N-acetylcysteine qd. No artificial liver was applied, patients were observed for changes of clinical symptoms, biochemical and viral indexes 28 days later and for 12 week survival rates. Results: (1) Compared with those before treatment, the levels of ALT, HBV-DNA and TB in the two groups decreased significantly, while PTA levels in the two groups increased. (2) The changes of PTA and TB levels after treatment in the two groups have significantly difference. (3) The incidence of nausea and vomiting in the treatment group was significantly higher than that in the control group. There was a small amount of chest tightness in both groups, but there was no significant difference. (4) There was no significant difference in 12 week survival rates between the treatment group (96.7%) and the control group (90.0%). Conclusion: N-acetylcysteine combined with telbivudine can be well used in the treatment of acute-on-chronic liver failure.