还原型谷胱甘肽在老年慢性肺心病急性加重期肝损害患者中的应用

目的探讨还原型谷胱甘肽(GSH)对老年慢性肺心病患者急性加重期肝损害的作用.方法 66例60岁以上老年慢性肺心病急性加重期肝损害患者随机分为两组.所有入选患者采用慢性肺心病急性加重期常规方案治疗.对照组(n=31)护肝采用静脉滴注肌苷1.0g,维生素C 2.0g和门冬氨酸钾镁20mL,1次/d,连用2周.治疗组(n=35)护肝采用GSH1.2g经静脉输入,2次/d,连用2周.同时监测治疗前后肝功能指标血丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、总胆汁酸(TBA)、白蛋白(ALB)、凝血酶原时间(PT)及child-push评分并进行对照比较.结果治疗组较对照组在慢性肺心病急性加重期肝损害的肝功能复常方面显示更为良好的治疗效应,ALT,AST,TBIL,TBA和child-push评分改善明显好于对照组(P均＜0.01);治疗组30d内急性肾功能衰竭的发生率低于对照组(P＜0.05);PT,ALB,出院时的死亡率和30d内多脏器功能障碍综合征(MODS)发生率两组比较无显著性差异(P均＞0.05).结论 GSH治疗老年慢性肺心病急性加重期患者肝损害是有效的和安全的.在慢性肺心病常规方案治疗的基础上应用GSH对老年慢性肺心病急性加重期患者肝损害具有一定的改善作用,其疗效优于常规护肝治疗.

Application of reduced glutathione in the elderly with hepatic dysfunction induced by acute exacerbation of chronic cor pulmonale

OBJECTIVE To investigate the effect of r ed uced glutathione (GSH) on the hepatic dysfunction induced by acute exacerbation of chronic cor pulmonale in the elderly.METHOD A total of 66 patients aged 60 years or older with hepat ic dysfunction following acute exacerbation of chronic cor pulmonale were random ly divided into 2 groups. All patients received conventional basic therapy for a cute exacerbation of chronic cor pulmonale. The control group (n=31) receive d intravenous inosine 1.0g, vitamin C 2.0g, and kali magnesii aspartatis 20mL on ce daily for 2 weeks. The GSH group (n=35) received intravenous GSH 1.2g q12 h for 2 weeks. The protective effect against hepatic damage was evaluated by mea suring alanine aminotransferase (ALT), aspartate transaminase (AST), total bilir ubin (TBIL), total bile acid (TBA), albumin (ALB), prothrombin time (PT) and chi ld-pugh score at admission and after treatment.RESULTS The GSH group was superior to the control group in the improvements of hepatic function and symptom. The improvements of ALT, AST, TBIL , TBA and child-pugh score in the GSH group were significantly better than thos e in the control group (P<0.01). The 30-day incidence of acute renal failur e in the GSH group was lower than that in the control group (P<0.05). There were no statistical differences in the ALB, PT, mortality at discharge and 30-d ay incidence of multiple organ dysfunction syndrome (MODS) between the 2 groups (P>0.05).CONCLUSION GSH is an effective and safe treatment for hepatic d ysfunction induced by acute exacerbation of chronic cor pulmonale in the elderly . The efficacy of GSH is superior to that of conventional treatment for hepatic dysfunction on the basis of controlling infection, improving hypoxemia and hyper capnia and treating the right heart failure.