硫普罗宁联合多烯磷脂酰胆碱治疗酒精性肝病患者疗效及血清TLR4、MD-2和TGF-β1水平变化

目的 探讨应用硫普罗宁联合多烯磷脂酰胆碱治疗酒精性肝病(ALD)患者的疗效及对血清Toll样受体4(TLR4)、髓样分化蛋白-2(MD-2)和转化生长因子-β1(TGF-β1)水平的影响。方法 2018年1月～2019年12月我院收治的104例ALD患者,采用随机数字表法分为观察组52例和对照组52例。给予对照组患者多烯磷脂酰胆碱胶囊口服治疗,观察组则在对照组治疗的基础上予以硫普罗宁片口服治疗,两组均连续治疗3个月。采用 ELISA 法检测血清TLR4、MD-2和TGF-β1水平。结果 在治疗3个月末,观察组血清丙氨酸氨基转移酶(ALT)水平为(34.8±13.9)U/L,显著低于对照组【(73.5±25.1)U/L,P<0.05】,血清天门冬氨酸氨基转移酶(AST)水平为(43.1±14.2)U/L,显著低于对照组【(89.0±28.6)U/L,P<0.05】,血清总胆红素(TBIL)水平为(15.5±9.7)μmol/L,显著低于对照组【(28.3±12.9)μmol/L,P<0.05】,血清谷氨酰转肽酶(GGT)水平为(53.9±14.2)U/L,显著低于对照组【(82.2±29.1)U/L,P<0.05】;血清总胆固醇(TC)水平为(4.1±0.5)mmol/L,显著低于对照组【(5.4±0.7)mmol/L,P<0.05】,甘油三酯(TG)水平为(1.3±0.6)mmol/L,显著低于对照组【(2.7±1.0)mmol/L,P<0.05】,血清高密度脂蛋白胆固醇(HDL-C)水平为(1.2±0.3)mmol/L,显著高于对照组【(1.0±0.4)mmol/L,P<0.05】,血清低密度脂蛋白胆固醇(LDL-C)水平为(3.4±0.9)mmol/L,显著低于对照组【(4.1±1.1)mmol/L,P<0.05】;血清TLR4水平为(3.0±0.6)pg/mL,显著低于对照组【(4.2±1.0)pg/mL,P<0.05】,血清MD-2水平为(415.4±128.5)pg/mL,显著低于对照组【(531.7±145.8)pg/mL,P<0.05】,血清TGF-β1水平为(3.4±1.1)pg/mL,显著低于对照组【(5.8±1.6)pg/mL,P<0.05】。结论 应用硫普罗宁联合多烯磷脂酰胆碱治疗ALD患者近期疗效较好,可能与该联合治疗降低了血清TLR4、MD-2和TGF-β1水平,减轻了肝损伤,改善了血脂代谢紊乱有关。

Short-term efficacy of tiopronin and polyene phosphatidylcholine combination in treatment of patients with alcoholic liver disease

Objective To investigate the short-term efficacy of tiopronin and polyene phosphatidylcholine combination in treatment of patients with alcoholic liver disease(ALD)and its effect on serum toll-like receptor 4(TLR4),myeloid differentiation protein-2(MD-2)and transforming growth factor-β1(TGF-β1)levels.Methods 104 patients with ALD were enrolled in our hospital between January 2018 control group(n=52).The patients in the control group were treated with polyene phosphatidylcholine capsule orally,and those in the observation group were and December 2019,and were randomly divided into observation(n=52)and treated with tiopronin and polyene phosphatidylcholine combination.The treatment in both groups last continuously for 3 months.Serum TLR4,MD-2 and TGF-β1 levels before and after 3 months of treatment were detected by ELISA.Results At the end of three month treatment,serum alanine aminotransferase(ALT)level in the observation group was(34.8±13.9)U/L,much lower than(73.5±25.1)U/L,P<0.05],serum aspartic acid transaminase(AST)level was(43.1±14.2)U/L,significantly lower than(89.0±28.6)U/L,P<0.05],serum total bilirubin(TBIL)level was(15.5±9.7)μmol/L,significantly lower than(28.3±12.9)μmol/L,P<0.05],and serum gamma-glutamyl transpeptidase(GGT)level was(53.9±14.2)U/L,significantly lower than(82.2±29.1)U/L,P<0.05]in the control group;serum total cholesterol(TC)level was(4.1±0.5)mmol/L,much lower than(5.4±0.7)mmol/L,P<0.05],serum triglyceride(TG)level was(1.3±0.6)mmol/L,significantly lower than(2.7±1.0)mmol/L,P<0.05],serum high density lipoprotein cholesterol(HDL-C)was(1.2±0.3)mmol/L,significantly higher than(1.0±0.4)mmol/L,P<0.05],and serum low density lipoprotein cholesterol(LDL-C)level was(3.4±0.9)mmol/L,much lower than(4.1±1.1)mmol/L,P<0.05]in the control;serum TLR4 level was(3.0±0.6)pg/mL,significantly lower than(4.2±1.0)pg/mL,P<0.05],serum MD-2 level was(415.4±128.5)pg/mL,much lower than(531.7±145.8)pg/mL,P<0.05],and serum TGF-β1 level was(3.4±1.1)pg/mL,much lower than(5.8±1.6)pg/mL,P<0.05]in the control.Conclusion The combination of tiopronin and polyene phosphatidylcholine in treatment of patients with ALD is efficacious,which might be related to the reduction of serum TLR4,MD-2 and TGF-β1 levels and alleviation of liver function.