复方甘草酸苷联合丁二磺酸腺苷蛋氨酸治疗酒精性肝炎伴胆汁淤积患者疗效研究

目的 探讨应用复方甘草酸苷联合丁二磺酸腺苷蛋氨酸治疗酒精性肝炎(AH)伴胆汁淤积患者的疗效及对患者血清可溶性血管粘附分子 1(sVCAM 1)、磷脂转运蛋白(PLTP)和氧化应激指标的影响。方法 2018年5月~2019年7月我院消化内科收治的114例AH伴胆汁淤积患者,被随机分为对照组57例和观察组57例,分别给予丁二磺酸腺苷蛋氨酸或在此基础上联合应用复方甘草酸苷治疗4周。采用ELISA法检测血清sVCAM 1和PLTP水平,采用硫代巴比妥酸法检测血清丙二醛(MDA),采用比色法检测血清谷胱甘肽过氧化物酶(GST-Px)和采用邻苯三酚法检测血清超氧化物歧化酶(SOD)水平。结果 在治疗结束时,观察组血清TBIL水平为(24.6±6.4)μmol/L,显著低于对照组【(47.6±12.4)μmol/L,P<0.05】,血清丙氨酸氨基转移酶(ALT)水平为(36.1±11.4)U/L,显著低于对照组【(47.6±12.4)U/L,P<0.05】,血清天冬氨酸氨基转移酶(AST)水平为(45.3±14.8)U/L,显著低于对照组【(75.9±19.5)U/L,P<0.05】,血清碱性磷酸酶(ALP)水平为(81.9±21.3)U/L,显著低于对照组【(122.3±35.8)U/L,P<0.05】;血清sVCAM 1水平为(453.3±31.8)ng/mL,显著低于对照组【(573.4±41.2)ng/mL,P<0.05】,血清PLTP水平为(3.6±0.4)pg/mL,显著低于对照组【(4.7±0.6)pg/mL,P<0.05】;血清MDA水平为(23.8±2.8)mmol/L,显著低于对照组【(28.6±2.7)mmol/L,P<0.05】,而血清GST-Px水平为(115.5±8.2)mmol/L,显著高于对照组【(106.7±8.1)mmol/L,P<0.05】,血清SOD水平为(186.3±10.6)U/L,显著高于对照组【(153.7±10.4)U/L,P<0.05】。结论 应用复方甘草酸苷联合丁二磺酸腺苷蛋氨酸治疗酒精性肝炎伴胆汁淤积患者可降低血清sVCAM 1和PLTP水平,抑制机体氧化应激反应,改善和促进肝功能恢复,疗效确切。   

Improvement of liver function and subsiding jaundice by compound glycyrrhizin and adenosylmethionine succinate in the treatment of patients with alcoholic hepatitis

Objective The aim of this study was to investigate the clinical efficacy of compound glycyrrhizin and adenosylmethionine succinate combination in treatment of patients with alcoholic hepatitis(AH)with cholestasis and its influences on serum soluble vascular adhesion molecule 1(sVCAM 1),phospholipid transporter(PLTP)and oxidative stress parameters.Methods 114 patients with AH and hyperbilirubinemia were recruited in Department of Gastroenterology in our hospital,and were divided randomly into observation(n=57)and control group(n=57).The patients in control group was treated with intravenous adenosylmethionine succinate injection,and those in the observation group were treated with compound glycyrrhizin and adenosylmethionine combination for four weeks.Serum sVCAM 1,PLTP,malondialdehyde(MDA),glutathione peroxidase(GST-Px)and superoxide dismutase(SOD)levels were detected.Results At the end of treatment,serum bilirubin level in the observation group was(24.6±6.4)μmol/L,which was significantly lower than(47.6±12.4)μmol/L,P<0.05]in the control group,serum alanine aminotransferase level was(36.1±11.4)U/L,much lower than(47.6±12.4)U/L,P<0.05]in the control group,serum aspartate aminotransferase level was(45.3±14.8)U/L,significantly lower than(75.9±19.5)U/L,P<0.05]in the control,serum alkaline phosphatase level was(81.9±21.3)U/L,significantly lower than(122.3±35.8)U/L in the control;serum sVCAM 1 level was(453.3±31.8)ng/mL,which was significantly lower than(573.4±41.2)ng/mL,P<0.05]in the control,and serum PLTP level was(3.6±0.4)pg/mL,significantly lower than(4.7±0.6)pg/mL,P<0.05]in the control;serum MDA level was(23.8±2.8)mmol/L,much lower than(28.6±2.7)μmmol/L,P<0.05]in the control,while serum GST-Px level was(115.5±8.2)mmol/L,which was significantly higher than(106.7±8.1)mmol/L,P<0.05]and serum SOD level was(186.3±10.6)U/L,significantly higher than(153.7±10.4)U/L,P<0.05]in the control.Conclusion The intravenous administration of compound glycyrrhizin and adenosylmethionine succinate in the treatment of patients with alcoholic hepatitis with intrahepatic cholestasis could improve liver function index normalization and subsiding jaundice,which might be related to the decreased serum sVCAM 1 and PLTP levels,and the inhibition of oxidative stress response,and warrants further investigation.