药物性胆汁淤积型肝病的治疗研究

目的探讨药物性胆汁淤积型肝病的有效治疗方案。方法 217例患者符合药物性胆汁淤积型肝损害的诊断标准。分为SAM+H+UDCA组、SAM+H组、SAM+UDCA组、H+UDCA组、中药组。观察各组患者治疗前及治疗4周后的临床症状、体征,检测血清碱性磷酸酶(ALP)、转氨酶(AST、ALT)、总胆红素(TBil)、r-谷氨酰转肽酶(r-GT)、胆碱酯酶(CHE)等生化指标。采用配对设计t检验方法进行统计学分析。结果疗程满4周后,各组临床症状有明显改善,尤其是瘙痒症状评分明显下降。治疗后,各组主要生化指标血清TBil、ALT、AST、ALP、r-GT均下降,CHE升高。其中以血清TBil下降明显,差异有统计学意义(P0.05)。SAM+H+UDCA组和SAM+H组较其他治疗组总胆红素下降速度快、幅度大。但两组之间治疗后TBil水平差异无统计学意义(P0.05);加用激素组随治疗时间延长,使用激素的副作用发生率增加。结论腺苷蛋氨酸与激素联合应用是治疗药物性胆汁淤积型肝病的较好方法,但需注意激素引起的不良反应。

Analysis of treatment in drug-induced cholestasis liver injury

Objective To investigate effective treatment plans of drug-induced cholestasis liver injury. Methods 217 cases of drug-induced eholestasis liver injury were divided into 5 groups in different treatments for 4 weeks, respec- tively, including SAM ＋ H ＋ UDCA group, SAM ＋ H group, SAM ＋ UDCA group, H ＋ UDCA group, and traditional chinese medicine group. Before and after treatment, the symptoms and signs of drug-induced cbolestasis liver injury were evaluated. Moreover, serum samples were collected and ALT, AST, ALP, TBil, r-GT and CHE were analyzed. Paired t-test analysis was performed to estimate the efficacy of different treatments groups. Results After 4-week treat- ment, the symptoms, especially, pruritus in drug-induced cholestasis liver injury of all patients were ameliorated. After treatment, serum TBil, ALT, AST, ALP and r-GT of all groups were decreased, while the serum CHE of all groups was increased. Espeeially, the serum TBil in SAM ＋ H ＋ UDCA group and SAM ＋ H group was decreased faster than that in other groups. However, there was no significant difference in serum level of TBil between SAM ＋ H ＋ UDCA group and SAM ＋ H group （P 〉 0.05）. Furthermore, the hormone could increase the incidence of itself side-effect. Conclusion Combined application of adenosine methionine and hormone is a better method for treatment of drug-induced cholestatic liver disease, but should pay attention to adverse reactions induced by hormone.