大剂量腺苷蛋氨酸治疗严重慢性肝病所致高胆红素血症的疗效观察

目的观察大剂量腺苷蛋氨酸对各种原因导致的高胆红素血症的疗效。方法严重慢性肝病患者63例(病毒性肝炎所致肝硬化39例,酒精性肝硬化18例,药物性肝病2例,原发性胆汁性肝硬化4例)。入院时平均血清胆红素水平为195.1 mmol/L,经常规保肝治疗4周后,肝功能无明显改善,胆红素水平升高。在原治疗基础上,加大腺苷蛋氨酸剂量至2.0 g,2次/d静推。每周复查肝功能,以血清总胆红素水平作为主要观察指标。结果 63例患者中,3例乙肝和酒精混合因素的肝硬化在入组治疗不足2周时,因出现消化道大出血而退出观察。60例患者治疗满4周,胆红素水平明显下降,与常规保守治疗后胆红素水平相比,差异有统计学意义(P<0.01)。结论在某些严重肝病所导致的严重高胆红素血症患者,常规保肝治疗效果不佳时,可以尝试大剂量S-腺苷蛋氨酸治疗。

Effect of large doses of ademetionine on hyperbilirubinemia caused by severe chronic liver disease

Objective To observe the effects of high dose ademetionine on hyperbilirubinemia caused by all kinds of causes.Methods 63 cases of severe chronic liver disease(39 cases of viral hepatitis induced liver cirrhosis,18 cases of alcoholic cirrhosis,2 cases of drug induced liver disease,4 cases of primary biliary cirrhosis).At the time of admission,the mean serum bilirubin level was 195.1 mmol/L,and the liver function had no significant improvement after 4 weeks of regular treatment while the bilirubin level was improved.The dose of ademetionine increased to 2.0 g iv.(twice daily) with the basis of original treatment.The liver function was observed weekly with the total serum bilirubin level as the main indicator.Results 3 cases of cirrhosis induced by hepatitis B and alcohol factors dropped out due to massive upper gastrointestinal hemorrhage for less than 2 weeks of treatment.60 cases were treated for 4 weeks,and the total serum bilirubin level decreased,compared with regular treatment(P<0.01).Conclusion Large dose of ademetionine can be attempted in treatment for hyperbilirubinemia induced by some severe liver disease when the effects of conventional treatment is poor.