腺苷蛋氨酸联合熊去氧胆酸治疗早产儿肠外营养相关性胆汁淤积疗效观察

目的:探讨腺苷蛋氨酸(SAME)联合熊去氧胆酸(UDCA)治疗早产儿肠外营养相关性胆汁淤积(PNAC)的疗效.方法:32例PNAC患儿随机分为治疗组与对照组各16倒,两组病例均予保肝及基础治疗,治疗组在此基础上加用腺苷蛋氨酸30～60 mg/(ks·d)和熊去氧胆酸10 ～20 mg/( ks·d),连续应用14 d为1个疗程.检测两组患儿治疗前后血清中总胆红素(TBIL)、结合胆红素(DBIL)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆汁酸(TBA)水平.结果:采用SAME联合UDCA治疗2周后,治疗组患儿血清中TBIL、DBIL、ALT、GGT、TBA与对照组比较均显著降低(P＜0.01),肝脏明显缩小(P＜0.01).两组均未见明显药物不良反应.结论:SAME联合联合UDCA能降低血清胆红素及内源性胆汁酸水平,可促进胆红素、TBA排泄,具有明显的利胆、退黄的疗效,是有效和安全的.

Clinical Study of s-Adenosyl Methionine Combined with Ursodeoxycholic Acid in Preterm Infants with Parenteral Nutrition-associated Cholestasis

Objective: To explore the curative effect and safety of s-adenosyl methionine(SAME) combined with ursodeoxycholic acid(UDCA) on parenteral nutrition-associated cholestasis(PNAC) in preterm infants.Methods: Thirty two preterm infants with PNAC were randomly divided into two groups: treatment group(16 cases) received SAME [30~60 mg/(kg·d)] and UDCA [10~20 mg/(kg·d)] on the basis of conventional treatment for 14 days;control group(16 cases) received conventional treatment only.The level of serum total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),γ-glutamyl transpeptidase(GGT),and total bile acid(TBA) were measured before and after treatment.Results: The levels of serum TBIL,DBIL,ALT,GGT,TBA were significantly lower in treatment group than those in control group after treatment(P<0.01).The size of liver significantly decreased in treatment group compared with that in control group after treatment(P<0.01).There was no significant difference in side effects between two groups.Conclusions: SAME combined with UDCA exerts definite therapeutic effects on PNAC in preterm infants,which is better than the effect of conventional treatment.