应用N-乙酰半胱氨酸治疗慢性乙型肝炎重度患者临床疗效初步研究

目的 探讨应用注射用 N-乙酰半胱氨酸(NAC)治疗慢性乙型肝炎重度患者的临床疗效。方法 2015年1月～2018年12月我院诊治的慢性乙型肝炎重度患者62例,被分为观察组32例和对照组30例。在对照组,给予护肝、降黄、抗病毒等综合治疗,观察组在对照组治疗的基础上加用NAC静脉滴注,连续治疗6 w。采用放射免疫法检测血清Ⅲ型前胶原(PC-Ⅲ)、IV型胶原(IV-C)、血清透明质酸(HA)和层黏连蛋白(LN)]水平,采用ELISA法检测血清白介素-1β(IL-1β)、IL-6、IL-8和肿瘤坏死因子-α(TNF-α)水平。结果 在治疗6 w末,观察组血清ALT和AST水平分别为(45.4±2.9)U/L和(74.3±8.7)U/L,与对照组比较无显著性差异,观察组血清TBIL水平为(85.1±54.6)μmol/L,显著低于对照组;观察组血清PC-Ⅲ、IV-C、HA和LN水平分别为(87.1±15.8)μg/L、(74.5±15.2)μg/L 、(95.7±13.7)μg/L和(83.9±16.5)μg/L,显著低于对照组;观察组血清IL-6、IL-8和TNF-α水平分别为(15.1±2.8)μg/L、(5.2±2.9)μg/L和(13.7±0.9) μg/L,显著低于对照组;观察组病情控制率为87.1%,显著高于对照组。结论 应用NAC治疗慢性乙型肝炎重度患者临床疗效显著且无明显的不良反应,能降低血清胆红素和肝纤维化指标水平,减轻炎症相关的细胞因子水平。

Preliminary study on the clinical efficacy of N-acetylcysteine in the treatment of patients with chronic icteric hepatitis B

Objective The purpose of this study was to investigate the clinical efficacy of N-acetylcysteine(NAC) in the treatment of patients with chronic icteric hepatitis B. Methods A total of 62 patients with chronic hepatitis B(CHB) and hyperbilirubinemia were recruited in our hospital between January 2015 and December 2018,and they were randomly divided into observation(n = 32) and control group(n = 30). The patients in the control group were treated with comprehensive supporting treatment,such as liver protection,jaundice reduction,immune regulation and anti-viral therapy,and the patients in the observation group were treated with intravenous infusion of NAC at dose of 8.0 g daily on the basis of treatment in the control group for six weeks. Serum Ⅲ type collagen(PC-Ⅲ),type Ⅳ collagen(Ⅳ-C),hyaluronic acid(HA),laminin(LN) ] levels were detected by radioimmunoassay,and serum interleukin-1 beta(IL-1β),IL-6,IL-8 and tumor necrosis factor alpha(TNF-α) ]were assayed by ELISA. Results At the end of six week treatment,serum ALT and AST levels in the observation group were(45.4±2.9) U/L and(74.3±8.7) U/L,not significantly different as compared to (54.0±3.9) U/L and(83.6±12.1) U/L,P>0.05],while total serum bilirubin level were(85. 1 ± 54. 6) μmol/L,much lower than (172. 4 ± 66. 3) μmol/L,P < 0. 05] in the control;serum PC-Ⅲ,Ⅳ-C,HA and LN levels were(87.1±15.8) μg/L,(74.5±15.2) μg/L,(95.7±13.7) μg/L and(83.9±16.5) μg/L,significantly lower than (122.1±14.3) μg/L,(95.6±12.6) μg/L,(153. 1 ± 18. 0) μg/L and(132. 6 ± 10. 1) μg/L,respectively,P<0.05] in the control;serum IL-6,IL-8 and TNF-α levels were(15. 1 ± 2. 8) μg/L,(5. 2 ± 2.9) μg/L and(13.7±0.9) μg/L,significantly lower than (32.95±6.2) μg/L,(10.5±3.4) μg/L and(23.9±3.4) μg/L,respectively,P<0.05] in the control;the disease control rate in the observation was 87.1%,much higher than 64. 3%(P < 0.05) in the control.Conclusion The application of NAC in the treatment of patients with chronic icteric hepatitis B is efficacious and safe,which might decrease serum bilirubin levels and alleviate liver fibrosis.