营养支持联合美他多辛治疗酒精性肝病患者肝功能和外周血细胞参数的变化
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摘要
目的探讨营养支持联合美他多辛治疗酒精性肝病患者对肝功能、红细胞和血小板参数的影响。方法2015年5月～2017年10月我院诊治的酒精性肝病患者90例,被分为两组,每组45例,分别给予美他多辛片或美他多辛联合营养支持治疗4周,后者为给予35～40 kcat·kg~(-1)·d~(-1)的热量。结果治疗前,两组肝功能指标差异无统计学意义(P>0.05),治疗结束时,两组血清ALT、GGT和TBIL水平明显降低,ALB明显升高;治疗前,两组凝血功能指标差异无统计学意义(P>0.05),治疗后两组PT、APTT和TT均明显缩短,FIB显著升高;治疗前,两组红细胞参数和血红蛋白水平差异无统计学意义(P>0.05),治疗后两组RBC、HGB和HCT均显著上升,RDW和MCV显著下降;治疗前,两组血小板计数(PLT)、血小板平均体积(MPV)和血小板分布宽度(PDW)相比无统计学差异(P>0.05),治疗后PLT显著上升,MPV和PDW明显降低(P<0.05),联合组以上变化均显著优于对照组(P<0.05)。结论营养支持联合美他多辛治疗酒精性肝病患者能够显著改善肝功能、凝血功能、红细胞和血小板参数,提示营养支持治疗可能更重要,需要高度重视。
Objective To explore the impact of nutrition support and medusa administration on liver function,erythrocyte and platelet parameters in patients with alcoholic liver diseases(ALD). Methods 90 patients with ALD were recruited in our hospital between May 2015 and October 2017,and they were divided into two groups with 45 cases in each group. All the patients were given glutathione,portuguese aldehyde lactone intravenously and 45 patients were treated with metadoxine,while another 45 were treated with combination of metadoxine and nutritional support at 35～40 kcat·kg~(-1)·d~(-1). The regimen lasted for four weeks. Results At presentation,serum liver function and blood coagulation function index in the two groups were not statistically significantly different(P>0.05),while serum ALT,GGT and bilirubin levels at the end of the treatment in the two groups significantly decreased and coagulation function improved;before the treatment,the red blood cell parameters,including RBC counts,HBG levels,HCT,RDW and MCV in the two groups had no statistically significantly differen(tP>0.05),while at the end of the treatment,the RBC counts,HBG and HCT in the two groups were significantly increased,e.g(.3.45±0.46)×10~(12)/L vs.(5.32±0.51)×10~(12)/L,(90.12±3.67) g/L vs.(140.92±6.02) g/L,(0.32±0.12)% vs.(0.46±0.11) % in the combination group,and(3.44±0.42)×10~(12)/L vs.(4.96 ±0.48)×10~(12)/L,(89.92 ±3.54)g/L vs.(135.67±6.23) g/L,(0.32±0.10)% vs.(0.41±0.10) % in metadoxine-treated group,and MCV and RDW decreased,e.g.(19.34±1.92)% vs.(12.43±1.21)% and(109.24±6.34)fL vs.(95.19±5.92) fL in the combination,and(19.15±1.89)% vs.(14.91±1.19)% and(109.01±6.45)fL vs.(99.43±6.42)fL in the metadoxine-treated group(P<0.05);Before the treatment,the platelet parameters,such as PLT counts,MPV and PDW had no statistically significantly different(P >0.05),and at the end of the treatment,the platelet counts significantly increased in the two groups,e.g.(98.43 ±10.02)×10~9/L vs.(219.04±9.78)×10~9/L in the combination group,an(98.68 ±10.13)×10~9/L vs.(200.43 ±10.24)×10~9/L in metadoxine-treated group(P<0.05),while the MPV and PDW decreased obviously,e.g(.12.74±2.02) fL vs(.10.76±1.13) fL and(17.93±2.01) fL vs.(14.28±1.45) fL in the combination group,and(12.84±2.11) fL vs(.11.63±1.02)fL,and(17.87±1.98) f L vs.(15.89±1.51) f L in metadoxine-treated group(P<0.05);All the improvements above in combination group were significantly superior to those in metadoxine-treated group(P<0.05). Conclusion The metadoxine combined with nutrition support in treatment of patients with ALD might significantly improve the liver function,erythrocyte and platelet parameters,which needs further and long-term investigation.
Objective To explore the impact of nutrition support and medusa administration on liver function,erythrocyte and platelet parameters in patients with alcoholic liver diseases(ALD). Methods 90 patients with ALD were recruited in our hospital between May 2015 and October 2017,and they were divided into two groups with 45 cases in each group. All the patients were given glutathione,portuguese aldehyde lactone intravenously and 45 patients were treated with metadoxine,while another 45 were treated with combination of metadoxine and nutritional support at 35～40 kcat·kg~(-1)·d~(-1). The regimen lasted for four weeks. Results At presentation,serum liver function and blood coagulation function index in the two groups were not statistically significantly different(P>0.05),while serum ALT,GGT and bilirubin levels at the end of the treatment in the two groups significantly decreased and coagulation function improved;before the treatment,the red blood cell parameters,including RBC counts,HBG levels,HCT,RDW and MCV in the two groups had no statistically significantly differen(tP>0.05),while at the end of the treatment,the RBC counts,HBG and HCT in the two groups were significantly increased,e.g(.3.45±0.46)×10~(12)/L vs.(5.32±0.51)×10~(12)/L,(90.12±3.67) g/L vs.(140.92±6.02) g/L,(0.32±0.12)% vs.(0.46±0.11) % in the combination group,and(3.44±0.42)×10~(12)/L vs.(4.96 ±0.48)×10~(12)/L,(89.92 ±3.54)g/L vs.(135.67±6.23) g/L,(0.32±0.10)% vs.(0.41±0.10) % in metadoxine-treated group,and MCV and RDW decreased,e.g.(19.34±1.92)% vs.(12.43±1.21)% and(109.24±6.34)fL vs.(95.19±5.92) fL in the combination,and(19.15±1.89)% vs.(14.91±1.19)% and(109.01±6.45)fL vs.(99.43±6.42)fL in the metadoxine-treated group(P<0.05);Before the treatment,the platelet parameters,such as PLT counts,MPV and PDW had no statistically significantly different(P >0.05),and at the end of the treatment,the platelet counts significantly increased in the two groups,e.g.(98.43 ±10.02)×10~9/L vs.(219.04±9.78)×10~9/L in the combination group,an(98.68 ±10.13)×10~9/L vs.(200.43 ±10.24)×10~9/L in metadoxine-treated group(P<0.05),while the MPV and PDW decreased obviously,e.g(.12.74±2.02) fL vs(.10.76±1.13) fL and(17.93±2.01) fL vs.(14.28±1.45) fL in the combination group,and(12.84±2.11) fL vs(.11.63±1.02)fL,and(17.87±1.98) f L vs.(15.89±1.51) f L in metadoxine-treated group(P<0.05);All the improvements above in combination group were significantly superior to those in metadoxine-treated group(P<0.05). Conclusion The metadoxine combined with nutrition support in treatment of patients with ALD might significantly improve the liver function,erythrocyte and platelet parameters,which needs further and long-term investigation.
引文
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[13]Allam MM,El Gazzar WB.Exendin-4,a glucagon-like peptide-1receptor agonist downregulates hepatic receptor for advanced glycation end products in non-alcoholic steatohepatitis rat model.Arch Physiol Bioch,2018,124(1):10-17.
[14]Pelegrina A,MartíJ,Miquel R,et al.Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy:“a note of caution”.World J Surg Oncol,2017,15(1):224.
[15]Tecer D,Sezgin M Kanik A,et al.Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis.Biomark Med,2016,10(9):967-974.
[16]王迎春,孔维宗.酒精性肝病的营养支持.实用肝脏病杂志,2014,17(5):456-458.
[17]Wang J,Yan X,Yang Y,et al.A novel predictive model using routinely clinical parameters to predict liver fibrosis in patients with chronic hepatitis B.Oncotarget,2017,8(35):59257.
[18]Xu WS,Qiu XM,Ou Q,et al.Red blood cell distribution width levels correlate with liver fibrosis and inflammation:a noninvasive serum marker panel to predict the severity of fibrosis and inflammation in patients with hepatitis B.Medicine,2015,94(10):e612.
[19]Honda F,Hiramatsu A,Hyogo H,et al.Evaluation of glycemic variability in chronic liver disease patients with type 2diabetes mellitus using continuous glucose monitoring.Plos One,2018,13(4):e0195028.
[2]邹正升,赵军,王晓霞,等.住院的酒精性肝病患者临床疾病特点分析.实用肝脏病杂志,2014,17(1):26-29.
[3]Louvet A,Mathurin P.Alcoholic liver disease:mechanisms of injury and targeted treatment.Nat Rev Gastroenterol Hepatol,2015,12(4):231.
[4]焦栓林,赵晓蕊,欧阳洪,等.自体骨髓间充质干细胞联合促肝细胞生长素治疗失代偿期酒精性肝硬化疗效分析.实用肝脏病杂志,2017,20(6):773-774.
[5]Pavlov C,Casazza G,Nikolova D,et al.Transient elastography for diagnosis of stages of hepatic fibrosis and cirrhosis in people with alcoholic liver disease.Cochrane Db Syst Rev,2015,2015(1):1-81.
[6]Mathurin P,Bataller R.Trends in the management and burden of alcoholic liver disease.J Hepatol,2015,62(1S):S38-S46.
[7]Song X,Liu Z,Zhang J,et al.Anti-inflammatory and hepatoprotective effects of exopolysaccharides isolated from pleurotus geesteranus on alcohol-induced liver injury.Sci Rep UK,2018,8(1):10493.
[8]中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年修订版).中华肝脏病杂志,2010,18(3):167-170.
[9]张敏.重症酒精性肝炎与肝移植.实用肝脏病杂志,2014,17(1):12-14.
[10]中华医学会.临床诊疗指南.肠外肠内营养学分册.北京:人民卫生出版社,2010:408-4l1.
[11]Chen P,Starkel P,Turner JR,et al.Dysbiosi-induced intestinal inflammation activates tumor necrosis factor receptor I and mediates alcoholic liver disease in mice.Hepatology,2015,61(3):883-894.
[12]Nojkov B,Cappell MS.Distinctive aspects of peptic ulcer disease,Dieulafoy's lesion,and Mallory-Weiss syndrome in patients with advanced alcoholic liver disease or cirrhosis.World J Gastroenterol,2016,22(1):446.
[13]Allam MM,El Gazzar WB.Exendin-4,a glucagon-like peptide-1receptor agonist downregulates hepatic receptor for advanced glycation end products in non-alcoholic steatohepatitis rat model.Arch Physiol Bioch,2018,124(1):10-17.
[14]Pelegrina A,MartíJ,Miquel R,et al.Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy:“a note of caution”.World J Surg Oncol,2017,15(1):224.
[15]Tecer D,Sezgin M Kanik A,et al.Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis.Biomark Med,2016,10(9):967-974.
[16]王迎春,孔维宗.酒精性肝病的营养支持.实用肝脏病杂志,2014,17(5):456-458.
[17]Wang J,Yan X,Yang Y,et al.A novel predictive model using routinely clinical parameters to predict liver fibrosis in patients with chronic hepatitis B.Oncotarget,2017,8(35):59257.
[18]Xu WS,Qiu XM,Ou Q,et al.Red blood cell distribution width levels correlate with liver fibrosis and inflammation:a noninvasive serum marker panel to predict the severity of fibrosis and inflammation in patients with hepatitis B.Medicine,2015,94(10):e612.
[19]Honda F,Hiramatsu A,Hyogo H,et al.Evaluation of glycemic variability in chronic liver disease patients with type 2diabetes mellitus using continuous glucose monitoring.Plos One,2018,13(4):e0195028.