脂溶性维生素注射液联合丁二磺酸腺苷蛋氨酸治疗酒精性肝病伴胆汁淤积患者的效果及对血清sVCAM-1、PLTP水平的影响
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摘要
目的探究脂溶性维生素注射液联合丁二磺酸腺苷蛋氨酸治疗酒精性肝病伴肝并胆汁淤积的临床疗效及对患者血清可溶性黏附分子(s VCAM-1)、磷脂转运蛋白(PLTP)水平的影响。方法回顾性选取2016年1月至2017年8月收治的140例酒精性肝病伴胆汁淤积患者,依照治疗方法的不同分成对照组和观察组,每组70例。对照组给予丁二磺酸腺苷蛋氨酸治疗,观察组在对照组基础上给予脂溶性维生素注射液联合治疗。对比两组患者的临床疗效、治疗前后血生化指标、结合胆汁酸(CBA)、血清肝胆酸(CG)、s VCAM-1及PLTP差异及症状改善情况。结果观察组的临床总有效率为92. 9%,显著高于对照组的81. 4%,差异具有统计学意义(P <0. 05)。治疗后,两组患者天冬氨酸氨基转移酶(AST)、总胆汁酸(TBA)、γ-谷氨酰转肽酶(GGT)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、Ⅲ型前胶原(PC-Ⅲ)、血清胆红素(SB)、透明质酸酶(HA)及Ⅳ型胶原蛋白(Ⅳ-C)均显著降低,而白蛋白(Alb)显著升高,且观察组各指标相比于对照组变化更显著(P <0. 05)。治疗后,两组患者CBA、CG、s VCAM-1及PLTP水平均显著降低,且观察组更低于对照组,差异具有统计学意义(P <0. 05)。治疗后,两组多数患者症状消失或减弱,且观察组患者更优于对照组(P <0. 05)。结论脂溶性维生素注射液联合丁二磺酸腺苷蛋氨酸治疗酒精性肝病伴胆汁淤积可明显的改善患者肝功能及胆汁酸的代谢,这可能与联合治疗对血清s VCAM-1、PLTP水平的降低作用有关。
Objective To investigate the clinical effect of liposoluble vitamin injection combined with adenosylmethionine butyrate in the treatment of alcoholic liver disease with cholestasis and its effect on serum soluble adhesion molecule( s VCAM-1) and phospholipid transport protein( PLTP). Methods 140 patients with alcoholic liver disease with cholestasis were selected from January 2016 to August 2017. According to the different treatment methods,the patients were divided into control group and observation group with 70 cases in each group. The control group was treated with adenosylmethionine butylate,and the observation group was treated with fat-soluble vitamin injection on the basis of the control group. The clinical efficacy,blood biochemical indexes,CBA,serum CG,s VCAM-1 and PLTP were compared between the two groups before and after treatment,and the occurrence of adverse reactions were also analyzed. Results The total clinical effective rate of the observation group was 92. 9%,which was significantly higher than that of the control group( 81. 4%). The difference was statistically significant( P < 0. 05). After treatment,two groups of patients with aspartate aminotransferase( AST),total bile acid( TBA),gamma glutamyl transpeptidase( GGT),alanine aminotransferase( ALT),total bilirubin( TBIL),type III procollagen( PC-III),serum bilirubin( SB),hyaluronidase( HA) and type IV collagen( IV-C) were significantly reduced,and albumin( Alb) was significantly increased,and the indexes in observation group were more significant than those in the control group( P < 0. 05). After treatment,the levels of CBAG CGN VCAM-1 and PLTP in the two groups were significantly decreased,and those in the observation group were lower than those in the control group( P < 0. 05). After treatment,the adverse symptoms of most of the patients in the two groups disappeared or weakened,and the patients in the observation group were better than those in the control group( P < 0. 05). Conclusion Fat-soluble vitamin injection combined with adenosylmethionine butyrate can significantly improve liver function and bile acid metabolism in patients with alcoholic liver disease with cholestasis,which may be related to the decrease of serum s VCAM-1,PLTP level.
Objective To investigate the clinical effect of liposoluble vitamin injection combined with adenosylmethionine butyrate in the treatment of alcoholic liver disease with cholestasis and its effect on serum soluble adhesion molecule( s VCAM-1) and phospholipid transport protein( PLTP). Methods 140 patients with alcoholic liver disease with cholestasis were selected from January 2016 to August 2017. According to the different treatment methods,the patients were divided into control group and observation group with 70 cases in each group. The control group was treated with adenosylmethionine butylate,and the observation group was treated with fat-soluble vitamin injection on the basis of the control group. The clinical efficacy,blood biochemical indexes,CBA,serum CG,s VCAM-1 and PLTP were compared between the two groups before and after treatment,and the occurrence of adverse reactions were also analyzed. Results The total clinical effective rate of the observation group was 92. 9%,which was significantly higher than that of the control group( 81. 4%). The difference was statistically significant( P < 0. 05). After treatment,two groups of patients with aspartate aminotransferase( AST),total bile acid( TBA),gamma glutamyl transpeptidase( GGT),alanine aminotransferase( ALT),total bilirubin( TBIL),type III procollagen( PC-III),serum bilirubin( SB),hyaluronidase( HA) and type IV collagen( IV-C) were significantly reduced,and albumin( Alb) was significantly increased,and the indexes in observation group were more significant than those in the control group( P < 0. 05). After treatment,the levels of CBAG CGN VCAM-1 and PLTP in the two groups were significantly decreased,and those in the observation group were lower than those in the control group( P < 0. 05). After treatment,the adverse symptoms of most of the patients in the two groups disappeared or weakened,and the patients in the observation group were better than those in the control group( P < 0. 05). Conclusion Fat-soluble vitamin injection combined with adenosylmethionine butyrate can significantly improve liver function and bile acid metabolism in patients with alcoholic liver disease with cholestasis,which may be related to the decrease of serum s VCAM-1,PLTP level.
引文
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[14]吴晓乐,杨丹,毛朝亮,等.磷脂转移蛋白在人冠状动脉粥样硬化中的表达与动脉粥样硬化的关系[J].临床心血管病杂志,2015,31(1):46-49.
[15]李振,宋国华,肖强,等.高密度脂蛋白对脂肪细胞腺苷酸激活蛋白激酶的调节作用[J].生物化学与生物物理进展,2015,42(9):804-809.
[2]陈艳,辛隽.丁二磺酸腺苷蛋氨酸联合扶正化瘀胶囊治疗乙型肝炎病毒肝硬化的临床观察[J].中国药房,2015,26(15):2082-2084.
[3]陈有维,唐娟,何乐愚,等.血清PCT与s ICAM-1和s VCAM-1在慢性肾炎患者细菌感染中的应用[J].中华医院感染学杂志,2017,27(19):4359-4362.
[4]秦树存,于杨,赵亚南,等.磷脂转运蛋白在高密度脂蛋白代谢和胆固醇逆向转运中的生物学作用[J].中国动脉硬化杂志,2015,23(12):1210-1214.
[5]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[J].中华肝脏病杂志,2006,14(3):164-166.
[6]中华医学会肝病学分会中华医学会消化病学分会中华医学会感染病学分会.胆汁淤积性肝病诊断和治疗共识(2015)[J].临床肝胆病杂志,2015,31(12):1989-1999.
[7]Mikkelsen MR,Hendriksen C,Schidt FV,et al.Coping and rehabilitation in alcoholic liver disease patients after hepatic encephalopathyin interaction with professionals and relatives[J].J Clin Nurs,2015,24(23-24):3627-3637.
[8]Childers RE,Ahn J.Diagnosis of Alcoholic Liver Disease:Key Foundations and New Developments[J].Clin Liver Dis,2016,20(3):457-471.
[9]Grabherr F,Grander C,Adolph TE,et al.Ethanol-mediated suppression of IL-37 licenses alcoholic liver disease[J].Liver Int,2018,38(6):1095-1101.
[10]李莉霞,杜隽铭,陆晓彤.围产期危重症患者药物治疗分析与药学监护[J].中国药房,2017,28(11):1561-1566.
[11]Ivashkin VT,Maevskaya MV,Kobalava ZD,et al.Open-label study of ademetionine for the treatment of intrahepatic cholestasis associated with alcoholic liver disease[J].Minerva Gastroenterol Dietol,2018,64(3):208-219.
[12]Wang JL,Li P,Jiang Z,et al.Diagnostic value of alcoholic liver disease(ALD)/nonalcoholic fatty liver disease(NAFLD)index combined withγ-glutamyl transferase in differentiating ALD and NAFLD[J].Korean J Intern Med,2016,31(3):479-487.
[13]张锋.益肝退黄汤联合脂溶性维生素治疗酒精性肝病伴肝内胆汁淤积疗效及对血清甘胆酸、结合胆汁酸和s VCAM-1水平的影响[J].现代中西医结合杂志,2017,26(30):3365-3367.
[14]吴晓乐,杨丹,毛朝亮,等.磷脂转移蛋白在人冠状动脉粥样硬化中的表达与动脉粥样硬化的关系[J].临床心血管病杂志,2015,31(1):46-49.
[15]李振,宋国华,肖强,等.高密度脂蛋白对脂肪细胞腺苷酸激活蛋白激酶的调节作用[J].生物化学与生物物理进展,2015,42(9):804-809.