前列地尔联合水飞蓟宾对老年肝硬化病人疗效、纤维化指标及炎症因子水平的影响
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摘要
目的探讨前列地尔与水飞蓟宾联合用药治疗老年肝硬化病人的临床疗效及对病人纤维化指标、炎症因子水平的影响。方法选取2015年12月至2017年5月我院收治的年龄>60岁的肝硬化老年病人90例,按照随机数字表法分为对照组与观察组,每组各45例。对照组在常规治疗基础上给予前列地尔治疗,观察组在对照组治疗基础上给予水飞蓟宾治疗。检测治疗前后对2组病人肝脏酶学指标、纤维化指标及炎症因子水平进行比较分析,并比较2组治疗后的临床疗效。结果观察组临床疗效明显优于对照组(P<0. 05)。治疗后2组病人血清中丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰基转移酶(GGT)、层粘连蛋白(LN)、透明质酸酶(HA)、Ⅲ型前胶原(PC-Ⅲ)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子α(TNF-α)水平均明显降低;且观察组下调趋势较对照组明显,差异均有统计学意义(P<0. 05)。结论前列地尔与水飞蓟宾联合用药对老年肝硬化具有较好的临床疗效,可明显恢复病人肝功能,改善病人纤维化情况,并缓解炎症状态。
Objective To investigate the clinical efficacy of alprostadil combined with silybin in the treatment of the elderly patients with cirrhosis and the influence on liver fibrosis index and inflammatory factors. Methods A total of 90 patients with cirrhosis aged over 60 years old admitted to our hospital from December 2015 to May 2017 were randomly divided into control group and observation group,with 45 cases in each group. The control group was treated with alprostadil on the basis of routine treatment,and the observation group was treated with silybin on the basis of the control group. The clinical efficacy and liver function index such as alanine aminotrans ferase( ALT),aspartale amino transferase( AST),gamma-glutamyyl transferase( GGT) after treatment were compared between the two groups. The levels of serum laminin( LN),hyaluronidase( HA),procollagen Ⅲ( PC-Ⅲ),interleukin 6( IL-6),high-sensitivity C-reactive protein( hs-CRP) and tumor necrosis factor α( TNF-α) were detected and compared between the two groups before and after treatment. Results After treatment,the clinical efficacy of the observation group was better than that of the control group( P<0. 05). After treatment,the serum levels of ALT,AST,GGT,LN,HA,PC-Ⅲ,IL-6,hs-CRP and TNF-α in the two groups were significantly decreased,especially in the observation group( P< 0. 05). Conclusions The combination of alprostadil and silibinin has a good clinical effect on elderly patients with cirrhosis. It can obviously restore the liver function,improve the fibrosis and relieve the inflammatory state of the patients.
Objective To investigate the clinical efficacy of alprostadil combined with silybin in the treatment of the elderly patients with cirrhosis and the influence on liver fibrosis index and inflammatory factors. Methods A total of 90 patients with cirrhosis aged over 60 years old admitted to our hospital from December 2015 to May 2017 were randomly divided into control group and observation group,with 45 cases in each group. The control group was treated with alprostadil on the basis of routine treatment,and the observation group was treated with silybin on the basis of the control group. The clinical efficacy and liver function index such as alanine aminotrans ferase( ALT),aspartale amino transferase( AST),gamma-glutamyyl transferase( GGT) after treatment were compared between the two groups. The levels of serum laminin( LN),hyaluronidase( HA),procollagen Ⅲ( PC-Ⅲ),interleukin 6( IL-6),high-sensitivity C-reactive protein( hs-CRP) and tumor necrosis factor α( TNF-α) were detected and compared between the two groups before and after treatment. Results After treatment,the clinical efficacy of the observation group was better than that of the control group( P<0. 05). After treatment,the serum levels of ALT,AST,GGT,LN,HA,PC-Ⅲ,IL-6,hs-CRP and TNF-α in the two groups were significantly decreased,especially in the observation group( P< 0. 05). Conclusions The combination of alprostadil and silibinin has a good clinical effect on elderly patients with cirrhosis. It can obviously restore the liver function,improve the fibrosis and relieve the inflammatory state of the patients.
引文
[1]马维兰,康海虎,马正军.老年肝硬化病人凝血四项与抗凝血酶Ⅲ、D-二聚体的水平变化及意义[J].实用老年医学,2017,31(9):879-880.
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[4]王忠琼,刘翼,夏国栋,等.前列地尔对乙肝肝硬化患者血清炎性因子及肝功能的影响[J].医学研究生学报,2017,30(6):611-614.
[5]Asgarshirazi M,Shariat M,Sheikh M.Comparison of efficacy of folic acid and silymarin in the management of antiepileptic drug induced liver injury:a randomized clinical trial[J].Hepatobiliary Pancreat Dis Int,2017,16(3):296-302.
[6]Jalali SM,Najafzadeh H,Bahmei S.Protective role of silymarin and D-penicillamine against lead-induced liver toxicity and oxidative stress[J].Toxicol Ind Health,2017,33(6):512-518.
[7]韩怡,胡乃中.还原型谷胱甘肽联合水飞蓟宾治疗肝硬化的临床观察[J].中国药房,2016,27(9):1200-1202.
[8]Brcena R,Moreno A,Rodríguez GMA,et al.Safety and anti-HCV effect of prolonged intravenous silibinin in HCVgenotype 1 subjects in the immediate liver transplant period[J].J Hepatol,2013,58(3):421-426.
[9]黄静.水飞蓟宾通过Wnt/β-catenin信号通路对酒精性肝纤维化模型大鼠的保护作用机制的实验研究[D].安徽中医药大学,2016.
[10]周克,付荣泉,丁继光,等.恩替卡韦联合水飞蓟宾对乙型肝炎肝硬化患者肝纤维化指标的影响研究[J].现代实用医学,2016,28(6):743-746.
[11]Beinhardt S,Rasoul RS,Scherzer TM,et al.Silibinin monotherapy prevents graft infection after orthotopic liver transplantation in a patient with chronic hepatitis C[J].JHepatol,2011,54(3):591-592.
[2]Fathalah WF,Abdel Aziz MA,Abou El Soud NH,et al.High dose of silymarin in patients with decompensated liver disease:A Randomized Controlled Trial[J].J Interferon Cytokine Res,2017,37(11):480-487.
[3]de Avelar CR,Pereira EM,de Farias Costa PR,et al.Effect of silymarin on biochemical indicators in patients with liver disease:Systematic review with meta-analysis[J].World J Gastroenterol,2017,23(27):5004-5017.
[4]王忠琼,刘翼,夏国栋,等.前列地尔对乙肝肝硬化患者血清炎性因子及肝功能的影响[J].医学研究生学报,2017,30(6):611-614.
[5]Asgarshirazi M,Shariat M,Sheikh M.Comparison of efficacy of folic acid and silymarin in the management of antiepileptic drug induced liver injury:a randomized clinical trial[J].Hepatobiliary Pancreat Dis Int,2017,16(3):296-302.
[6]Jalali SM,Najafzadeh H,Bahmei S.Protective role of silymarin and D-penicillamine against lead-induced liver toxicity and oxidative stress[J].Toxicol Ind Health,2017,33(6):512-518.
[7]韩怡,胡乃中.还原型谷胱甘肽联合水飞蓟宾治疗肝硬化的临床观察[J].中国药房,2016,27(9):1200-1202.
[8]Brcena R,Moreno A,Rodríguez GMA,et al.Safety and anti-HCV effect of prolonged intravenous silibinin in HCVgenotype 1 subjects in the immediate liver transplant period[J].J Hepatol,2013,58(3):421-426.
[9]黄静.水飞蓟宾通过Wnt/β-catenin信号通路对酒精性肝纤维化模型大鼠的保护作用机制的实验研究[D].安徽中医药大学,2016.
[10]周克,付荣泉,丁继光,等.恩替卡韦联合水飞蓟宾对乙型肝炎肝硬化患者肝纤维化指标的影响研究[J].现代实用医学,2016,28(6):743-746.
[11]Beinhardt S,Rasoul RS,Scherzer TM,et al.Silibinin monotherapy prevents graft infection after orthotopic liver transplantation in a patient with chronic hepatitis C[J].JHepatol,2011,54(3):591-592.