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

doi:10.3969/j.issn.1672-5069.2020.03.009

摘要/Abstract

摘要： 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。

关键词: 慢性乙型肝炎, 重度, N-乙酰半胱氨酸, 细胞因子, 治疗 , ,

Abstract: 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 , while total serum bilirubin level were (85.1±54.6)μmol/L, much lower than 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 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 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.

Key words: Hepatitis B, Hyperbilirubinemia, N-acetylcysteine, Cytokines, Therapy

艾国,王鸣,朱纪玲,邢铭友. 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[J]. 实用肝脏病杂志, 2020, 23(3): 336-339.

Ai Guo, Wang Ming, Zhu Jiling, et al.. Preliminary study on the clinical efficacy of N-acetylcysteine in the treatment of patients with chronic icteric hepatitis B[J]. Journal of Practical Hepatology, 2020, 23(3): 336-339.

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