硫普罗宁联合多烯磷脂酰胆碱治疗酒精性肝病患者疗效及血清TLR4、MD-2和TGF-β1水平变化

doi:10.3969/j.issn.1672-5069.2021.01.018

摘要/Abstract

摘要： 目的探讨应用硫普罗宁联合多烯磷脂酰胆碱治疗酒精性肝病(ALD)患者的疗效及对血清Toll样受体4(TLR4)、髓样分化蛋白-2(MD-2)和转化生长因子-β1(TGF-β1)水平的影响。方法 2018年1月～2019年12月我院收治的104例ALD患者,采用随机数字表法分为观察组52例和对照组52例。给予对照组患者多烯磷脂酰胆碱胶囊口服治疗,观察组则在对照组治疗的基础上予以硫普罗宁片口服治疗,两组均连续治疗3个月。采用 ELISA 法检测血清TLR4、MD-2和TGF-β1水平。结果在治疗3个月末,观察组血清丙氨酸氨基转移酶(ALT)水平为(34.8±13.9)U/L,显著低于对照组【(73.5±25.1)U/L,P<0.05】,血清天门冬氨酸氨基转移酶(AST)水平为(43.1±14.2)U/L,显著低于对照组【(89.0±28.6)U/L,P<0.05】,血清总胆红素(TBIL)水平为(15.5±9.7)μmol/L,显著低于对照组【(28.3±12.9)μmol/L,P<0.05】,血清谷氨酰转肽酶(GGT)水平为(53.9±14.2)U/L,显著低于对照组【(82.2±29.1)U/L,P<0.05】;血清总胆固醇(TC)水平为(4.1±0.5)mmol/L,显著低于对照组【(5.4±0.7)mmol/L,P<0.05】,甘油三酯(TG)水平为(1.3±0.6)mmol/L,显著低于对照组【(2.7±1.0)mmol/L,P<0.05】,血清高密度脂蛋白胆固醇(HDL-C)水平为(1.2±0.3)mmol/L,显著高于对照组【(1.0±0.4)mmol/L,P<0.05】,血清低密度脂蛋白胆固醇(LDL-C)水平为(3.4±0.9)mmol/L,显著低于对照组【(4.1±1.1)mmol/L,P<0.05】;血清TLR4水平为(3.0±0.6)pg/mL,显著低于对照组【(4.2±1.0)pg/mL,P<0.05】,血清MD-2水平为(415.4±128.5)pg/mL,显著低于对照组【(531.7±145.8)pg/mL,P<0.05】,血清TGF-β1水平为(3.4±1.1)pg/mL,显著低于对照组【(5.8±1.6)pg/mL,P<0.05】。结论应用硫普罗宁联合多烯磷脂酰胆碱治疗ALD患者近期疗效较好,可能与该联合治疗降低了血清TLR4、MD-2和TGF-β1水平,减轻了肝损伤,改善了血脂代谢紊乱有关。

关键词: 酒精性肝病, 硫普罗宁, 多烯磷脂酰胆碱, 血清Toll样受体4, 髓样分化蛋白-2, 转化生长因子-β1, 治疗

Abstract: Objective To investigate the short-term efficacy of tiopronin and polyene phosphatidylcholine combination in treatment of patients with alcoholic liver disease (ALD) and its effect on serum toll-like receptor 4(TLR4), myeloid differentiation protein -2(MD-2) and transforming growth factor -β1(TGF-β1) levels. Methods 104 patients with ALD were enrolled in our hospital between January 2018 control group (n=52). The patients in the control group were treated with polyene phosphatidylcholine capsule orally, and those in the observation group were and December 2019, and were randomly divided into observation (n=52) and treated with tiopronin and polyene phosphatidylcholine combination. The treatment in both groups last continuously for 3 months. Serum TLR4, MD-2 and TGF-β1 levels before and after 3 months of treatment were detected by ELISA. Results At the end of three month treatment, serum alanine aminotransferase (ALT) level in the observation group was (34.8±13.9) U/L, much lower than , serum aspartic acid transaminase (AST) level was (43.1±14.2) U/L, significantly lower than , serum total bilirubin (TBIL) level was (15.5±9.7) μmol/L, significantly lower than , and serum gamma-glutamyl transpeptidase (GGT) level was (53.9±14.2) U/L, significantly lower than in the control group; serum total cholesterol (TC) level was (4.1±0.5) mmol/L, much lower than , serum triglyceride (TG) level was (1.3±0.6) mmol/L, significantly lower than , serum high density lipoprotein cholesterol (HDL-C) was (1.2±0.3) mmol/L, significantly higher than , and serum low density lipoprotein cholesterol (LDL-C) level was (3.4±0.9) mmol/L, much lower than in the control; serum TLR4 level was (3.0±0.6) pg/mL, significantly lower than , serum MD-2 level was (415.4±128.5) pg/mL, much lower than , and serum TGF-β1 level was (3.4±1.1) pg/mL, much lower than in the control.Conclusion The combination of tiopronin and polyene phosphatidylcholine in treatment of patients with ALD is efficacious, which might be related to the reduction of serum TLR4, MD-2 and TGF-β1 levels and alleviation of liver function.

Key words: Alcoholic liver disease, Tiopronin, Polyene phosphatidylcholine, Toll-like receptor 4, Myeloid differentiation protein-2, Transforming growth factor-β 1, Therapy

陈燕屏, 黄绍强, 邓鑫, 熊超. 硫普罗宁联合多烯磷脂酰胆碱治疗酒精性肝病患者疗效及血清TLR4、MD-2和TGF-β1水平变化[J]. 实用肝脏病杂志, 2021, 24(1): 67-70.

Chen Yanping, Huang Shaoqiang,Deng Xin ,et al. Short-term efficacy of tiopronin and polyene phosphatidylcholine combination in treatment of patients with alcoholic liver disease[J]. Journal of Practical Hepatology, 2021, 24(1): 67-70.

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