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目的探讨还原型谷胱甘肽(GSH)预防极低出生体重儿(VLBWI)胃肠外营养相关胆汁淤积(PNAC)的疗效及其作用机制。方法 2005年6月至2009年6月在本院应用胃肠外营养的VLBWI,随机分为对照组和观察组,观察组入院即开始应用GSH(阿拓莫兰)0.2g/d连用7d。两组患儿在日龄2d及21d时分别检测肝功能、血浆丙二醛(MDA)和GSH含量,对应用胃肠外营养14d以上者进行分析。结果对照组98例,发生胆汁淤积41例(41.8%),观察组110例,发生胆汁淤积28例(25.5%),两组差异有统计学意义(P<0.05)。对照组住院时间(49.1±18.3)d,血浆MDA值(31.4±2.5)nmol/L,GSH含量(56.2±3.8)mg/L,DBil(32.7±4.1)μmol/L,TBA(64.2±10.6)μmol/L。观察组住院时间(38.5±12.9)d,血浆MDA值(22.3±4.1)nmol/L,GSH含量(96.5±6.7)mg/L,DBil(18.3±5.2)μmol/L,TBA(32.1±6.9)μmol/L,两组差异均有统计学意义(P<0.05)。结论 GSH可显著降低VLBWIPNAC的发生率,减少住院天数,未观察到药物不良反应。其作用机制可能通过减少体内脂质过氧化提高机体抗氧化防御系统功能。
Objective To investigate the efficacy and mechanism of reduced glutathione (GSH) in preventing parenteral nutrition-related cholestasis (PNAC) in very low birth weight infants (VLBWI). Methods From June 2005 to June 2009, VLBWI of parenteral nutrition in our hospital was randomly divided into control group and observation group. The observation group was started to apply GSH (Atropomnium) 0.2g / d for 7 days. The liver function, plasma malondialdehyde (MDA) and GSH contents of the two groups were detected on day 2 and day 21, respectively, and their parenteral nutrition for more than 14 days was analyzed. Results In the control group, 98 cases had cholestasis in 41 cases (41.8%), and 110 cases in observation group had cholestasis in 28 cases (25.5%). There was significant difference between the two groups (P <0.05). The mean length of hospital stay was (49.1 ± 18.3) d in the control group, MDA in the serum was (31.4 ± 2.5) nmol / L, GSH content was 56.2 ± 3.8 mg / L, DBil was 32.7 ± 4.1 μmol / L, μmol / L. The length of hospital stay (38.5 ± 12.9) d, the serum MDA level (22.3 ± 4.1) nmol / L, the GSH content of 96.5 ± 6.7 mg / L, DBil of 18.3 ± 5.2 μmol / L, TBA of 32.1 ± 6.9, μmol / L, the difference between the two groups was statistically significant (P <0.05). Conclusion GSH can significantly reduce the incidence of VLBWIPNAC, reduce the number of hospital days, no adverse drug reactions observed. Its mechanism of action may improve the body’s antioxidant defense system function by reducing lipid peroxidation in the body.