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目的:探讨还原型谷胱甘肽联合丹参川芎嗪对酒精性肝炎(AH)患者肝纤维化及炎性因子的影响。方法:选择我院2013-03-2017-08收治的AH患者104例,按随机数字表法分为对照组和治疗组各52例,对照组给予常规药物和还原型谷胱甘肽治疗,治疗组在对照组的基础上加用丹参川芎嗪,连续治疗4周。2组患者均于治疗前及治疗后4周观察临床症状改善情况,同时检测谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)、Ⅲ型前胶原肽(PⅢNP)、Ⅳ型胶原(ⅣC)、肿瘤坏死因子-α(TNF-α)和白介素-18(IL-18)水平的变化;分析AH患者血IL-18与ALT、PⅢNP水平的相关性。结果:治疗组的总有效率(94.2%)高于对照组总有效率(71.2%),差异有统计学意义(P<0.05);治疗前2组患者ALT、AST、PⅢNP、ⅣC、TNF-α和IL-18水平比较,差异无统计学意义。治疗后4周,2组患者ALT、AST、PⅢNP、ⅣC、TNF-α和IL-18水平均较治疗前降低,治疗组低于对照组,差异均有统计学意义(P<0.05)。AH患者血IL-18与ALT、PⅢNP水平呈正相关(r=0.315、0.277,P<0.01)。结论:还原型谷胱甘肽联合丹参川芎嗪对AH患者的疗效优于单药治疗,能降低ALT、AST、PⅢNP、ⅣC、TNF-α和IL-18水平,降低肝纤维化,取得良好疗效,值得推广应用。
Objective: To investigate the effect of reduced glutathione and ligustrazine tetramethylpyrazine on hepatic fibrosis and inflammatory cytokines in patients with alcoholic hepatitis (AH). Methods: A total of 104 patients with AH who were treated in our hospital from March 2013 to March 2016 were divided into control group and treatment group (n = 52) according to random number table. The control group was treated with conventional drugs and reduced glutathione Group in the control group based on the use of Salvia Ligustrazine, continuous treatment for 4 weeks. Two groups of patients were observed before and after treatment for 4 weeks to improve the clinical symptoms, at the same time detection of alanine aminotransferase (ALT), aspartate aminotransferase (AST), type Ⅲ procollagen peptide (P Ⅲ NP), type Ⅳ collagen ), Tumor necrosis factor-α (TNF-α) and interleukin-18 (IL-18) levels in patients with AH. The correlation between serum IL-18 and ALT and PⅢNP levels in patients with AH was analyzed. Results: The total effective rate (94.2%) in the treatment group was higher than that in the control group (71.2%), the difference was statistically significant (P <0.05). The ALT, AST, PⅢNP, α and IL-18 levels, the difference was not statistically significant. Four weeks after treatment, the levels of ALT, AST, PⅢNP, ⅣC, TNF-α and IL-18 in both groups were lower than those before treatment, and the difference was statistically significant (P <0.05). The level of IL-18 in patients with AH was positively correlated with the levels of ALT and PⅢNP (r = 0.315,0.277, P <0.01). CONCLUSION: Reduced glutathione combined with Salviae Miltiorrhizae is better than monotherapy in AH patients, and can reduce the levels of ALT, AST, PⅢNP, ⅣC, TNF-α and IL-18, reduce liver fibrosis and achieve good therapeutic effect , It is worth promoting application.