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目的 探讨还原型谷胱甘肽(GSH)对老年慢性肺心病患者急性加重期肝损害的作用。方法 66例60岁以上老年慢性肺心病急性加重期肝损害患者随机分为两组。所有入选患者采用慢性肺心病急性加重期常规方案治疗。对照组(n=31)护肝采用静脉滴注肌苷1. 0g,维生素C2. 0g和门冬氨酸钾镁20mL, 1次/d,连用2周。治疗组(n=35)护肝采用GSH1. 2g经静脉输入, 2次/d,连用2周。同时监测治疗前后肝功能指标血丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、总胆汁酸(TBA)、白蛋白(ALB)、凝血酶原时间(PT)及child pugh评分并进行对照比较。结果 治疗组较对照组在慢性肺心病急性加重期肝损害的肝功能复常方面显示更为良好的治疗效应,ALT,AST,TBIL,TBA和child pugh评分改善明显好于对照组(P均<0. 01);治疗组30d内急性肾功能衰竭的发生率低于对照组(P<0. 05);PT,ALB,出院时的死亡率和30d内多脏器功能障碍综合征(MODS)发生率两组比较无显著性差异(P均>0. 05)。结论 GSH治疗老年慢性肺心病急性加重期患者肝损害是有效的和安全的。在慢性肺心病常规方案治疗的基础上应用GSH对老年慢性肺心病急性加重期患者肝损害具有一定的改善作用,其疗效优于常规护肝治疗。
Objective To investigate the effect of reduced glutathione (GSH) on acute liver injury in elderly patients with chronic cor pulmonale. Methods Sixty-six patients with acute liver injury over 60 years old with chronic cor pulmonale were randomly divided into two groups. All patients were treated with routine regimen of acute exacerbation of chronic pulmonary heart disease. The control group (n = 31) liver protection by intravenous inositol 1.0g, vitamin C2. 0g and potassium aspartate 20mL, 1 / d, once every 2 weeks. Treatment group (n = 35) liver protection with GSH1. 2g intravenous infusion, 2 times / d, once every 2 weeks. At the same time, the indexes of liver function such as ALT, AST, TBIL, TBA, ALB, prothrombin time (PT) and child pugh scores and compared. Results Compared with the control group, the therapeutic effect of ALT, AST, TBIL, TBA and child pugh was significantly better than that of the control group (P < 0.01). The incidence of acute renal failure within 30 days in treatment group was lower than that in control group (P <0.05); PT, ALB, mortality at discharge and multiple organ dysfunction syndrome (MODS) The incidence of no significant difference between the two groups (P all> 0.05). Conclusion GSH is effective and safe in treating liver damage in elderly patients with acute exacerbation of chronic pulmonary heart disease. The application of GSH on the basis of routine regimen of chronic pulmonary heart disease has some improvement on liver damage in elderly patients with acute exacerbation of chronic pulmonary heart disease, and its curative effect is superior to that of conventional liver protection.