目的 探討納曲酮聯(lián)合腺苷蛋氨酸治療酒精性肝病合并膽汁淤積的臨床療效。方法 選取2014年3月-2015年5月第四軍醫(yī)大學(xué)唐都醫(yī)院收治的酒精性肝病合并膽汁淤積患者96例,隨機分為對照組和治療組,每組各48例。對照組在基礎(chǔ)治療上靜脈滴注注射用丁二磺酸腺苷蛋氨酸1.0 g加入到5%葡萄糖溶液500 mL,1次/d,6周后改為口服丁二磺酸腺苷蛋氨酸腸溶片,0.5 g/次,2次/d。治療組在對照組基礎(chǔ)上口服鹽酸納曲酮片,25 mg/次,1次/d。兩組均連續(xù)治療10周。觀察兩組患者的臨床療效,同時比較兩組治療前后丙氨酸氨基轉(zhuǎn)移酶(ALT)、γ-谷氨酰轉(zhuǎn)肽酶(GGT)、血清膽紅素(SB)、天冬氨酸氨基轉(zhuǎn)移酶(AST)、總膽紅素(TBIL)、總膽汁酸(TBA)、白蛋白(Alb)、透明質(zhì)酸酶(HA)、層黏連蛋白(LN)、III型前膠原(PC-III)、IV型膠原蛋白(IV-C)的變化。結(jié)果 治療后,對照組和治療組的總有效率分別為77.1%、91.7%,兩組比較差異具有統(tǒng)計學(xué)意義(P < 0.05)。治療后,兩組患者Alb均顯著升高、TBA、ALT、AST、TBIL、SB、GGT、HA、PC-III、IV-C、LN均顯著降低,同組治療前后差異具有統(tǒng)計學(xué)意義(P < 0.05);且治療組這些觀察指標的改善程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學(xué)意義(P < 0.05)。結(jié)論 納曲酮聯(lián)合腺苷蛋氨酸治療酒精性肝病合并膽汁淤積具有較好的臨床療效,可改善患者肝功能和肝纖維化指標,具體一定的臨床推廣應(yīng)用價值。

Objective To observe the clinical efficacy of naltrexone combined with ademetionine in treatment of alcoholic liver disease complicated with cholestasis. Methods Patients (96 cases) with alcoholic liver disease complicated with cholestasis in Tangdu Hospital of the Fourth Military Medical University from March 2014 to May 2015 were randomly divided into control and treatment groups, and each group had 48 cases. The patients in the control group were iv administered with Ademetionine 1,4-Butanedisulfonate for injection on the basis of foundation treatment, 1.0 g added into 5% glucose solution 500 mL, once daily. After 6 weeks, they were po administered with Ademetionine 1,4-butanedisulfonate Enteric-coated Tablets, 0.5 g/time, twice daily. The patients in treatment group were po administered with Naltrexone Hydrochloride Tablets, 25 mg/time, once daily. Two groups were treated for 10 weeks. After treatment, the efficacy was evaluated, and the changes of ALT, GGT, SB, AST, TBIL, TBA, Alb, HA, LN, PC-III, and IV-C in the two groups before and after treatment were compared. Results After treatment, the efficacies in the control and treatment groups were 77.1% and 91.7%, respectively, and there were differences between two groups (P < 0.05). After treatment, Alb were significantly increased, TBA, ALT, AST, TBIL, SB, GGT, HA, PC-III, IV-C, and LN were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). These observational indexes in the treatment group were better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Naltrexone combined with ademetionine has curative effect in treatment of alcoholic liver disease complicated with cholestasis, and can improve liver function and liver fibrosis indexes, which has a certain clinical application value.