复方二氯醋酸二异丙胺治疗布鲁氏菌病肝损害的效果探究

Effect of diisopropylamine dichloroacetate tablets on brucellosis with liver damage

目的探究复方二氯醋酸二异丙胺治疗布鲁氏菌病肝损害的效果。方法65例布鲁氏菌病肝损害患者,入院均以多西环素+利福平为基础的抗菌药物治疗,在此基础上均给予复方二氯醋酸二异丙胺口服。比较患者治疗前后的肝功能异常指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBIL)升高,白蛋白(ALB)下降]占比;比较患者治疗前后的肝功能指标(ALT、AST、GGT、TBIL、ALP、ALB)水平;比较患者治疗前后的ALT、AST升高程度占比;分析患者的不良反应发生情况。结果治疗后ALT升高、AST升高、GGT升高、ALP升高、TBIL升高及ALT、AST同时升高占比分别为6.15%、4.62%、12.31%、3.08%、7.69%、4.62%,低于治疗前的27.69%、20.00%、27.69%、12.31%、20.00%、18.46%,差异具有统计学意义(P<0.05);治疗前后的ALB下降及ALT、AST、TBIL同时升高占比比较,差异无统计学意义(P>0.05)。患者治疗后的ALT(15.87±11.69)U/L、AST(21.28±9.09)U/L、GGT(42.12±37.04)U/L、TBIL(13.60±5.24)μmol/L、ALP(80.22±36.12)U/L均低于治疗前的(28.63±22.85)U/L、(30.83±22.29)U/L、(71.74±97.69)U/L、(16.98±7.03)μmol/L、(101.85±75.86)U/L,差异具有统计学意义(P<0.05);治疗前后的ALB比较,差异无统计学意义(P>0.05)。治疗后ALT升高、AST升高占比低于治疗前,差异具有统计学意义(P<0.05)。且治疗后ALT、AST均为轻度升高。治疗过程中,有3例患者出现恶心、呕吐症状,考虑可能为口服多西环素后的不良反应,调整口服药用药时间为餐后2 h,患者症状缓解。结论对于应用以多西环素+利福平为基础治疗的布鲁氏菌病肝损害患者,给予复方二氯醋酸二异丙胺治疗,肝功能指标有明显改善,亦无严重不良反应的发生,值得临床使用。

Objective To investigate the effect of diisopropylamine dichloroacetate tablets on brucellosis with liver damage.Methods 65 cases of brucellosis with liver damage were treated with doxycycline+rifampicin-based antibacterial drugs after admission,on which they were all given oral diisopropylamine dichloroacetate tablets.Comparison was made on percentage of abnormal liver function indicators[including alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),total bilirubin(TBIL)increase,albumin(ALB)decrease]before and after treatment;the levels of liver function indicators[including ALT,AST,GGT,TBIL,ALP,ALB]before and after treatment;percentage of elevated ALT and AST before and after treatment.The occurrence of adverse reactions in patients was analyzed.Results After treatment,the percentage of ALT increase,AST increase,GGT increase,ALP increase,TBIL increase,and ALT and AST simultaneous increase were 6.15%,4.62%,12.31%,3.08%,7.69%,and 4.62%,which were lower than 27.69%,20.00%,27.69%,12.31%,20.00%,and 18.46%before treatment,and the differences were statistically significant(P<0.05).The difference was not statistically significant when comparing the percentage of ALB decrease and the percentage of ALT,AST,and TBIL simultaneous increase before and after treatment(P>0.05).The ALT(15.87±11.69)U/L,AST(21.28±9.09)U/L,GGT(42.12±37.04)U/L,TBIL(13.60±5.24)μmol/L,and ALP(80.22±36.12)U/L after treatment were lower than(28.63±22.85)U/L,(30.83±22.29)U/L,(71.74±97.69)U/L,(16.98±7.03)μmol/L,and(101.85±75.86)U/L before treatment,and the differences were statistically significant(P<0.05).The differences were not statistically significant when comparing ALB before and after treatment(P>0.05).The percentages of ALT increase and AST increase after treatment was lower than those before treatment,and the difference was statistically significant(P<0.05).The ALT and AST were mildly increased after treatment.During the treatment,3 patients showed nausea and vomiting symptoms,which were considered to be the adverse reactions of oral doxycycline,and the patients’symptoms were relieved after the time of oral medication adjusted to 2 h after meal.Conclusion For brucellosis patients with liver damage treated by doxycycline+rifampicin,the treatment with diisopropylamine dichloroacetate tablets can significantly improve the liver function indexes,and there is no serious adverse reaction,which is worthy of clinical use.