氧化苦参碱对胆碱酯酶影响的临床研究

Clinical research on the effect of Oxymatrine on serum cholinesterase

目的 研究氧化苦参碱 (OM)治疗病毒性肝炎过程中 ,胆碱酯酶 (ChE)的动态变化及与同期白蛋白 (ALB)、凝血酶原活动度 (PTA)及其他肝功能的关系。方法 98例病毒性肝炎患者分成 4组 ;A组 31例 (静脉注射OM) ,B组 30例 (口服OM) ,C组 7例 (肌内注射OM) ,D组 30例 (一般护肝药物 ,不用OM)。定期检测血清ChE、ALB、PTA、肝功能、肾功能、血常规、血清补体 1型受体 (sCR1)、红细胞黏附功能 (EIIAF)指标。结果 A、B、C 3组在治疗中ChE明显下降 ,治疗前中后比较 ,差异有显著意义 (P值分别为 <0 0 0 1、<0 0 0 1、0 0 2 3) ;同时在ChE数值及异常率与对照组比较 ,差异有显著意义(P <0 0 0 1)。A、B、C 3组在治疗前中后 ,ALB、PTA随病情而变化 (P值均 >0 0 5 )。4组治疗后病情均有明显好转 ,ChE的下降并不伴随肝功能的恶化。结论 OM制剂在治疗病毒性肝炎中ChE明显下降 ,但反映肝脏实质功能的ALB、PTA等指标无改变 ,ALT、AST、TBiL好转。在OM治疗结束后 ,ChE迅速恢复正常。所以 ,ChE的下降并不表明病情的恶化 ,其机理尚待探讨。

Objective To investigate the effect of Oxymatrine (OM) on serum cholinesterase (ChE) during the treatment of viral hepatitis and the relationship between the change of ChE and the change of albumin (ALB),prothrombin activity (PTA) and other liver function tests. Methods A total of 98 patients with viral hepatitis were divided into four groups. Group A consisted of 31 patients and were treated with OM intravenous infusion;Group B consisted of 30 patients,treated with OM orally;Group C consisted of 7 patients and were treated with OM intramuscular injection while Group D consisted of 30 patients,and were not treated with OM. ChE,ALB,PTA,liver function,renal function,soluble complement receptor-1 (sCR1) and erythrocyte innate immune adhesion function (EIIAF) were regularly determined. Results ChE in Group A,B,C was dropped obviously during the treatment ( P <0.001,<0.001,0.023).But there were no change in ALB,PTA,sCR1,EIIAF ( P >0.05),and remarkable improvement of ALT,AST,TBiL was seen during the treatment in Groups A,B,C. After the treatment with OM,the level of ChE recovered soon. Conclusion Serum level of ChE significantly declined during the treatment of viral hepatitis with OM,but no change was found in ALB,PTA,sCR1,EIIAF while liver function tests showed better results. So the drop of ChE does not mean depravation of patient's liver disease.