重组人生长激素联合乳果糖治疗慢性重型病毒性肝炎的疗效分析

Effects of rhGH combined with lactuiose on the prognosis of chronic severe viral hepatitis

目的观察重组人生长激素(rhGH)联合乳果糖肠道滴注治疗慢性重型病毒性肝炎的疗效及安全性,并探讨其可能的作用机制。方法慢性重型病毒性肝炎患者108例,分为治疗组(50例)和对照组(58例)。治疗组:rhGH 4．5 IU／d,肌肉注射,每天1次,连续2～4周;生理盐水100 ml+乳果糖30 ml +灭滴灵2．0g/次,肠道滴注,每天1次,2～4周;基础治疗同对照组。对照组:仅给予基础治疗。记录患者治疗前后症状、体征及肝脏生化指标变化,随访终点为6个月。应用Kaplan-Meier生存分析、log-rank 检验及Cox风险模型分析rhGH治疗与患者预后的关系。结果对于改善临床症状,治疗组和对照组总有效率分别为88．0％和38．1％(P<0．01);两组肝脏生化指标比较,治疗组均优于对照组(P<0．05)。Kaplan- Meiei生存曲线显示,治疗组和对照组3个月生存率分别为68．00％和22．41％(P<0．001),6个月生存率分别为58．00％、13．79％(P<0．001)。Cox风险模型分析显示,rhGH治疗是影响患者预后的独立因素。结论 rhGH联合乳果糖肠道滴注可改善慢性重型病毒性肝炎患者的症状及肝功能,延长其存活时间。

Objective To observe the effects and safety of recombinant human growth hormone （rhGH） combined with laetulose for treatment of patients with chronic severe viral hepatitis. Methods One hundred and eight patients with chronic severe viral hepatitis were hospitalized from January 2001 to Feruary 2004, randomly divided into two groups ： （1） 50 patients in rhGH-treated group, 4.5 IU of rhGH i.m.injeetion every day for 2 to 4 weeks, 100 ml normal saline, 30 ml laetulose and 2 g metronidazole drip-injected every day for 2 to 4 weeks, received the same basic treatments as control group; （2） 58 patients in control group, ordy received basic treatments. Their symptoms, complications and liver function were recorded. The survival time was analyzed using Kaplan-Meier survival curve. The end-point of follow-up was 6 months. The prognostic factors were analyzed using log-rank check and Cox analysis. Results Compared with control group, the total efficiency in rhGH-treated group was 88.0% vs 38.1% （P 〈 0.01 ）. The serum albumin, proalbumin and cholesterol were significantly increased after rhGH treatment （ P 〈 0.05）. Kaplan-Meier survival curve showed that the survival rate of rhGH-treated group was significantly higher than the control group. The 3-month survival rate of rhGH-treated group and control group were 68.00% and 22.41%, respectively （ P 〈 0.001） ; while the 6-month survival rate were 58.00% and 13.79%, respectively （P 〈 0.001）. RhGH was an independent prognostic factor in patients with chronic severe viral hepatitis. Conclusion RhGH combined with laetulose could significantly improve the symptoms and liver functions in patients with severe viral hepatitis, and may prolong the survival of these patients.