苦参碱注射液治疗婴儿巨细胞病毒性肝炎的疗效观察

Observation of Curative Effect of Matrine Injection on Infant Cytomegalovirus Hepatitis

目的探讨苦参碱注射液治疗婴儿巨细胞病毒（CMV）肝炎的疗效。方法CMV肝炎患儿42例随机分成2组：苦参碱注射液治疗组22例与更昔洛韦治疗组20例。苦参碱治疗组用苦参碱注射液（20～25 mg/d）静脉滴注,1次/d,连用14 d。间隔7～10 d后,用苦参碱注射液20～25 mg/d静脉滴注,1次/d,连用5 d,共2、3个疗程。更昔洛韦治疗组用更昔洛韦15 mg/（kg·d）静脉滴注,2次/d,连用14 d。间隔7～10 d后,用更昔洛韦5 mg/（kg·d）静脉滴注,1次/d,连用5 d,共2、3个疗程。治疗前后予荧光定量聚合酶链反应（FQ-PCR）法检测各组血清人巨细胞病毒（HCMV）DNA拷贝数,于不同时间放射免疫法测定其血清TNF-α水平。观察二组临床及实验室结果。结果1.苦参碱治疗与更昔洛韦治疗组治疗6周血清HCMVDNA拷贝数均明显下降,二者比较无显著性差异（P〉0.05）。2.用药第4周苦参碱治疗组血清TNF-α水平下降最明显,与更昔洛韦治疗组比较有显著性差异（P〈0.01）。3.二组治疗6周前后ALT、总胆红素（TBIL）、结合胆红素（DBIL）、未结合胆红素（IBIL）、胆汁酸（TBA）比较均无显著性差异（Pa〉0.05）。4.二组治疗6周前后肝大比较无显著性差异（P〉0.05）。结论苦参碱注射液可有效抑制HCMVDNA复制,并能调控TNF-α分泌,调节免疫功能,发挥抗HCMV感染、保护肝细胞的作用。

Objective To observe the curative effect of naatrine injection on infant cytonaegalovirus （CMV） hepatitis. Methods Forty - two cases of CMV hepatitis were randomly divided into 2 groups：treatnaent group （n = 22） and control group （n = 20 ）. The treatment group was given naatrine injection intravenously（ 20 -25 ） mg/d once daily for 14 days . Ten days after the first course, naatrine injection was given in travenously for another 5 days in a dosage of （20 -25 ）mg/d. Then the treatment was repeated 2,3 times. The control group with ganciclovir 5 mg/（ kg·d） twice daily for 14 days. After 7 - 10 days with ganciclovir 5 mg/（ kg·d） once daily for 5 days,then the treatment was repeated 2、3 times. All cases＇ blood human cytonaegalovirus（HCMV） DNA copies were detected by FQ - PCR technique before and after treated. Radioinanaunoassay was used to detect the expression of TNF - α in the different periods. Clinical and laboratory resuhs were observed. Results 1. There were no significant differences in HCMV DNA copies between the 2 groups after treated for 6 weeks （ P 〉 0.05 ）. 2. There were significant differences in the levels of TNF - α after treated for 4 weeks （ P 〈 0.01 ）. 3. There were no significant differences in ALT, total bilirubin（TBIL） ,direct bilirubin （DBIL）, indirect bilirubin （IBIL）, bile acids （TBA） between the 2 groups before and after treated 6 weeks （ Pa 〉 0.05 ）. 4. There were no significances between the 2 groups before and after treated 6 weeks in the change of liver. Conclusions Matrine injection can inhibit HCMV DNA replication. It can also control the expression of TNF - α and regulate the function of the inanaune system. There fore naatrine injection has an antivirus efficacy in HCMV infection.