还原型谷胱甘肽对严重延迟复苏烧伤患者肝功能损害的治疗作用

Effect of reduced glutathione on impairment of hepatic function after delayed resuscitation of severe burn shock

目的探讨还原型谷胱甘肽（GSH）对严重延迟复苏烧伤患者肝功能损害的影响。方法选择40例严重延迟复苏烧伤患者，随机分为两组，治疗组20例静脉滴注GSH；对照组20例给予能量合剂，均连续治疗7～14d。于治疗前及治疗后7d、14d抽取患者静脉血，检测血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、7-谷氨酰转肽酶（7-GT）、碱性磷酸酶（ALP）、总胆红素（TBIL）及直接胆红素（DBIL），并进行对比分析。结果治疗组治疗后7d各指标即显著下降，14d时进一步下降，与治疗前比较差异均有统计学意义（P〈0．05或P〈0．01）；对照组治疗后7d虽较治疗前有所下降，但差异无统计学意义，14d时各指标均显著下降（P均〈0．05）。与对照组14d时比较，治疗组ALT、AST、γ-GT、TBIL、DBIL下降显著（P均〈0．05），而ALP差异无统计学意义。结论早期给予GSH对改善严重延迟复苏烧伤患者肝功能损害的疗效显著。

Objective To investigate the protective effects of the reduced glutathione （GSH） on hepatic injury after delayed resuscitation in patients with severe burn. Methods Forty severely burned patients with hepatic injury after delayed resuscitation were randomly divided into two groups： treatment group （T, 20 cases） and control group （C, 20 cases）. In the T group, the patients were treated with GSH for 7 14 days, while the patients in the C group were treated with same quantity of ＂energy mixture＂ as control. The venous blood sample of each patient of the two groups was collected and examined for the content of alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, γ-glutamyltranspeptidase （γ-GT）, alkaline phosphatase （ALP）, total bilirubin （TBIL）, and direct bilirubin （DBIL） before the treatment and 7 days and 14 days after the treatment. Results The contents of the enzymes in the T group were significantly decreasing gradually in all patients after 7 days and 14 days of treatment （P〈0. 05 or P〈 0.01）. In the C group, the enzymes showed a decrease in quantity 7 days after the management but without statistical significance. However, they still showed significant decrease on 14th day with the ＂ energy mixture＂ treatment （all P〈0. 05）. After 14 days of the treatment, ALT, AST, γ-GT, TBIL and DBIL showed obvious decrease in the T group compared to the C group （all P〈0.05）, but there was no significant difference in ALP between the two groups. Conclusion The results of this study indicates that early use of GSH may be beneficial in the management of protecting hepatic injury after delayed resuscitation for severe burn.