N-乙酰半胱氨酸和还原型谷胱甘肽治疗重型肝炎的临床对比观察

A clinical comparative study of N-acetylcysteine and glutathione treatment in fulminant hepatitis

目的比较N-乙酰半胱氨酸（NAC）和还原型谷胱甘肽（GSH）治疗重型肝炎的疗效。方法将55例住院的重型肝炎患者随机分为GSH组（25例）和NAC组（30例）两组，分别在综合治疗的基础上加用GSH1．2g和NAC8．0g静脉点滴，连续用药28天，在用药过程中记录患者的临床症状、体征、血生化指标和凝血功能，并进行Child-push和MELD评分，同时观察不良反应。结果两组患者的肝功能和凝血功能均改善，两组比较无显著性差异（P〉0．05）；在治疗的第21天和28天，NAC组的TBbil和DBil下降率明显高于GSH组，差异有显著性（P〈0．05）；28天时NAC组的PTA提升率高于GSH组[（67．26±28．64）％vs（36．92±21．23）％，P〈0．05]；NAC组的Child-Pugll评分和MELD评分均出现下降，并显著优于GSH组（P〈0．05）。NAC的不良反应主要为头晕、恶心、呕吐和皮肤瘙痒，无严重不良反应。结论与GSH组比较，NAC在减低重型肝炎患者的血清胆红素水平和改善凝血酶原活动度方面更具有优势，NAC治疗过程中患者耐受性较好，安全性较高。

Objective To evaluate the effects of N-acetylcysteine （NAC） and glutathione （GSH） on patients with fulminant hepatitis. Methods Fifty-five patients with fulminant hepatitis were randomly divided into a GSH group and a NAC group. Besides the same combined therapy, the GSH group patients received a daily injection of 1.2 g GSH, the NAC group patients received a daily injection of 8.0 g NAC. Both groups subjected to study for 28 days. The changes of patient＇ s symptoms, biochemistry parameters, Child-Pugh marks,MELD marks and adverse effects were observed during the period of treatment. Results Both groups have obvious therapeutic effects. The decrease rate of TBil and DBil in NAC group were sig- nificantly higher than that of GSH group at the 21 and .the 28 day of treating time（P 〈0.05 ）. The increase rate of PTA in NAC group was significantly higher than that of GSH group at the 28 day of treating time（P 〈 0.05）. The decrease of Child-Pugh and MELD marks in the NAC group were also higher than that of GSH group（P 〈0.05）. The main adverse effects of NAC was dizzy, nausea, vomiting and pruritus. Condusion Compared with GSH, NAC was more effective in dereasing TBil and DBil and increasing PTA. Serious adverse effects of NAC were not observed.