复方甘草酸苷对重型肝炎的治疗作用及机制研究

Efficacy and mechanism of compound glycyrrhizin on serious hepatitis: report of 30 patients

目的观察复方甘草酸苷对于重型肝炎的治疗作用并探讨其作用机制。方法在综合支持疗法的基础上加用复方甘草酸苷注射液治疗重型肝炎患者30例,对照组仅采用相同的综合支持疗法,动态观察2组患者病死率、肝功能指标、血浆内毒素及多种炎性因子水平。结果治疗第3周末,治疗组病死率为26.7%(8/30),对照组病死率为43.3%(13/30);治疗过程中治疗组患者血清ALT及AST水平显著低于对照组(P<0.01);治疗第3周末,治疗组血清总胆红素水平及血浆凝血酶原时间均值显著低于对照组(P<0.05);治疗后各时相点治疗组TNF-α水平均显著低于对照组(P<0.01);治疗后第2、3周,治疗组患者血浆内毒素及IL-6水平显著低于对照组(P<0.01)。结论复方甘草酸苷用于治疗重型肝炎,可促进肝功能恢复,可能有助于降低病死率,其机制与降低患者血浆内毒素及细胞因子所致的继发性肝损伤有关。

Objective To investigate the efficacy and mechanism of compound glycyrrhizin on patients with serious hepatitis. Methods Thirty patients who were hospitalized from August 2005 to June 2007 with diagnosed with serious hepatitis were enrolled into treatment group and treated by compound glycyrrhizin injection （80 to 100 ml per day, for 3 consecutive weeks） and common supporting medicines, while the other 30 patients in control group were treated only with same supporting medicines. Mortality, biochemical parameters, plasma levels of endotoxin and inflammatory factors in patients of both groups were observed during the treatment. Results By the end of three-week of treatment, 8 patients in the treatment group died with the mortality of 26.7% （8/30）. Thirteen patients died in the control group and the mortality was 43.3% （13/30）. Serum ALT and AST levels in treatment group were significantly lower than those of control group during the treatment. The average level of serum total bilirubin and plasma prothrombin time in treatment group was lower than those of control group by end of the third treatment week. The level of TNF-alpha in treatment group was lower than that of control group during treatment. The levels of plasma endotoxin and interleukin-6 in treatment group were significantly lower than those of the control group at the second and third treatment week. Conclusion Compound glycyrrhizin improves the biochemical parameters of patients with serious hepatitis, and probably, improves the survival of patients with severe hepatitis. The implying mechanism might be that compound glycyrrhizin declines plasma endotoxin levels and lessen cytokine-induced secondary hepatic injuries.