恶性梗阻性黄疸引流术后应用腺苷蛋氨酸的临床研究

Clinical study of S.adenosyl-L-methionine in the treatment of malignant obstructive jaundice after surgical drainage

目的探讨恶性梗阻性黄疸患者术后应用腺苷蛋氨酸对临床症状和肝功能的影响。方法选取本院2009年1月至2010年12月收治的恶性梗阻性黄疸患者45例，完全随机分为2组。2组均行手术治疗。术后对照组20例行常规护肝治疗，研究组25例患者在此基础上加用腺苷蛋氨酸1000mg／d静脉滴注。观察2组患者治疗后临床症状和肝功能的变化。结果治疗14d后，研究组临床症状明显减轻，ALT、AST、谷氨酰转移酶（GGT）、血清总胆红素（TBil）、血清直接胆红素（DBil）、碱性磷酸酶（ALP）较对照组改善[研究组分别为（46．3±20．7）、（67．6±23．0）、（111．0±62．3）U／L，（33．0±24．9）、（19．3±10．7）μmol／L，（166．4±44．2）U／L，对照组分别为（107．4±72．4）、（101．6±56．6）、（249．2±104．2）U／L，（137．3±70．9）、（54．8±26．0）μmol／L，（331．6±99．4）U／L]，差异均有统计学意义（均P〈0．05）。研究组未出现明显药物不良反应。结论恶性梗阻性黄疸患者胆道引流术后应用腺苷蛋氨酸能显著改善临床症状，加快胆红素的排泄和肝脏酶谱的改善，促进黄疸消退。

Objective To study the effect of S-adenosyl-L-methionine on the liver functions in patients re- ceiving biliary drainage for malignant obstructive jaundice. Methods Totally 45 cases with malignant obstructive jaundice from Jaunary 2009 to December 2010 were randomized into two groups after undergoing surgical drainage. Control group（20 cases） had normal treatment; study group（25 cases）had additional intravenous infusion of 1000 mg of S-adenosyl-L-methionine per day on the base treatment. Clinical symptoms and liver function were observed. Results Fourteen-day treatment with S-adenosyl-L-methionine could reduce the clinical symptoms. The levels of serum glutamate transaminase, aspartate aminotransferase, glutamyl transpeptidase, total bilirubin, direct bilirubin and alkaline phosphatase were reduced more significantly than those in control group ,P 〈 0. 05. Conclusion Applying S-adenosyl-L-methionine to patients with malignant obstructive jaundice after sugical drainage of the biliary tract can improve the clinical symptoms, signs and the decrease of serum bilirubin and liver enzymes.