质子泵抑制剂用于肝硬化患者的疗效评估

Effective assessment of PPI in cirrhotic patients

目的观察质子泵抑制剂(PPI)对肝硬化患者临床症状、肝功能的影响。方法比较32例肝硬化患者PPI治疗前后肝功能、凝血功能、肝脏影像学、临床症状、并发症及不良反应等,分析PPI用于肝硬化的疗效。结果 PPI治疗后患者临床症状明显缓解,治疗前后症状对比为腹水为20例vs 4例(P=0.000),乏力为27例vs 10例(P=0.000),纳差为21例vs 6例(P=0.001)。门静脉内径较治疗前显著减小(后前对比):13.00 mm±1.08 mm vs 13.70 mm±1.38 mm(P=0.000)。PPI治疗后Child-Pugh评分较治疗前明显改善:Child A级为20例vs 10例,Child B级为10例vs 18例,Child C级为2例vs 4例(P=0.002)。PPI治疗1周前后ALT:44.30 u/L±22.72 u/L vs 36.02 u/L±22.63 u/L(P=0.001)。ALB较治疗前升高,TBIL下降,但差异均无统计学意义。观察期内,发生自发性腹膜炎者2例,并发肝肾综合征2例,其中1例死亡;发生肝性脑病者4例经治疗后均好转。结论 PPI用于肝硬化治疗,可减少肝功能损害、减轻门脉高压症及缓解临床症状;肝硬化患者应用PPI并不增加本病并发症的发生率,亦未见其他明显不良反应可能有益。

Objective To observe the influence of PPI on clinical symptoms and hepatic function in cirrhotic patients. Methods A total of 32 cirrhotic patients were studied by observing the diversity of hepatic function,coagulation function,hepaography,clinical symptoms,complication and adverse reaction prior and post PPI treatment,statistic analysis of curative effect of PPI on hepatic cirrhosis were made. Results After PPI treatment,clinical symptoms of patients obviously relieved（pretherapy vs posttherapy）： ascites： 20 cases vs 4 cases（P=0.000）;anergy： 27cases vs 10 cases（P=0.000）;anepithymia： 21 cases vs 6 cases（P=0.001）.Portal vein diameter obviously minished（posttherapy vs prethearapy）： 13.00 mm±1.08 mm vs 13.70 mm ± 1.38 mm（P=0.000）.Child-Pugh score ameliorated before Child A： 20 cases vs 10 cases;Child B： 10 cases vs 18 cases;Child C 2 cases vs 4 cases（P=0.002）.One week after PPI treatment,ALT level was lowed： ALT： 44.30 u/L±22.72 u/L vs 36.02 u/L±22.63 u/L（P=0.001）.ALB level rised and TBIL level reduced,but they had no significant difference in the period of experiment（P0.05）.During experiment period,two cases of cirrhosis patients concurred spontaneous peritonitis happened（SBP）.Two cases concurred hepatorenal syndrome（HRS）,thereinto,one case died.Four cases concurred hepatic encephalopathy and all of them released after treatment. Conclusion The PPI treatment for cirrhosis is significantly better at reducing functional impairment of liver,ameliorateing portal hypertension and releaseing clinical symptoms,with fewer adverse effects,and do not increase complications of cirrhosis.It will be benefit for treating cirrhosis.