S-腺苷蛋氨酸联合熊去氧胆酸治疗极低出生体质量患儿肠外营养相关性胆汁淤积症的疗效观察

Efficacy of S-adenosylmethionine and ursodeoxycholic acid on parenteral nutrition associated cholestasis in very low birth weight infants

目的观察S-腺苷蛋氨酸联合熊去氧胆酸治疗极低出生体质量患儿肠外营养相关性胆汁淤积症的疗效。方法研究对象为本院2008年1月-2012年10月出生的极低出生体质量患儿67例，出生后接受静脉营养（PN）并出现肠外营养相关性胆汁淤积症（PNAc），随机分为观察组36例，对照组31例。对照组在减少肠外营养基础上给予口服熊去氧胆酸10～30mg／（kg·d）治疗10d，观察组在对照组治疗基础上联合S-腺苷蛋氨酸30～50mg／（k·d）治疗10d。治疗前后分别检测2组患儿血清谷丙转氨酶（ALT）、总胆红素（TBIL）、直接胆红素（DBIL）和总胆酸（TBA）的水平。结果2组各观察指标ALT、TBIL、DBIL、TBA的水平均较治疗前下降，差异有统计学意义（P〈0．01）。观察组ALT、TBIL、DBIL、TBA的水平较对照组下降更明显（P〈0．05）。结论S-腺苷蛋氨酸联合熊去氧胆酸治疗极低出生体质量患儿胆汁淤积症疗效更显著，安全性高，值得临床推广。

Objective To observe the efficacy of the S- adenosylmethionine and ursodeoxy- cholic acid on parenteral nutrition associated cholestasis in very low birth weight infants. Methods Sixty-seven very low birth weight infants received parenteral nutrition （PN） after born, and suffered from parenteral nutrition associated cholestasis（PNAC）. They were randomly divided into observation group （n = 36） and the control group （n =31 ）. In the control group, the patients received the reduced dose of parenteral nutrition, and were treated with ursodeoxyeholic acid of dosage 10 - 30 mg/（kg·d） for 10 days. In the observation group, the patients received same treatment as those in the control group, and treated with S-adenosylmethionine of dosage 30-50 mg/（kg· d） for 10 days. Before and after treatment in two groups, we detected their serum levels of alanine aminotransferase （ALT）, total bilirubin （TBIL）, direct bilirubin （DBIL）, and total bile acid （TBA）. Results Levels of ALT, TBIL, DBIL and TBA in two groups were lower than the levels before treatment, and the difference was significant （P〈0.01）. Levels of ALT, TBIL, DBIL and TBA in the observation group significantly decreased compared with that of control group （ P 〈 0.05 ）. Conclusion Efficacy of S- denosylmethionine combined with ursodeoxycholic acid is better in treatment of PNAC.