左卡尼汀联合葡醛内酯治疗巨细胞病毒感染致小儿肝损伤的临床观察

Clinical observation of levocarnitine combined with glucurolactone in treatment of infantile liver injury induced by cytomegalovirus

目的观察左卡尼汀联合葡醛内酯治疗巨细胞病毒感染所致小儿肝损伤的临床疗效和安全性。方法选取2010年3月—2014年3月天津市儿童医院内科收治的巨细胞病毒感染致肝功能损伤患儿84例,回顾性的分为治疗组(40例)和对照组(44例)。两组患儿均静脉滴注更昔洛韦注射液5 mg/(kg·次),2次/d作为基础治疗,同时给予对症支持治疗。对照组加服葡醛内酯片1片/次,3次/d。治疗组在对照组基础上加用左卡尼汀口服溶液,1 g/次,1次/d。两组均连续治疗7 d以上。比较两组的临床疗效,同时观察两组患者治疗7 d时,肝功能主要指标丙氨酸氨基转移酶(ALT)、门冬氨酸转氨酶(AST)、总胆红素(TBIL)、碱性磷酸酶(ALP)、血清γ-谷氨酰转肽酶(GGT)、总蛋白(TP)的变化。结果治疗后,治疗组和对照组的总有效率分别为95.00%、72.73%,两组总有效率比较差异有统计学意义(P<0.05)。两组患儿治疗7 d后,肝功能主要指标ALT、AST、TBIL、ALP、GGT均较治疗前显著降低,TP水平较治疗前显著增高,同组治疗前后差异有统计学意义(P<0.05);且治疗后,治疗组ALT、AST、ALP、GGT水平均低于对照组,TP高于对照组,两组比较差异有统计学意义(P<0.05)。结论左卡尼汀联合葡醛内酯治疗巨细胞病毒感染致小儿肝损伤具有较好的临床疗效,可降低肝功能主要指标水平,其保护肝脏、降酶的作用明显优于单用葡醛内酯。

Objective To investigate the clinical effect and safety of levocarnitine combined with glucurolactone in treatment of infantile liver injury induced by cytomegalovirus. Methods Patients（84 cases）with infantile liver injury induced by cytomegalovirus from Tianjin Children＇s Hospital from March 2010 to August 2013 were retrospectively divided into treatment（n=40） and control（n=44） groups. The patients in the two groups were iv administered with Ganciclovir Injection as foundation treatment, 5 mg/（kg·time）, twice daily, and they were given support therapy. The patients in the control group were po administered with Glucurolactone Tablets, 1 tablet/time, three times daily. The patients in the treatment group were po administered with Levocarnitine Oral Solution at the basis of the control group, 1 g/time, once daily. The patients in the two groups were treated for more than 7 d. After the treatment, the efficacy was evaluated, while the changes of main indicators of liver function including ALT, AST, TBIL, ALP, GGT, and TP in two groups were compared. Results The efficacies in the treatment and control groups were 95.00% and 72.73%, respectively, and there were differences between the two groups（P〈0.05）. After the treatment, ALT, AST, TBIL, ALP, and GGT in two groups were significantly reduced, while TP was increased, and the difference was statistically significant in the same group（P〈0.05）. After the treatment, the levels of ALT, AST, ALP, and GGT in the treatment group were lower than those in the control group, and TP was higher than that in the control group, with significant difference between two groups（P〈0.05）. Conclusion Levocarnitine combined with glucurolactone has good clinical effect in treatment of infantile liver injury induced by cytomegalovirus, can reduce the levels of main indicators of liver function, and its liver protective and declining enzyme actions are superior to glucurolactone lonely.