前列腺素E1治疗慢性乙型肝炎慢加急性肝衰竭早期患者的临床研究

Clinical Research and Analysis of Curative Effect of Prostaglandin E1 on HBV Related Acute on Chronic Liver Failure

目的:探讨前列腺素E1(PGE1)对早期乙型肝炎慢加急性肝衰竭患者的临床疗效及安全性。方法:采用随机对照方法进行前瞻性试验。将100例早期乙型肝炎慢加急性肝衰竭患者随机分为前列腺素E1治疗组和综合治疗组(对照组),前列腺素E1治疗组在常规内科综合治疗的基础上加用PGE1 10μg治疗,每天1次,疗程4周,综合治疗组为常规内科综合治疗。观察和比较治疗前后两组的肝功能指标水平、消化道和全身症状以及不良反应的发生情况,评价两组的临床疗效。结果:治疗过程中,前列腺素E1治疗组的总有效率为80%,显著优于综合治疗组的62%(P<0.05)。治疗过程中,两组患者血清胆红素水平均明显下降,但前列腺素E1治疗组下降幅度较对照组更加明显。治疗第2周时,治疗组和对照组患者血清胆红素水平分别为252±103μmol/L和269±113.2μmol/L(P<0.05),4周时,则分别为89.8±53.2μmol/L和114.8±62.5μmol/L(P<0.01),显著低于第2周时水平。临床症状好转率和其他化验指标(如ALT、GGT)均较治疗前显著降低,但无统计学差异(P>0.05)。前列腺素E1治疗组不良反应的发生率为14%,而综合治疗组未见不良反应发生。结论:PGE1治疗早期乙型肝炎慢加急性肝衰竭患者的疗效明显优于综合内科治疗组,能显著改善肝功能,促进黄疸消退,不良反应少。

Objective： To investigate the therapeutic effect and safety of prostaglandin E1（PGE1） on patients suffering from hepatitis B related acute on chronic liver failure. Methods： Prospective tests were progressed with random comparison and single blind methods. 100 patients with hepatitis B related acute on chronic liver failure were randomly divided into the PGE1 group and control group（internal medicine general treatment）. On the basis of internal medicine general treatment, PGE1 group was treated with PGE1 10μg every day. Both groups were treated intravenously once a day for four weeks. The changes of liver function index level; clinical efficacy as well as gastrointestinal and systemic symptoms of adverse reactions were observed and compared before and after treatment between two groups. Results： After 2 and 4 weeks＇ treatment, the Tbil, ALT, GGT levels of both groups significantly decreased than those before treatment, which were obviously lower in the 4th week of treatment than those in the 2nd week of treatment. The serum Tbil level of PGE1 group was significantly lower than that of the control group（P〈0.05）, but no obvious significance was observed in the serum ALT, GGT levels between the the two groups（P〉0.05）. The incidence rate of adverse reactions of PGE1 group was 14%, but no adverse reaction was observed in the control group. Conclusion： Prostaglandin E1 could more effectively treat the hepatitis B related acute on chronic liver failure than the internal medicine general treatment, and significantly improve the liver function, promote the jaundice vanishing, and has few adverse reactions.