腺苷蛋氨酸与熊去氧胆酸联合治疗巨细胞病毒感染相关婴儿肝炎综合征的效果

Clinical effect of adenosylmethionine combined with ursodeoxycholic acid on treatment of cytomegalovirus infection-associated infantile hepatitis syndrome

目的探究腺苷蛋氨酸与熊去氧胆酸联合治疗对巨细胞病毒感染相关婴儿肝炎综合征患儿肝功能及炎症指标的影响。方法共纳入2014年3月-2016年6月经华中科技大学同济医学院附属武汉儿童医院诊治的巨细胞病毒感染致婴儿肝炎综合征患儿80例,根据随机数表法分为研究组(n=40)和对照组(n=40)。两组患儿均给予常规抗病毒及对症治疗,对照组患儿给予熊去氧胆酸口服治疗,研究组患儿在对照组的基础上加用腺苷蛋氨酸静脉滴注治疗。两组治疗时间均为2~3周。比较两组患儿治疗前后血清丙氨酸氨基转移酶(Alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(Aspartate aminotransferase,AST)、总胆红素(Total bilirubin,TBIL)、总胆汁酸(Total bile acid,TBA)、白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)水平和巨细胞病毒特异抗体(Cytomegalovirus specific antibodies,CMV-IgM)变化。观察两组患儿临床疗效及不良反应发生情况。结果治疗后,研究组患儿CMV-IgM阳性率为10.00%,低于对照组的45.00%,差异具有统计学意义(P=0.032);研究组总有效率为92.50%,高于对照组的75.00%,差异具有统计学意义(χ^2=9.135,P=0.003);两组患儿TBIL、ALT、AST、TBA肝功能指标均低于治疗前,但研究组患儿TBIL、ALT、AST、TBA肝功能指标低于对照组(P<0.05);两组患儿血清IL-6、TNF-α水平均较治疗前降低,但研究组患儿血清IL-6、TNF-α水平低于对照组(P<0.05);两组不良反应发生率的比较无统计学差异。结论腺苷蛋氨酸联合熊去氧胆酸治疗巨细胞病毒感染相关婴儿肝炎综合征疗效显著,可有效减轻患儿全身炎症反应,改善肝功能。

OBJECTIVE To investigate the effect of adenosylmethionine combined with ursodeoxycholic acid on the hepatic function and inflammatory markers of children with cytomegalovirus infection-associated infantile hepatitis syndrome.METHODS A total of 80 infants with cytomegalovirus infection-associated infantile hepatitis syndrome in Wuhan Children’s Hospital Affiliated to Tongji were enrolled from March 2014 to June 2016.They were divided into study group(n=40)and control group(n=40)according to the random number tables.Both groups were given routine antiviral and symptomatic treatment.The control group was given ursodeoxycholic acid oral treatment and the study group was given both adenosylmethionine intravenous drip therapy and ursodeoxycholic acid oral treatment.All patients were treated for 2 to 3 weeks.The serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),total bile acid(TBA)and interleukin(IL)-6,tumor necrosis factor(TNF)-αand cytomegalovirus specific antibodies(CMV-IgM)were compared between the two groups before and after the treatment.The clinical efficacy and adverse reactions of the two groups were observed.RESULTS After the treatment,the positive rate of CMV-IgM in the study group was 10.00%,which was significantly lower than that in the control group 45.00%(P=0.032).The total effective rate in the study group was 92.50%,which was significantly higher than that in the control group 75.00%(χ^2=4.501,P=0.034).Levels of hepatic function indexes in the 2 groups,such as ALT,AST,TBIL and TBA were significantly lower after the treatment than that before the treatment.But levels of hepatic function indexes including TBIL,ALT,AST and TBA in the study group were significantly lower than those in the control group(P<0.05).The serum IL-6 and TNF-αlevels were significantly lower after treatment than before.But the serum IL-6,TNF-αlevels in the study group were significantly lower than in the control group(P<0.05).The incidence of adverse reactions in the two groups did not show significantly difference.CONCLUSION Adenosylmethionine combined with ursodeoxycholic acid was effective in the treatment of infantile cytomegalovirus infection-associated hepatitis syndrome,which can effectively alleviate the systemic inflammatory response and improve the hepatic function.