水飞蓟宾葡甲胺联合胆宁片治疗酒精性肝炎患者疗效及其对血脂和氧化应激指标的影响

Very short-term efficacy of silybin meglumine and Danning tablet combination in treatment of patients with alcoholic hepatitis

目的探讨应用水飞蓟宾葡甲胺联合胆宁片治疗酒精性肝炎患者疗效及其对血脂和氧化应激指标的影响。方法2017年3月~2019年6月我院肝病科诊治的酒精性肝炎患者146例,被随机分为对照组(n=73例)和观察组(n=73例),分别给予胆宁片或胆宁片联合水飞蓟宾葡甲胺治疗3个月。使用UV1800紫外可见分光光度计测定血清超氧化物歧化酶(SOD)和丙二醛(MDA)水平,使用Thermo Trace 1310气相色谱质谱联用仪测定血清游离脂肪酸(FFA)含量。结果治疗后,观察组血清总胆固醇(TC)水平为(4.9±0.7)mmol/L,显著低于对照组【(5.5±1.2)mmol/L,P<0.05】,而血高密度脂蛋白(HDL-C)水平为(1.3±0.9)mmol/L,显著高于对照组【(1.0±0.5)mmol/L,P<0.05】,两组血甘油三酯(TG)和低密度脂蛋白(LDL-C)水平变化差异无统计学意义【分别为(1.7±0.3)mmol/L对(1.7±0.7)mmol/L和(3.2±0.4)mmol/L对(3.4±0.7)mmol/L,P>0.05】;治疗后,观察组血清丙氨酸氨基转移酶(ALT)水平为(35.9±7.7)U/L,显著低于对照组【(63.5±9.2)U/L,P<0.05】,天冬氨酸氨基转移酶(AST)水平为(39.5±6.3)U/L,显著低于对照组【(65.5±7.8)U/L,P<0.05】,谷氨酰转肽酶(GGT)水平为(123.8±6.6)U/L,显著低于对照组【(145.7±7.2)U/L,P<0.05】,碱性磷酸酶(ALP)水平为(57.3±12.5)U/L,显著低于对照组【(78.4±13.1)U/L,P<0.05】;治疗后,观察组血清SOD水平为(132.9±19.3)nmol/L,显著高于对照组【(105.5±12.6)nmol/L,P<0.05】,MDA水平为(9.5±2.3)nmol/L,显著低于对照组【(14.4±3.6)nmol/L,P<0.05】,游离脂肪酸(FFA)水平为(24.3±3.1)nmol/L,显著低于对照组【(30.2±3.3)nmol/L,P<0.05】。结论应用水飞蓟宾葡甲胺联合胆宁片治疗酒精性肝炎患者可以显著改善血脂水平,抑制氧化应激指标,短期具有保护肝功能的作用,值得临床进一步研究。

Objective The aim of this study was to investigate the short-term efficacy of silybin meglumine and Danning tablet,a herbal medicine,combination in treatment of patients with alcoholic hepatitis(AH).Methods 146 consecutive patients with AH were recruited in our hospital between March 2017 and June 2019,and were randomly divided into control group(n=73)and observation group(n=73).The patients in the control group were given Danning tablets,and those in the observation group were treated with silybin meglumine and Danning combination for 3 months.Serum superoxide dismutase(SOD),alondialdehyde(MDA)and free fatty acid(FFA)were detected.Results Serum total cholesterol(TC)level in the combination group was(4.9±0.7)mmol/L,significantly lower than【(5.5±1.2)mmol/L,P<0.05】,and high density lipoprotein cholesterol(HDL-C)was(1.3±0.9)mmol/L,much higher than【(1.0±0.5)mmol/L,P<0.05】in the control,and serum triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)levels in the two groups were not significantly different【(1.7±0.3)mmol/L vs.(1.7±0.7)mmol/L and(3.2±0.4)mmol/L vs.(3.4±0.7)mmol/L,respectively,P>0.05】;serum alanine aminotransferase level was(35.9±7.7)U/L,serum aspartate aminotransferase level was(39.5±6.3)U/L,serum glutamyl transpeptidase level was(123.8±6.6)U/L,and serum alkaline phosphatase level was(57.3±12.5)U/L,all significantly lower than those in the control[(63.5±9.2)U/L,(65.5±7.8)U/L,(145.7±7.2)U/L and(78.4±13.1)U/L,respectively,P<0.05】;serum SOD level was(132.9±19.3)nmol/L,much higher than【(105.5±12.6)nmol/L,P<0.05】,serum MDA level was(9.5±2.3)nmol/L,significantly lower than【(14.4±3.6)nmol/L,P<0.05】,and serum FFA level was(24.3±3.1)nmol/L,much lower than【(30.2±3.3)nmol/L,P<0.05】in the control.Conclusion The administration of silybin meglumine and a herbal medicine combination in treatment of patients with AH might in short-term ameliorate blood lipid metabolism,inhibit oxidative stress and improve liver functions,which needs further multi-central investigations.