劳拉西泮与奥沙西泮治疗酒精性肝病并发酒精戒断综合征患者临床疗效对比研究

Comparative study on the clinical efficacy of lorazepam and oxazepam in treatment of patients with alcoholic liver diseases and alcohol withdrawal syndrome

目的对比观察劳拉西泮与奥沙西泮治疗酒精性肝病(ALD)并发酒精戒断综合征(AWS)患者的临床疗效。方法 2017年11月~2020年11月我院诊治的127例ALD并发AWS患者,采用随机数字表法将患者分为对照组63例和观察组64例,分别给予劳拉西泮和奥沙西泮治疗7 d。应用酒精戒断综合征评定量表(AWSS)[10]评估临床症状,应用焦虑自评量表(SAS)[11]评估焦虑症状。采用ELISA法检测血清透明质酸(HA)、层粘连蛋白(LN)、三型前胶原N端肽(PC-Ⅲ)和四型胶原(Ⅳ-C)。结果在治疗结束时,观察组有效率为96.9%,显著高于对照组的81.0%,差异有统计学意义(P<0.05);治疗前,两组AWSS和SAS评分和血清ALT、AST、GGT、TBIL、ALP、CHE、HA、LN、PC-Ⅲ和Ⅳ-C水平无统计学差异(P>0.05);治疗结束时,观察组AWSS和SAS评分分别为(9.5±2.4)分和(30.8±6.4)分,与对照组【分别为(14.2±3.5)分和(48.2±9.1)分,P<0.05】比,差异显著;血清ALT、AST、GGT、TBIL和ALP水平分别为(30.5±8.1) U/L、(71.6±15.3)U/L、(466.1±22.7) U/L、(23.5±6.5)μmol/L和(82.3±12.4) U/L,显著低于对照组【分别为(52.2±11.3) U/L、(105.6±18.4) U/L、(626.3±25.4) U/L、(35.2±8.6)μmol/L和(118.3±14.7) U/L,P<0.05】;血清HA、PC-Ⅲ和Ⅳ-C水平分别为(116.8±18.3)μg/L、(123.1±12.3)μg/L和(80.2±11.6)μg/L,显著低于对照组【分别为(146.2±22.3)μg/L、(155.5±16.8)μg/L和(98.8±15.4)μg/L,P<0.05】。结论奥沙西泮治疗ALD并发AWS患者临床疗效显著,可改善症状,减轻焦虑情绪,促进肝功能恢复。

Objective This clinical trial aimed to compare the efficacy of lorazepam and oxazepam in treatment of patients with alcoholic liver diseases( ALD) and alcohol withdrawal syndrome( AWS). Methods A total of 127 patients with ALD and AWS were enrolled in our hospital between November 2017 and November 2020,and were randomly divided into control( n = 63)and observation group( n = 64),receiving lorazepam and oxazepam,respectively,for seven days. The scores of alcohol withdrawal syndrome scale( AWSS) and self-rating anxiety scale( SAS) score were evaluated. Serum hyaluronic acid( HA),laminin( LN),type III procollagen N-terminal peptide( PC-III) and type-Ⅳ collagen( Ⅳ-C) were detected by ELISA. Results At the end of7 day treatment,the efficient rate in observation group was 96.9%,significantly higher than 81.0% in the control( P< 0.05);at presentation,the AWSS and SAS,serum alanine transaminase( ALT),aspartate aminotransferase( AST),glutamyl transpeptidase( GGT),total bilirubin( TBIL) and alkaline phosphatase( ALP) as well as HA,LN,PC-Ⅲ and Ⅳ-C levels were not significantly different between the two groups( P>0.05);after treatment,the AWSS and SAS in observation were( 9.5± 2.4) and( 30.8±6.4),significantly different as compared to [( 14.2±3.5) and( 48.2±9.1),respectively,P<0.05]in the control;serum ALT,AST,GGT,TBIL and ALP levels were( 30.5±8.1) U/L,( 71.6±15.3) U/L,( 466.1±22.7) U/L,( 23.5±6.5) μmol/L and( 82.3±12.4) U/L,all much lower than [( 52.2±11.3) U/L,( 105.6±18.4) U/L,( 626.3±25.4) U/L,( 35.2±8.6) μmol/L and( 118.3±14.7) U/L,P<0.05]in the control;serum HA,PC-Ⅲ and Ⅳ-C levels were( 116.8±18.3) μg/L,( 123.1±12.3) μg/L and( 80.2±11.6) μg/L,significantly lower than [( 146.2±22.3) μg/L,( 155.5±16.8) μg/L and( 98.8±15.4) μg/L,respectively,P< 0. 05] in the control. Conclusion The clinical efficacy of oxazepam is good in treatment of ALD patients with complicated AWS, which could improve clinical symptom and anxiety relieving.