保肝药物在多西环素治疗恙虫病合并肝损害中的应用效果分析

Analysis of the application effect of hepatoprotective drugs in scrub typhus complicated with liver damage treated by doxycycline

目的观察在多西环素治疗恙虫病合并肝损害中保肝药物的应用效果。方法55例采用多西环素治疗的恙虫病合并肝损害患者,依据保肝药物使用情况分为单一组(19例)、二联组(29例)、三联组(7例)。单一组仅使用1类保肝药物治疗,二联组使用2类保肝药物治疗,三联组使用3类保肝药物治疗。比较三组住院时间、保肝药物治疗前后肝功能指标[血清谷丙转氨酶(ALT)、血清谷草转氨酶(AST)]、临床疗效。结果单一组、二联组住院时间分别为(9.74±3.72)、(9.90±3.23)d,短于三联组的(13.57±5.38)d,差异具有统计学意义(P<0.05)。55例患者出院时肝功能复常率为18.18%(10/55)。治疗前,单一组ALT、AST水平分别为(109.30±73.64)、(129.10±74.82)U/L,二联组分别为(144.70±99.15)、(170.10±120.30)U/L,三联组分别为(198.00±184.60)、(313.60±250.00)U/L;治疗后,单一组ALT、AST水平分别为(81.47±67.71)、(67.12±56.57)U/L,二联组分别为(77.76±35.57)、(57.11±28.03)U/L,三联组分别为(56.06±27.44)、(34.27±4.21)U/L。三组治疗前ALT和AST水平比较差异具有统计学意义(P<0.05),保肝药物应用种类随着治疗前ALT和AST上升而增多。单一组、二联组治疗后ALT、AST水平均低于本组治疗前,差异具有统计学意义(P<0.05);三联组治疗后AST水平低于本组治疗前,差异有统计学意义(P<0.05)。单一组总有效率为89.47%,二联组为89.66%,三联组为100.00%,三组比较差异无统计学意义(P>0.05)。结论在多西环素治疗恙虫病合并肝损害中,使用1~2类不同作用机制的保肝药物可获得显著的临床效果。

Objective To observe the application effect of hepatoprotective drugs in scrub typhus complicated with liver damage treated by doxycycline.Methods A total of 55 patients with scrub typhus and liver damage treated by doxycycline were divided into single-therapy group(19 cases),dual-therapy group(29 cases)and triple-therapy group(7 cases)according to the use of hepatoprotective drugs.The singletherapy group was treated with only class 1 liver-protective drugs,the dual-therapy group group was treated with class 2 liver-protective drugs,and the triple-therapy group was treated with class 3 liver-protective drugs.The hospitalization time,liver function indexes[serum alanine aminotransferase(ALT),serum aspartate aminotransferase(AST)]before and after hepatoprotective drug treatment,and clinical efficacy were compared among the three groups.Results The hospitalization time of the single-therapy group and the dual-therapy group were(9.74±3.72)and(9.90±3.23)d,which was shorter than(13.57±5.38)d of the triple-therapy group,and the difference was statistically significant(P<0.05).The liver function recovery rate of 55 patients was 18.18%(10/55)at discharge.Before treatment,the levels of ALT and AST were(109.30±73.64)and(129.10±74.82)U/L in the single-therapy group,(144.70±99.15)and(170.10±120.30)U/L in the dual-therapy group,and(198.00±184.60)and(313.60±250.00)U/L in the triple-therapy group;after treatment,the levels of ALT and AST in the single-therapy group were(81.47±67.71)and(67.12±56.57)U/L,(77.76±35.57)and(57.11±28.03)U/L in the dual-therapy group,and(56.0±627.44)and(34.27±4.21)U/L in the triple-therapy group.Before treatment,there were significant differences in ALT and AST levels among the three groups(P<0.05),and the types of liver-protecting drugs increased with the increase of ALT and AST before treatment.After treatment,the levels of ALT and AST in the single-therapy group and the dual-therapy group were lower than those before treatment in this group,and the difference was statistically significant(P<0.05).After treatment,the level of AST in the triple-therapy group was lower than that before treatment in this group,and the difference was statistically significant(P<0.05).The total effective rate was 89.47%in the single-therapy group,89.66%in the dual-therapy group,and 100.00%in the triple-therapy group,and the difference was not statistically significant among the three groups(P>0.05).Conclusion In scrub typhus complicated with liver damage and treated by doxycycline,1 or 2 types of hepatoprotective drugs with different mechanisms can achieve significant clinical effects.