人生长激素联合乳果糖防治慢性重型肝炎多器官功能不全临床研究

Prevention and treatment of multiorgan disfunction imdnced by severe chronic hepatitis by combined growth hormone and lactulose

目的多器官功能不全是重型肝炎患者死亡的主要原因,大部分患者因不能及时进行肝脏移植而死亡。如何有效的防治重型肝炎多器官功能不全,为患者赢得肝脏移植的时机,是降低其病死率的关键。本研究目的是观察重组人生长激素(rhGH)联合乳果糖肠道滴注防治慢性重型肝炎患者并发症的疗效,并对其作用机制进行了初步的探讨。材料与方法1999年1月～2002年2月住院的慢性重型肝炎患者48例。向患者或家属说明治疗方法,同意使用人生长激素者入治疗组,否者入对照组。治疗组28例,对照组20例。治疗方法:①人生长激素(国产)4～4.5u/次,qd,肌内注射,连续2～4周;②0.9％生理盐水100ml+乳果糖30ml+灭滴灵2.0克/次,qod,肠道滴注,2～4周;两组的基础治疗基本一致。根据修改的疗效标准判断其效果。结果治疗组大部分患者临床症状明显改善,显效率21.4％(6/28);有效率53.5％(15/28),总有效率75％;血清前白蛋白、白蛋白、IGFBP1、胆固醇水平明显增加(P<0.05);而对照组显效率为5％(1/20),有效率为35％(7/20)。总有效率40％,约60％患者前白蛋白、白蛋白、IGFBP1、胆固醇水平持续下降。结论生长激素能明显改善慢性重型肝炎患者的蛋白质代谢,肠道滴注乳果糖能较有效的控制肠源性内毒素,可能防止并发症的发生、发展。我们的研究结果提供了一些初步的依据:人生长激素联合乳果糖可能对防治重型肝炎并发多器官功能不全具有较好的作用。

Objective Multiple organ disfunction is a severe life threatening conditions as a results of severe hepatitis development, and has a high mortality up to 80% .The objective of this study was to observe the efficiency and safety of combined human growth hormone (rhGH) and lactuloae for treatment and/or prevention of severe chronic hepatitis with multiorgan disfunction. The mechanism of drugs was also studied. Materials and Method Forty - eight inpatients with severe chronic hepatitis admitted from January 1999 to February, 2002 were included.The patients were divided into rhGH treatment and control group respectively, according to voluntary administration of rbGH or not.Of mem, was in 28 patients rhGH - treatment group and 20 in control group.4 ~ 4.5IU of rhCH was intramuscle injected daily for 2 ~ 4 weeks. 100ml of enemas contained 30ml of Lactuloae, 2g of metronidazole and 0.9% saline was enemaed every one day tor 2 - 4 weeks.Their symptoms .and complications were noted.Liver and kidney functions were analyzed by OLYMPUS analyzer.The serum CH, IGF- 1 ICFBP1 and IGFBVP3 were measured by ELISA kits.The assessment of efficiency was made according to the new criteria modified by ourself. Results Compared with control group, the total efficiency in rhGH treatment group was 75%, (P<0.05) .Majority of symptoms were gradually relieved.The serum Albumin (26.1±4.1 befor vs 30.2±5.3, 31.9±5.1g/L after 2, 4 weeks respectively, P<0.05), proalbumin (79.6±28.0 vs 106.6±54.4, 108.4±55.0g/ L after 2, 4weeks respectively, P<0.05), cholesterol (76.3± 16.7 vs 85.6± 32.3, 96.1± 38.7mg/dl after 2, 4 weeks, P<0.05), IGFBP1 (56.8±47.2 vs 89.7± 50.3 ng/ml after 2 weeks, P<0.05), were significantly increased after rhGH treatment.However, the serum GH was declined. The increased tendency of serum ICF1 and IGFBP3 after rhGH tratment was also observed. Conclusions The method of combined rhGH and lactulose may be benefit for prevention of severe chronic hepatitis development. These data provide preliminary evidence that combined rhGH and lactuloae may be a novel approach tor prevention and/or treatment of severe heaptitis with multiorgan disfunction.