摘要
目的探讨熊去氧胆酸(UDCA)在胆汁淤积性肝病(ICH)患儿中的临床应用价值。方法选择186例ICH患儿作为观察对象,采用随机数字表法分组。对照组(93例)口服双歧杆菌活菌制剂,观察组(93例)在对照组用药基础上联合UDCA,疗程2周。观察用药前和用药2周患儿的血清炎症[白介素-4(IL-4)、白介素-6(IL-6)、白介素-10(IL-10)和肿瘤坏死因子α(TNF-α)]、肝功能[碱性磷酸梅(ALP)、总胆红素(TBil)、丙氨酸氨基转移酶(ALT)和γ-谷氨酰转肽酶(GGT)]、免疫调节因子和胆汁酸指标[可溶性黏附分子(sVCAM-1)、胆汁酸(CBA)和甘胆酸(CG)]、肠道菌群[乳酸杆菌、双歧杆菌、大肠杆菌及双歧杆菌与肠杆菌比值(B/E值)]指标变化情况,评估临床疗效和安全性。结果两组患儿用药2周的血清IL-4和IL-10表达水平升高,IL-6和TNF-α表达水平降低(P<0.05),且观察组IL-4和IL-10水平显著高于对照组,IL-6和TNF-α水平显著低于对照组(P<0.05)。两组患儿用药2周ALP、ALT、TBil、GGT、sVCAM-1、CBA和GG水平降低(P<0.05),且观察组ALP、ALT、TBil、GGT、sVCAM-1、CBA和GG水平明显低于对照组(P<0.05)。两组用药2周双歧杆菌、乳酸菌和B/E数量增多,且观察组双歧杆菌、乳酸菌和B/E数量明显高于对照组(P<0.05),两组患儿用药2周大肠杆菌数量降低(P<0.05),观察组用药2周大肠杆菌数量与对照组比较无明显改变(P>0.05)。观察组治疗总有效率为94.62%,显著高于对照组86.02%(χ^(2)=4.230,P<0.05)。观察组不良反应率为6.45%,与对照组5.38%相比差异无统计学意义(χ^(2)=0.103,P>0.05)。结论UDCA治疗ICH疗效突出,能抑制炎症反应,促进肠道菌群恢复,改善肝功能,其机制可能与调节sVCAM-1和胆汁酸指标有关,且用药安全。
Objective To explore the clinical value of ursodeoxycholic acid(UDCA)in infantile cholestatic hepatitis(ICH).Methods 186 infants with ICH were selected as observation objects and grouped by random number table method.The control group(93 cases)took oral preparations of live bifidobacteria,and the observation group(93 cases)took UDCA on the basis of the control group,for 2 weeks of treatment.The indicator changes of serum inflammation factors[Interleukin-4(IL-4),IL-6,IL-10 and tumor necrosis factor-α(TNF-α)],liver function[alkaline plum phosphate(ALP),total bilirubin(TBil),alanine aminotransferase(ALT)andγ-glutamyl transpeptidase(GGT)],immunoregulatory factors and bile acid indicators[soluble vascular cell adhesive molecule-1(sVCAM-1),conjugated bile acid(CBA)and cholyglycine(CG)],intestinal flora[Lactobacillus,Bifidobacteria,Escherichia coli,and the ratio of Bifidobacteria to Enterobacteria(B/E)value)]before and 2 weeks after the medication were observed,and clinical efficacy and safety were assessed.Results The expression levels of serum IL-4 and IL-10 increased,and the expression levels of IL-6 and TNF-αdecreased(P<0.05)after 2 weeks of treatment.And the levels of IL-4 and IL-10 in the observation group were significantly higher than those in the control group(P<0.05),the levels of IL-6 and TNF-αin the observation group were significantly lower than those in the control group(P<0.05).The levels of ALP,ALT,TBil,GGT,sVCAM-1,CBA,and GG in the two groups of infants were reduced after 2 weeks(P<0.05),and the levels of ALP,ALT,TBil,GGT,sVCAM-1,CBA and GG in the observation group were significantly lower than those in the control group(P<0.05).The numbers of Bifidobacteria,Lactobacillus and B/E value increased in the two groups after two weeks of medication,and the numbers of Bifidobacteria,Lactobacillus and B/E value in the observation group were significantly higher than those of the control group(P<0.05).The numbers of Escherichia coli(E.coli)in the two groups after two weeks of medication decreased(P<0.05),bu
作者
刘希
廖杉
刘小乖
LIU Xi;LIAO Shan;LIU Xiao-guai(Department of Infection,Xi’an City of Children’s Hospital,Shaanxi 710003,China)
出处
《肝脏》
2022年第6期703-707,共5页
Chinese Hepatology
基金
西安市卫生健康委员会项目(J201902036)
西安市儿童医院特殊项目(2019A04)。
关键词
熊去氧胆酸
胆汁淤积性肝病
炎症
胆汁酸
Ursodeoxycholic acid
Infantile cholestatic hepatitis
Inflammation
Bile acids
