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目的:探讨腺苷蛋氨酸(SAME)联合熊去氧胆酸(UDCA)治疗早产儿肠外营养相关性胆汁淤积(PNAC)的疗效。方法:32例PNAC患儿随机分为治疗组与对照组各16例,两组病例均予保肝及基础治疗,治疗组在此基础上加用腺苷蛋氨酸30～60 mg/(kg.d)和熊去氧胆酸10～20 mg/(kg.d),连续应用14 d为1个疗程。检测两组患儿治疗前后血清中总胆红素(TBIL)、结合胆红素(DBIL)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆汁酸(TBA)水平。结果:采用SAME联合UDCA治疗2周后,治疗组患儿血清中TBIL、DBIL、ALT、GGT、TBA与对照组比较均显著降低(P<0.01),肝脏明显缩小(P<0.01)。两组均未见明显药物不良反应。结论:SAME联合联合UDCA能降低血清胆红素及内源性胆汁酸水平,可促进胆红素、TBA排泄,具有明显的利胆、退黄的疗效,是有效和安全的。
Objective: To investigate the efficacy of adenosine methionine (SAME) combined with ursodeoxycholic acid (UDCA) in the treatment of preterm infant parenteral nutrition-associated cholestasis (PNAC). Methods: Thirty-two cases of PNAC were randomly divided into treatment group and control group, 16 cases in each group. Both groups were given hepatoprotective and basic treatment. The treatment group was given adenosine methionine 30-60 mg / (kg.d ) And ursodeoxycholic acid 10 ~ 20 mg / (kg.d), continuous application of 14 d for a course of treatment. The levels of total bilirubin (TBIL), bilirubin (DBIL), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), total bile acid (TBA) Level. Results: The serum levels of TBIL, DBIL, ALT, GGT and TBA in the treatment group were significantly lower than those in the control group (P <0.01), and the liver was significantly reduced (P <0.01) after treatment with SAME and UDCA for 2 weeks. No obvious adverse drug reactions were seen in both groups. Conclusion: Combination of SAME and UDCA can reduce the levels of serum bilirubin and endogenous bile acids, promote the excretion of bilirubin and TBA, and has obvious curative effect of gallbladder and yellowing. It is effective and safe.