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目的评价丹参酮ⅡA磺酸钠治疗日本血吸虫病肝纤维化的长期效果。方法选择2013—2014年在无锡市第九人民医院接受诊治的57例日本血吸虫病肝纤维化患者为观察对象,给予丹参酮ⅡA磺酸钠注射液静脉注射治疗,1次/d,每次60 mg,连续15 d,治疗前及治疗后6、12个月分别采用彩色多普勒超声诊断仪检测肝实质损害和肝脾肿大情况,并以放射免疫法测定患者血清肝纤维化4项指标。结果经丹参酮ⅡA磺酸钠治疗后,患者肝实质损害显著改善;患者治疗前及治疗后6、12个月门静脉内径分别为(17.2±3.1)mm、(11.2±0.9)mm和(8.6±1.3)mm,脾静脉宽度分别为(10.1±1.7)mm、(6.9±1.5)mm和(4.7±2.1)mm,脾厚度分别为(48.8±4.7)mm、(37.3±6.5)mm和(33.4±3.1)mm,治疗后肝脾超声影像学指标均较治疗前显著改善,差异均有统计学意义(P<0.05)。治疗前及治疗后6、12个月患者血清透明质酸(HA)含量分别为(402.2±31.7)ng/mL、(202.7±11.8)ng/mL和(117.3±10.6)ng/mL,层黏连蛋白(LN)含量分别为(507.8±59.9)ng/mL、(219.6±42.3)ng/mL和(127.6±20.0)ng/mL,Ⅳ型胶原纤维(C-Ⅳ)含量分别为(232.1±37.7)μg/mL、(135.2±9.5)μg/mL和(89.0±10.1)μg/mL,Ⅲ型前胶原肽(PⅢP)含量分别为(210.6±31.3)μg/mL、(112.4±21.5)μg/mL和(100.6±9.7)μg/mL,治疗后4项血清肝纤维化指标均较治疗前显著降低,差异均有统计学意义(P<0.05)。治疗过程中,仅2例患者出现一过性局部皮肤瘙痒。结论丹参酮ⅡA磺酸钠治疗日本血吸虫病肝纤维化长期效果显著,且无明显不良反应,值得临床推广应用。
Objective To evaluate the long-term effect of tanshinone Ⅱ A sulfonate in the treatment of schistosomiasis japonica hepatic fibrosis. Methods Fifty-seven patients with schistosomiasis japonica hepatic fibrosis undergoing diagnosis and treatment in Ninth People’s Hospital of Wuxi City from 2013 to 2014 were selected as the observation subjects and received intravenous injection of tanshinone Ⅱ A sodium sulfonate once a day for 60 mg , For 15 consecutive days. Before treatment and 6 and 12 months after treatment, color Doppler ultrasonography was used to detect liver parenchymal damage and hepatosplenomegaly. Four indicators of serum hepatic fibrosis were determined by radioimmunoassay. Results After treatment with sodium tanshinone Ⅱ A, the hepatic parenchymal lesions were significantly improved. The diameters of portal vein in patients before and 6 and 12 months after treatment were (17.2 ± 3.1) mm, (11.2 ± 0.9) mm and (8.6 ± 1.3) mm ) mm and splenic venous width were (10.1 ± 1.7) mm, (6.9 ± 1.5) mm and (4.7 ± 2.1) mm, and splenic thicknesses were (48.8 ± 4.7) mm, (37.3 ± 6.5) and 3.1) mm, after treatment of liver and spleen ultrasound imaging indicators were significantly improved than before treatment, the differences were statistically significant (P <0.05). Serum hyaluronic acid (HA) levels were (402.2 ± 31.7) ng / mL, (202.7 ± 11.8) ng / mL and (117.3 ± 10.6) ng / mL before and 6 and 12 months after treatment respectively The contents of LN were (507.8 ± 59.9) ng / mL, (219.6 ± 42.3) ng / mL and (127.6 ± 20.0) ng / mL, respectively. The contents of type Ⅳ collagen fibers were (232.1 ± 37.4 μg / mL, (135.2 ± 9.5) μg / mL and (89.0 ± 10.1) μg / mL, PⅢP were (210.6 ± 31.3) μg / mL and (112.4 ± 21.5) μg / mL and (100.6 ± 9.7) μg / mL, respectively. The four indicators of serum hepatic fibrosis after treatment were significantly lower than those before treatment, with statistical significance (P <0.05). During the course of treatment, only 2 patients had transient localized pruritus. Conclusion Tanshinone Ⅱ A sulfonate treatment of schistosomiasis japonica liver fibrosis long-term effect was significant, and no significant adverse reactions, it is worth promoting the clinical application.