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目的观察熊去氧胆酸治疗药物性肝病的临床疗效,对慢性药物性肝病的治愈率的影响,分析慢性药物性肝炎的病理组织学特点。方法回顾性分析了49例慢性药物性肝病患者,治疗组给予熊去氧胆酸联合常规保肝降酶药物,对照组给予常规保肝降酶药物治疗,治疗3个月和6个月后,观察两方案治疗后肝功能指标的变化、临床疗效,随访至6个月分析慢性药物性肝炎的治愈率并对治疗无效病例行肝脏穿刺及病理组织学检查。结果治疗3个月和6个月时,治疗组患者血清总胆红素(TBil)均值分别为56.17μmol/L和19.42μmol/L、碱性磷酸酶(ALP)均值分别为129.64 U/L和72.79 U/L、γ-谷酰转肽酶(GGT)均值分别为101 U/L和71 U/L,均较对照组明显下降(P<0.05),ALT在两组患者中均有大幅度下降,但差异无统计学意义(P>0.05),治疗3个月时治疗组的显效率(34.8%)和有效率(47.8%)均优于对照组(P<0.05),治疗6个月时显效率(69.7%)和有效率(21.7%)治疗组无明显差异(P>0.05),随访至6个月时发现治疗组慢性药物性肝炎的无效率(8.7%)明显低于对照组的(23.1%)(P<0.05),两组病例经熊去氧胆酸治疗后无效的慢性药物性肝炎病理组织学改变有所不同,治疗组以汇管区炎症伴肝细胞脂肪变为主,而对照组呈现汇管区小胆管增生、肝细胞脂肪变、肝细胞内胆汁淤积等多样化表现。结论熊去氧胆酸可以有效降低慢性药物性肝病患者的ALT、TBil、GGT、ALP水平,从而改善患者的肝细胞炎症及胆汁淤积,并能提高慢性药物性肝炎的治愈率,延缓慢性药物性肝炎病理组织学进展。
Objective To observe the clinical efficacy of ursodeoxycholic acid in the treatment of drug-induced liver disease, the effect on the cure rate of chronic drug-induced liver disease, and analyze the histopathological features of chronic drug-induced hepatitis. Methods A retrospective analysis of 49 patients with chronic drug-induced liver disease, the treatment group were given ursodeoxycholic acid combined with conventional liver and Jiangdu drug, the control group given conventional liver and Jiangdu drug treatment, treatment for 3 months and 6 months, The changes of liver function indexes and clinical curative effect were observed after treatment. The curative rate of chronic drug-induced hepatitis was analyzed 6 months after follow-up and liver puncture and histopathological examination were performed on the cases of ineffective treatment. Results At 3 and 6 months of treatment, the mean total serum TBil in the treatment group was 56.17 μmol / L and 19.42 μmol / L, respectively, and the average ALP was 129.64 U / L and 72.79 U / L and GGT were 101 U / L and 71 U / L, respectively, which were significantly lower than those of the control group (P <0.05). ALT in both groups were significantly (P> 0.05). The effective rate (34.8%) and effective rate (47.8%) in the treatment group were better than those in the control group (P <0.05) The effective rate (69.7%) and effective rate (21.7%) in the treatment group had no significant difference (P> 0.05). The follow-up to 6 months showed that the inefficiency of the chronic drug-induced hepatitis in the treatment group was significantly lower than that in the control group (23.1%) (P <0.05). The histopathological changes of chronic drug-induced hepatitis which were ineffective in two groups after treatment with UDCA were different. In the treatment group, inflammation in the portal area was accompanied by hepatocellular steatosis, The control group showed a small duct hyperplasia in the portal area, hepatocyte steatosis, intrahepatic cholestasis and other diversified performance. Conclusion UDCA can effectively reduce the levels of ALT, TBil, GGT and ALP in patients with chronic drug-induced liver disease, thereby improving hepatocellular inflammation and cholestasis, and can improve the cure rate of chronic drug-induced hepatitis and delay the chronic drug-induced Progress in Hepatitis Pathology.