【摘要】：目的：在常規(guī)治療的基礎上加用糖皮質激素(glucocorticoid, GCS)對膽汁淤積性肝病患兒進行治療觀察,比較常規(guī)療法和糖皮質激素對膽汁淤積性肝病的臨床治療效果。方法：選擇在廣西醫(yī)科大學第一附屬醫(yī)院兒科住院診斷為膽汁淤積性肝病患兒56例,采用簡單數(shù)字表法隨機分為常規(guī)用藥組(對照組,28例)和GCS治療組(實驗組,28例),對照組予以靜脈滴注丁二磺酸腺苷蛋氨酸和復方甘草酸苷,實驗組在常規(guī)治療的基礎上予以靜脈滴注氫化可的松琥珀酸鈉,1周后改為醋酸潑尼松片口服,2周內減停,總療程3周,此后兩組繼續(xù)口服復方甘草酸苷及熊去氧膽酸,定期門診隨訪,比較兩組治療前后肝功能指標的改善程度。結果：1.與治療前比較,兩組肝功能經(jīng)治療后均有好轉,對照組治療1周后TBIL、DBIL (P0.01) 及 TBA, ALT (P0.05)變化有顯著性差異,治療3周后TBIL、DBIL(P0.01)變化有顯著性差異,治療2月后TBIL、 DBIL、IBIL (P0.01)變化有顯著性差異：實驗組治療1周后TBIL、DBIL (P0.01)及IBIL、PA (P0.05)變化有顯著性差異,治療3周后TBIL、 DBIL、IBIL、ALB、PA (P0.01)變化有顯著性差異,治療2月后TBIL、 DBIL、IBIL、ALB (P0.01)及ALP、PA、CHE (P0.05)的變化有顯著性差異,其他指標無顯著性差異(P0.05)。2.治療1周、3周后PA上升的幅度,實驗組較對照組明顯,差異有顯著性；治療2月后肝功能各指標變化幅度均無顯著性差異(P值均0.05)。結論：1.糖皮質激素治療嬰兒膽汁淤積性肝病的降膽紅素效果與常規(guī)治療差別不大,對血清γ-GT無顯著作用,亦不能有效促進TBA排泌；2.糖皮質激素能促進前白蛋白的合成,有助于肝細胞功能的恢復；3.臨床治療嬰兒膽汁淤積性肝病需結合患兒病情,合理使用激素。
[Abstract]:Objective: to observe the effect of routine therapy and glucocorticoid (glucocorticoid, GCS) on cholestatic liver disease in children. Methods: 56 pediatric patients with cholestatic liver disease were selected from the first affiliated Hospital of Guangxi Medical University. A simple digital table method was used to divide the two groups randomly into two groups: control group (n = 28) and GCS group (n = 28). The control group was given intravenous drip of adenosylmethionine butyrate and compound glycyrrhizin. The experimental group was given hydrocortisone sodium succinate intravenously for 1 week on the basis of routine treatment. The treatment group was treated with prednisone acetate tablets for 3 weeks. After that, the two groups continued to take compound glycyrrhizin and ursodeoxycholic acid. To compare the improvement of liver function between the two groups before and after treatment. The result is 1: 1. The changes of TBIL,DBIL (P0.01) and TBA, ALT (P0.05) in the control group were significantly different after 1 week of treatment, and there were significant differences in the changes of TBIL,DBIL (P0.01) after 3 weeks of treatment. There were significant differences in TBIL, DBIL,IBIL (P0.01) and IBIL,PA (P0.01) after 1 week of treatment in experimental group, significant difference in TBIL, DBIL,IBIL,ALB,PA (P0.01) after 3 weeks of treatment, and significant difference in TBIL, DBIL,IBIL,ALB (P0.01) and ALP,PA,CHE (P0.05) after 2 months of treatment. There was no significant difference in other indexes (P0.05). The increase of PA in the experimental group was significantly higher than that in the control group (P < 0. 05), and there was no significant difference between the two months after treatment (P < 0. 05). Conclusion 1. The effect of glucocorticoid on reducing bilirubin in infantile cholestatic liver disease was not different from that in routine treatment, but had no significant effect on serum 緯 -GT, nor could it promote TBA excretion effectively. Glucocorticoid can promote the synthesis of prealbumin and contribute to the recovery of hepatocyte function. Clinical treatment of infantile cholestatic liver disease should be combined with the condition of children, rational use of hormones.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R725.7

【參考文獻】

相關期刊論文 前10條

1 李鑫;楊蕊;臧強;胡永秀;;糖皮質激素的藥理作用機制研究進展[J];國際藥學研究雜志;2009年01期

2 胡小英;陳靜;魏文瓊;馮霞;;思美泰治療嬰兒肝內膽汁淤積性肝炎的臨床觀察及護理[J];臨床護理雜志;2012年01期

3 劉曉華;劉杰;;糖皮質激素治療黃疸32例分析[J];齊齊哈爾醫(yī)學院學報;2010年05期

4 郭紅梅,王曉紅,朱啟昒;促肝細胞生長素治療嬰兒肝炎綜合征[J];實用兒科臨床雜志;2005年05期

5 高澤立;許潔;王功大;武忠導;邢國珍;趙琳;;肝病患者血清前白蛋白測定的臨床意義[J];胃腸病學和肝病學雜志;2006年01期

6 伍利軍;李海華;劉錦華;;腎上腺皮質激素治療肝衰竭的療效觀察[J];醫(yī)學綜述;2011年07期

7 黃欣,李艷,黃志華;微生態(tài)制劑干預新生兒黃疸機制研究[J];中國微生態(tài)學雜志;2002年01期

8 黃欣,黃志華;微生態(tài)制劑對肝內膽汁淤積性肝損傷兔模型膽汁和血清TNF-a、IL-6的影響[J];中國微生態(tài)學雜志;2003年03期

9 汪國運;蔡衛(wèi)民;陳峰;吳貴霞;;150例高膽紅素血癥慢性乙型病毒性肝炎治療體會[J];肝臟;2007年03期

10 王寶香;梅紅;彭罕鳴;;腺苷蛋氨酸治療嬰兒肝內膽汁淤積性肝炎50例[J];肝臟;2011年02期

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