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目的探讨还原型谷胱甘肽对肝硬化上消化道大出血患者预后的影响。方法42例患者给予还原型谷胱甘肽静滴(1.2g/d),疗程4周,并以常规治疗45例作对照。分别测定患者血中谷胱甘肽(GSH)水平、谷胱甘肽过氧化物酶(GSH-Px)活性和过氧化脂质(MDA)含量。以患者出血后发生腹水或腹水增多、黄疸或黄疸加深、肝性脑病和病死4个指标的累计频次数反映病情恶化。结果患者血中GSH水平、GSH-Px/MDA比值出血后均明显下降,72h达最低点,2周后开始回升。经还原型谷胱甘肽治疗的患者,上述指标2周后即显著恢复,4周后可达到出血前水平。其4个病情恶化指标的累计频次数也明显降低(24/42;41/45,P<0.01),且与Child-Pugh分级有关。结论肝硬化患者上消化道大出血后病情恶化可能与其抗氧化能力降低有关,抗氧化治疗有积极意义。
Objective To investigate the effect of reduced glutathione on the prognosis of cirrhosis patients with upper gastrointestinal bleeding. Methods 42 patients received intravenous injection of reduced glutathione (1.2g / d) for 4 weeks, and routine treatment of 45 cases as a control. The levels of glutathione (GSH), glutathione peroxidase (GSH-Px) and lipid peroxidation (MDA) in blood of patients were determined. Patients with ascites or ascites after hemorrhage increased, jaundice or jaundice deepened, hepatic encephalopathy and death of the four indicators of the cumulative frequency reflects the deterioration of the disease. Results The levels of GSH and GSH-Px / MDA in blood of patients were significantly decreased after hemorrhage, reaching the lowest point at 72 hours, and began to rise after 2 weeks. Patients treated with reduced glutathione, the above indicators significantly recovered after 2 weeks, after 4 weeks to reach the level of pre-bleeding. The cumulative frequency of the four disease progression indicators was significantly lower (24/42; 41/45, P <0.01), and was associated with Child-Pugh classification. Conclusions The worsening of the condition after upper gastrointestinal hemorrhage in cirrhotic patients may be related to the decrease of its anti-oxidative capacity, and the anti-oxidative therapy has positive significance.