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摘要：
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摘要：目的 探讨糖皮质激素治疗急性重度药物性胆汁淤积性肝病（drug-induced cholestatic liver disease，
DICLD）的早期疗效。方法 选取2013年7月至2018年6月呼和浩特市第二医院收治的122例DICLD患者
为研究对象，根据入院先后顺序分为常规组（59例）和观察组（63例）。两组在停用肝损伤药物，
给予异甘草酸镁保肝、奥美拉唑抑酸及营养支持的基础上，常规组给予S-腺苷蛋氨酸（S-adensyl-L-
methionyne，SAMe）1.0 g/（kg·d）静脉滴注，观察组给予甲泼尼龙1.0 mg /（kg·d）静脉滴注，均治
疗1周。检测丙氨酸氨基转移酶（alanine aminotransfease，ALT）、天门冬氨酸氨基转移酶（aspartate
transaminase，AST）、总胆红素（total bilirubin，TBil）、直接胆红素（direct bilirubin，DBil）/间接
胆红素（indirect bilirubin，IBil）、碱性磷酸酶（alkaline phosphatase，ALP）、总胆汁酸（total bile
acid，TBA）、前白蛋白（prealbumin，PA）、白蛋白（albumin，ALB）和γ-谷氨酰转移酶（gamma
glutamyltransferase，γ-GT）等生物化学指标。记录总有效率、不良反应及病情反弹情况。比较两组治疗
前后上述指标的差异。结果 治疗3 d，常规组和观察组患者ALT [（211.5 ± 76.2）U/L vs（158.3 ± 61.9）U/L]、
AST [（169.6 ± 59.2）U/L vs（132.1 ± 47.4）U/L]和TBil [（138.3 ± 46.1）μmol/L vs（92.7 ± 32.9）μmol/L]
差异有统计学意义（t = 2.527、P = 0.021，t = 2.412、P = 0.036，t =2.812、P = 0.011），ALP [（287.6 ±
76.7）U/L vs（258.5 ± 68.4）U/L]、γ-GT [（236.8 ± 82.2）U/L vs（198.4 ± 66.8）U/L]差异无统计学
意义（t = 0.997、P = 0.272，t = 0.821、P = 0.338）。治疗1周，常规组和观察组患者ALP [（252.6 ±
58.5）U/L vs（186.5 ± 41.4）U/L]、γ-GT [（192.6 ± 51.2）U/L vs（143.6 ± 39.8）U/L]和TBil [（94.2 ±
38.3）μmol/L vs（62.6 ± 26.4）μmol/L]差异有统计学意义（t = 2.460、P = 0.033，t = 2.288、P =
0.042，t = 2.733、P = 0.014），ALT [（131.5 ± 51.7）U/L vs（118.6 ± 37.3）U/L]和AST [（138.6 ±
64.6）U/L vs（112.2 ± 47.2）U/L]差异无统计学意义（t = 1.960、P = 0.065，t = 1.380、P = 0.198）。
治疗1周后，常规组和观察组显效率分别为6.8%（4/59）、27.0%（17/63），总有效率分别为67.8%
（40/59）、88.9%（56/63），差异均有统计学意义（χ 2 = 8.728、P = 0.003，χ 2 = 8.803、P = 0.004）。
常规组和观察组不良反应发生率分别为3.4%（2/59）、7.9%（5/63），差异无统计学意义（χ 2 =
1.165，P = 0.281）。结论 糖皮质激素治疗急性重度DICLD早期疗效优于SAMe。
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Abstract: Objective To investigate the early curative effects of glucocorticoid on acute severe drug-induced
cholestatic liver disease (DICLD). Methods A total of 122 patients with DICLD in the Second Hospital of
Hohhot from July 2013 to June 2018 were selected and divided into control group and observation group
according to the order of admission. On the basis of discontinue of liver-damaging drugs, liver protection,
omeprazole acid inhibition and nutritional support, patients in control group were treated with S-adensyl-L-
methionyne (SAMe) 1.0 g/(kg·d) and patients in observation group were treated with meprednisone 1.0 mg/(kg·d), the
treatment course was 1 week. Biochemical indicators including alanine aminotransfease (ALT), aspartate
transaminase (AST), total bilirubin (TBil), direct bilirubin (DBil) / indirect bilirubin (IBil), alkaline
phosphatase (ALP), total bile acid (TBA), prealbumin (PA), albumin (ALB) and gamma glutamyltransferase
(γ-GT) were detected. Efficiency, adverse reactions and disease rebound were record. The differences of the
above indexes before and after treatment were compared between the two groups. Results After treatment
for 3 d, the differences of ALT [(211.5 ± 76.2) U/L vs (158.3 ± 61.9) U/L], AST [(169.6 ± 59.2) U/L vs (132.1 ±
47.4) U/L] and TBil [(138.3 ± 46.1) μmol/L vs (92.7 ± 32.9) μmol/L] of patients between control group and
observation group were statistically significant (t = 2.527, P = 0.021; t = 2.412, P = 0.036; t =2.812, P = 0.011),
the difference of ALP [(287.6 ± 76.7) U/L vs (258.5 ± 68.4) U/L] and γ-GT [(236.8 ± 82.2) U/L vs (198.4 ±
66.8) U/L] were not statistically significant (t = 0.997, P = 0.272; t = 0.821, P = 0.338). After treatment for
1 week, the differences of ALP [(252.6 ± 58.5) U/L vs (186.5 ± 41.4) U/L], γ-GT [(192.6 ± 51.2) U/L vs (143.6 ±
39.8) U/L] and TBil [(94.2 ± 38.3) μmol/L vs (62.6 ± 26.4) μmol/L] of patients between control group and
observation group were statistically significant (t = 2.460, P = 0.033; t = 2.288, P = 0.042; t = 2.733, P = 0.014),
the differences of ALT [(131.5 ± 51.7) U/L vs (118.6 ± 37.3) U/L] and AST [(138.6 ± 64.6) U/L vs (112.2 ±
47.2) U/L] were not statistically significant (t = 1.960, P = 0.065; t = 1.380, P = 0.198). After treatment for 1
week, the marked effective rates of control group and observation group were 6.8% (4/59) and 27.0% (17/63),
respectively, the total effective rates were 67.8% (40/59) and 88.9% (56/63), respectively, the differences
were statistically significant (χ 2 = 8.728, P = 0.003; χ 2 = 8.803, P = 0.004). The incidence of adverse reactions
in control group and observation group were 3.4% (2/59) and 7.9% (5/63), respectively, the difference was
not statistically significant (χ 2 = 1.165, P = 0.281). Conclusions The early curative effect of glucocorticoid on
acute severe DICLD is better than SAMe.
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