目的 觀察左卡尼汀聯(lián)合葡醛內(nèi)酯治療巨細胞病毒感染所致小兒肝損傷的臨床療效和安全性.方法 選取2010年3月—2014年3月天津市兒童醫(yī)院內(nèi)科收治的巨細胞病毒感染致肝功能損傷患兒84例,回顧性的分為治療組(40例)和對照組(44例).兩組患兒均靜脈滴注更昔洛韋注射液5 mg/(kg·次),2次/d作為基礎治療,同時給予對癥支持治療.對照組加服葡醛內(nèi)酯片1片/次,3次/d.治療組在對照組基礎上加用左卡尼汀口服溶液,1 g/次,1次/d.兩組均連續(xù)治療7 d以上.比較兩組的臨床療效,同時觀察兩組患者治療7 d時,肝功能主要指標丙氨酸氨基轉(zhuǎn)移酶(ALT)、門冬氨酸轉(zhuǎn)氨酶(AST)、總膽紅素(TBIL)、堿性磷酸酶(ALP)、血清γ-谷氨酰轉(zhuǎn)肽酶(GGT)、總蛋白(TP)的變化.結(jié)果 治療后,治療組和對照組的總有效率分別為95.00%、72.73%,兩組總有效率比較差異有統(tǒng)計學意義(P<0.05).兩組患兒治療7 d后,肝功能主要指標ALT、AST、TBIL、ALP、GGT均較治療前顯著降低,TP水平較治療前顯著增高,同組治療前后差異有統(tǒng)計學意義(P<0.05);且治療后,治療組ALT、AST、ALP、GGT水平均低于對照組,TP高于對照組,兩組比較差異有統(tǒng)計學意義(P<0.05).結(jié)論 左卡尼汀聯(lián)合葡醛內(nèi)酯治療巨細胞病毒感染致小兒肝損傷具有較好的臨床療效,可降低肝功能主要指標水平,其保護肝臟、降酶的作用明顯優(yōu)于單用葡醛內(nèi)酯.

Objective To investigate the clinical effect and safety of levocarnitine combined with glucurolactone in treatment of infantile liver injury induced by cytomegalovirus. Methods Patients (84 cases)with infantile liver injury induced by cytomegalovirus from Tianjin Children's Hospital from March 2010 to August 2013 were retrospectively divided into treatment (n=40) and control (n=44) groups. The patients in the two groups were iv administered with Ganciclovir Injection as foundation treatment, 5 mg/(kg·time), twice daily, and they were given support therapy. The patients in the control group were po administered with Glucurolactone Tablets, 1 tablet/time, three times daily. The patients in the treatment group were po administered with Levocarnitine Oral Solution at the basis of the control group, 1 g/time, once daily. The patients in the two groups were treated for more than 7 d. After the treatment, the efficacy was evaluated, while the changes of main indicators of liver function including ALT, AST, TBIL, ALP, GGT, and TP in two groups were compared. Results The efficacies in the treatment and control groups were 95.00% and 72.73%, respectively, and there were differences between the two groups (P < 0.05). After the treatment, ALT, AST, TBIL, ALP, and GGT in two groups were significantly reduced, while TP was increased, and the difference was statistically significant in the same group (P < 0.05). After the treatment, the levels of ALT, AST, ALP, and GGT in the treatment group were lower than those in the control group, and TP was higher than that in the control group, with significant difference between two groups (P < 0.05). Conclusion Levocarnitine combined with glucurolactone has good clinical effect in treatment of infantile liver injury induced by cytomegalovirus, can reduce the levels of main indicators of liver function, and its liver protective and declining enzyme actions are superior to glucurolactone lonely.