2020 年第 10 期 第 15 卷

腺苷蛋氨酸干预对乙型肝炎病毒携带者体外循环心脏术后肝功能的影响

Effect of ademethionine on postoperative liver function in Hepatitis B virus carriers undergoing cardiopulmonary bypass

作者：韩博余建波李继勇任长伟戴江来永强周子凡

英文作者：

单位：首都医科大学附属北京安贞医院心脏外科100029

英文单位：Han Bo Yu Jianbo Li Jiyong Ren Changwei Dai Jiang Lai Yongqiang Zhou Zifan

关键词：腺苷蛋氨酸；体外循环；乙型肝炎病毒携带者

英文关键词：Ademethionine;Cardiopulmonarybypass;HepatitisB 

• 摘要：

• 目的 探讨腺苷蛋氨酸作为预充液对乙型肝炎病毒（HBV）携带者行体外循环心脏手术后肝功能的影响。方法 选取2016年5月至2019年5月于首都医科大学附属北京安贞医院行体外循环心脏手术的HBV携带患者88例，通过随机数字表法分为对照组和观察组，各44例。对照组患者术后给予0.9%氯化钠注射液静脉注射，观察组患者术后给予腺苷蛋氨酸+0.9%氯化钠注射液静脉注射，2次/d，连续治疗7 d。观察2组患者术前及术后1、3、7 d肝功能指标、炎症因子及不良反应发生情况。结果 2组患者术前肝功能指标及炎症反应指标差异均无统计学意义（均 P>0.05）。术后1 d，2组血清总胆红素、直接胆红素、天冬氨酸转氨酶（AST）水平均高于本组术前，但观察组低于对照组［(20±16)μmol/L比(29±20)μmol/L，(9.6±6.2)μmol/L比(19.2±7.6)μmol/L，(52±32)U/L比 (79±22)U/L］；胆碱酯酶水平均低于本组术前，但观察组高于对照组［(4 555±1 123)U/L比(3 936±864)U/L］（均P<0.05）。观察组术后1、3、7 d患者总胆红素、直接胆红素、丙氨酸转氨酶、AST水平均低于同时点对照组，胆碱酯酶水平高于同时点对照组（均P<0.05）。观察组术后1、7 d患者肿瘤坏死因子α、白细胞介素8、肌酸激酶同工酶、肌钙蛋白水平均低于同时点对照组，白细胞介素10水平均高于同时点对照组，差异均有统计学意义（均P＜0.05）。观察组患者不良反应发生率与对照组比较，差异无统计学意义［11.4%(5/44）比4.5%(2/44)，χ2=2.920，P=0.085］。结论 HBV携带者体外循环心脏手术后肝功能均有一定程度的损伤，术后短期应用腺苷蛋氨酸，能够改善HBV携带者肝功能，对患者的预后康复效果有积极作用。

• Objective To investigate the efficacy of adenosine methionine on postoperative liver function in Hepatitis B virus(HBV)carriers undergoing cardiopulmonary bypass(CPB). Methods A total of 88 patients carrying HBV and undergoing heart surgery under CPB from May 2016 to May 2019 in Beijing Anzhen Hospital, Capital Medical University were selected. The patients were randomly divided into control group(44 cases) and observation group(44 cases). Patients in control group were given 0.9% sodium chloride injection and observation group were given ademethionine and 0.9% sodium chloridc injection. Both groups received continuous treatment for 7 days, twice per day. The liver function indicators, inflammatory response indexex and adverse reactions were observed before and 1, 3, 7 d after surgery. Results There were no statistically significant differences between the two groups in preoperative liver function index and inflammatory response index(all P>0.05). One day after surgery, serum levels of total bilirubin(TBIL), direct bilirubin(DBIL) and aspartate aminotransferase(AST) in both groups were higher than those before surgery, which in observation group were lower than those in control group［(20±16)μmol/L vs (29±20)μmol/L, (9.6±6.2)μmol/L vs (19.2±7.6)μmol/L, (52±32)U/L vs (79±22)U/L］; cholinesterase levels were lower than those before surgery, cholinesterase level in observation group was higher than that in control group［(4 555±1 123)U/L vs (3 936+864)U/L, all P<0.05］. At 1, 3 and 7 d after surgery, the levels of TBIL, DBIL, alanine aminotransferase(ALT) and AST in observation group were lower than those in control group, and the level of cholinesterase was higher than that in control group at same time point (all P<0.05). The levels of tumor necrosis factor-α, interleukin-8（IL-8）, creatine kinase isoenzyme and cardiac troponin in observation group were lower than those in control group at 1 and 7 d after surgery, and the levels of IL-10 in observation group were higher than those in control group at same time point (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group［11.4%(5/44) vs 4.5%(2/44), χ2=2.920, P=0.085］. Conclusions The liver function of HBV carriers after CPB was aggravated to a certain damage. Short-term application of adenosine methionine after surgery can significantly improve the liver function of HBV carriers and play a positive role in the prognosis and rehabilitation of patients.