还原型谷胱甘肽对肝硬化患者上消化道大出血前后血中GSH-Px/LPO比值的影响

目的　观察肝硬化患者上消化道大出血前后血中谷胱甘肽 (GSH)水平和谷胱甘肽过氧化物酶 (Se GSH Px)活性与过氧化脂质 (LPO)比值的动态变化及还原型谷胱甘肽治疗的影响。方法　 57例患者随机分为常规治疗和还原型谷胱甘肽防治两组 ,前者给常规止血、保肝治疗 ,后者在常规治疗基础上加用还原型谷胱甘肽静滴 (1.2g·d- 1,连用3～ 4周 )。定时空腹采血 ,测定血中GSH水平、Se GSH Px活性和LPO含量 ,并观察记录两组患者发生腹水或腹水增多、黄疸或黄疸加深、肝性脑病和病死 4个病情恶化指标的累计频次数。结果　上消化道出血后常规治疗组患者血中GSH水平、Se GSH Px/LPO比值均明显下降 ,72h达最低点 ,2周后开始回升。还原型谷胱甘肽防治组上述损伤改变较小 ,回升快 ,2周后显著恢复 ,4周后即可达到出血前水平。还原型谷胱甘肽防治组患者 4个病情恶化指标的累计频次数明显低于常规治疗组 (2 4/ 2 7;41/ 3 0 ,P <0 .0 1) ,且与Child Pugh分级有关 ,B级优于C级 (6/ 12 ;17/ 7,P <0 .0 1)。结论　肝硬化患者上消化道大出血后体内抗氧化能力降低 ,致患者的病情恶化。抗氧化治疗有积极意义

Effect of glutathoine on the dynamic changes of GSH levels and GSH-Px/LPO ratio in liver cirrhosis patients with massive upper gastrointestinal hemorrhage

Objective To study the effects of glutathoine on the dynamic changes of GSH levels and GSH-Px/LPO ratio in liver cirrhosis patie nts with massive upper gastrointestinal hemorrhage. Methods After the patients were treated with glutathoine (1 .2～1.6g·d -1 , iv.) for 3～4 weeks, the glutathoine (GSH) level in blood, the glutathoine peroxidase (Se-GSH-Px) activity and the lipid peroxide (LPO) l evel in plasma were determined. Meanwhile, the clinical significance of glutatho ine therapy on the patients was observed. Results The GSH levels and GSH-Px/LPO ratio in all patient s were decreased significantly after bleeding stopped. The lowest points of GSH levels and GSH-Px/LPO ratio were observed at 72h after bleeding stopped. But th e Se-GSH-Px/LPO ratio in the patients treated with glutathoine was higher than that of controls ( P < 0.01 ), and the recovery changes were observed earli er at 2w after bloodless. A better prognosis correlated with Child-Pugh degree was observed in the patients treated with glutathoine, too. Conclusion The antioxidative capability of patients with li ver cirrhosis is decreased after massive upper gastrointestinal hemorrhage, and glutathoine therapy can increase the patients' GSH-Px/LPO ratio and improve th eir prognosis.