阿昔洛韦与还原型谷胱甘肽联合复方甘草酸苷对传染性单核细胞增多症合并肝功能异常患儿病情与预后的影响

Effect of acyclovir and reduced glutathione combined with compound glycyrrhizin on the condition and prognosis of children with infectious mononucleosis complicated with hepatic insufficiency

摘要:

目的 探讨予以传染性单核细胞增多症（IM）合并肝功能异常患儿阿昔洛韦与还原型谷胱甘肽联合复方甘草酸苷治疗的效果。方法 选择2022年1月至2024年6月吉安市第一人民医院收治的80例IM合并肝功能异常患儿，按随机数字表法分为对照组（采用阿昔洛韦与还原型谷胱甘肽治疗）和观察组（采用阿昔洛韦与还原型谷胱甘肽联合复方甘草酸苷治疗），各40例。两组均持续治疗1周。对比两组临床疗效、临床症状改善时间、肝功能指标〔丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和γ谷氨酰转肽酶（GGD）〕、免疫指标、不良反应、疾病预后。结果 观察组临床总有效率（95.00%）高于对照组（80.00%）（P＜0.05）；观察组三联征消失、肝脏恢复正常、异型淋巴细胞恢复正常、肝脾恢复正常时间分别为（5.20±1.27）d、（7.82±1.34）d、（8.86±1.54）d、（10.04±2.03）d，均短于对照组的（7.22±1.48）d、（9.26±1.76）d、（10.24±2.02）d、（12.65±2.67）d（P＜0.05）；观察组治疗后ALT、AST、GGD水平分别为（32.38±4.11）U/L、（29.36±4.44）U/L、（43.47±7.29）U/L，均低于对照组的（40.46±5.25）U/L、（35.36±5.14）U/L、（52.56±8.47）U/L（P＜0.05）；观察组治疗后CD3⁺、CD8⁺水平分别为（66.63±6.25）%、（35.37±4.08）%，低于对照组的（72.76±6.13）%、（44.43±5.17）%，CD4⁺、CD4⁺/CD8⁺水平分别为（38.37±4.96）%、（1.14±0.21）%，高于对照组的（32.37±4.43）%、（0.79±0.18）%，有统计学差异（P＜0.05）；两组不良反应发生率相近，差异无统计学意义（P＞0.05）；观察组EBV DNA转阴率（95.00%）高于对照组（80.00%）（P＜0.05）。结论 阿昔洛韦与还原型谷胱甘肽联合复方甘草酸苷在IM合并肝功能异常患儿中疗效显著，可有效促进其临床症状恢复，改善肝功能与免疫指标水平，且不会增加不良反应的发生，还可提升病毒清除能力，有利于改善疾病预后。

关键词:传染性单核细胞增多症; 肝功能异常; 阿昔洛韦; 还原型谷胱甘肽; 复方甘草酸苷; 病情; 预后

Abstract:

Objective To investigate the therapeutic effect of acyclovir and reduced glutathione combined with compound glycyrrhizin on children with infectious mononucleosis (IM) complicated with hepatic insufficiency.Methods A total of 80 children with infectious mononucleosis complicated with hepatic insufficiency admitted to Ji'an First People's Hospital from January 2022 to June 2024 were randomly divided into the control group (treated with acyclovir and reduced glutathione) and the observation group (treated with acyclovir and reduced glutathione combined with compound glycyrrhizin) using a random number table method, with 40 cases in each group. Both groups received continuous treatment for 1 week. The clinical efficacy, symptom improvement, liver function indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transpeptidase (GGD)], immune indicators, adverse reactions, and disease prognosis between two groups were compared.Results The total clinical effective rate of the observation group (95.00%) was higher than that of the control group (80.00%) (P＜0.05); The time for the disappearance of the triad, restoration of liver function, restoration of atypical lymphocytes, and restoration of liver and spleen function in the observation group were (5.20±1.27) d, (7.82±1.34) d, (8.86±1.54) d, (10.04±2.03) d, respectively, which were shorter than those in the control group [(7.22±1.48) d, (9.26±1.76) d, (10.24±2.02) d, and (12.65±2.67) d], with statistical differences (P＜0.05); The levels of ALT, AST, and GGD in the observation group after treatment were (32.38±4.11) U/L, (29.36±4.44) U/L, and (43.47±7.29) U/L, respectively, which were lower than those in the control group [(40.46±5.25) U/L, (35.36±5.14) U/L, and (52.56±8.47) U/L], with statistical differences (P＜0.05); After treatment, the levels of CD3⁺ and CD8⁺ in the observation group were (66.63±6.25)% and (35.37±4.08)%, respectively, which were lower than those in the control group [(72.76±6.13)% and (44.43±5.17)%]. The levels of CD4⁺ and CD4⁺/CD8⁺ were (38.37±4.96)% and (1.14±0.21)%, respectively, which were higher than those in the control group [(32.37±4.43)% and (0.79±0.18)%], with statistical differences (P＜0.05); The incidence of adverse reactions in the two groups was similar, with no statistically significant difference (P＞0.05); The EBV DNA conversion rate in the observation group (95.00%) was higher than that in the control group (80.00%) (P＜0.05). Conclusion Acyclovir and reduced glutathione combined with compound glycyrrhizin has significant therapeutic effects in children with IM complicated with hepatic insufficiency. It can effectively promote the recovery of clinical symptoms, improve liver function and immune index levels, and does not increase the occurrence of adverse reactions. It can also enhance virus clearance ability, which is beneficial for disease prognosis.

Key words:Infectious mononucleosis; Abnormal liver function; Acyclovir; Reduced glutathione; Compound glycyrrhizin; Medical condition; Prognosis