S-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁／焦虑的临床效果研究

目的：研究s-腺苷蛋氨酸治疗胆汁淤积性肝病伴抑郁／焦虑患者的临床效果。方法：选择2011年3月-2013年3月我院收治的51例不同病因的胆汁淤积性肝病（药物性肝损害13例、慢性乙型肝硬化14例、酒精性肝硬化11例、自身免疫性肝病6例、肝癌5例、胆管癌2例）并抑郁／焦虑的患者，予s-腺苷蛋氨酸1．0g治疗2周，应用SDS／SAS量表分别评估和比较治疗前后各组患者抑郁／焦虑程度的评分情况。结果：S-腺苷蛋氨酸治疗后，所有组别胆汁淤积性肝病肝病改善的临床总有效率94．12％，其中药物性肝损害、慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝硬化总有效率均为100．00％，肝癌的有效率为60．00％，胆管癌的有效率为50．00％，药物性肝损害患者临床疗效与其他各组有差异（P〈0．05）；药物性肝病患者SDS和SAS评分均较治疗前显著降低（P〈0．05）。而慢性乙型肝硬化、酒精性肝硬化、自身免疫性肝病、肝癌、胆管癌患者SDS和SAS评分与治疗前相比均无统计学差异（P〉0．05）。结论：S-腺苷蛋氨酸可改善药物性胆汁淤积性肝病并轻、中度抑郁／焦虑患者的肝功能，并有效减轻其抑郁／焦虑情绪。

Research on S-adenosylmethionine in the Treatment of Patients of Cholestatic Liver Diseases Associated with Anxiety/depression

Objective： To study the clinical effects of S-adenosyl methionine for patients with cholestatic liver disease associated with depression or anxiety. Methods： 51 patients with different causes of cholestatic liver diseases （13 cases of drug-induced liver injury, 14 cases of chronic hepatits B cirrhosis, 11 cases of alcoholic cirrhosis, 6 cases of autoimmune liver disease, 5 cases of hepatocellular carcinoma and 2 cases of cholangiocarcinoma） and depression or anxiety were selected in our hospital from March 2011 to March 2013 and treated with intravenous use of S-adenosyl methionine 1.0 g for 2 weeks. Then, Zung＇s SDS / SAS assessment were applied to compare the effects in these groups. Results： After treatment with S-adenosylmethionine, the total effetive ratio of all cholestatic liver diseases was 94.12%, including 100.00% in drug-induced liver injury, chronic hepatits B cirrhosis, alcoholic cirrhosis and autoimmune liver disease, 60.00% in hepatocellular carcinoma and 50.00% in cholangiocarcinoma. There was significant statistical differences between drug-induced cholestatic liver disease and the other groups （P〈0.05）. Scores of SDS and SAS significantly decreased in patients with drug-induced cholestatic liver disease after treated with S-adenosylmethionine （P〈0.05）, however, it seemed no change in chronic cholestatic liver disease （cirrhosis, autoimmune liver disease） as well as in hepatobiliary cancer （hepatocellular carcinoma, cholangiocarcinoma）. Conclusion： S-adenosylmethionine could improve the liver function in patients with drug-induced cholestatic liver disease associated with mild and moderate depression or anxiety, and effectively better their depressive or anxious mood.