维生素D联合前列地尔对熊去氧胆酸应答不佳的原发性胆汁性肝硬化疗效观察  

Clinical observation of Vitamin D combined with Alprostadil for the poor response to ursodeoxycholic acid in primary biliary cirrhosis

作　　者：袁剑峰[1] 张翠芳[1] YUAN J ian- f eng Z HANG Cui-f ang(Department of Infectious Disease, Huangshi Central Hospital, （Affiliated Hospital of Hubei Polytechnic University）, Edong Healthcare Group, Huangshi 435000, Chin)

机构地区：[1]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)感染科,湖北黄石435000

出　　处：《中国中西医结合消化杂志》2017年第9期651-655,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：[目的]探讨维生素D联合前列地尔对熊去氧胆酸应答不佳的原发性胆汁性肝硬变患者的临床疗效。[方法]选取2010年1月-2015年9月在黄石市中心医院感染科治疗的157例的原发性胆汁性肝硬化患者,采用随机数字表法分为2组,分别为常规剂量组(77例)和大剂量组(80例)13-15mg·kg^(-1)·d^(-1)、20-25mg·kg^(-1)·d^(-1)熊去氧胆酸进行治疗,疗程持续6个月。再用随机数字表的方法将熊去氧胆酸应答不佳的81例患者分为维生素D组、前列地尔组和联合组,3组均给予20~25mg·kg^(-1)·d^(-1)熊去氧胆酸治疗,27例维生素D组患者加用维生素D0.02mg/次,1次/d,27例前列地尔组加用前列地尔2ml+10ml生理盐水静脉注射,1次/d,每月治疗7d,联合组加用维生素D+前列地尔,用法用量同前2组。3组均治疗3月,观察治疗前后2组患者肝功能及T淋巴细胞亚群、细胞因子IL-2、TNF-α的变化、并比较治疗有效率和记录不良反应。[结果]常规剂量组(77例)和大剂量组(80例)对于UDCA应答不佳比较[58.4%(45/77)48.2%(39/81)],差异无统计学意义(P>0.05)。治疗后,维生素D组、前列地尔组和联合组总胆红素、谷丙转氨酸、谷草转氨酸、碱性磷酸酶和谷氨酸转移酶均降低,联合组下降程度优于另外2组,维生素D组下降程度优于前列地尔组,差异均具有统计学意义(P<0.05);治疗后,3组CD4^+水平下降,CD8^+水平上升,CD4^+/CD8^+比值下降,同时IL-2及TNF-α水平也较治疗前下降,联合组治疗后CD4^+、CD8^+、CD4^+/CD8^+、IL-2、TNF-α变化差异优于另外2组,维生素D组变化差异优于前列地尔组,差异均具有统计学意义(P<0.05);联合组的总有效率为95.2%(19/21)和维生素D组的71.4%(15/21)要高于前列地尔组47.6%(10/21),差异均具有统计学意义(P<0.05)。[结论]运用维生素D联合前列地尔治疗熊去氧胆酸应答不佳的原发性胆汁性肝硬变患者疗效良好,能够明显改善患者肝功能和免疫功能。[Objective]To investigate the clinical efficacy of primary biliary cirrhosis patients with vitamin D combined with alprostadil for the poor response to ursodeoxycholic acid.[Methods]A total of 157 cases of primary biliary cirrhosis patients admitted into infectious disease department of Huangshi Central Hospital from Jay.2010 to Sep.2015 were randomly divided into conventional-dose group with 77 cases were given 13-15mg·kg^（-1）·d^（-1） ursodeoxycholic acidtreatment,large dosegroup with 80 cases were given 20-25mg·kg^（-1）·d^（-1） ursodeoxycholic acidtreatment,the treatment course was 6 months.The primary biliary cirrhosis patients received ursodeoxycholic acid with poor response divided into vitamin D group and alprostadil group and combination group via the random number table,all patients were given 20-25 mg·kg^（-1）·d^（-1） ursodeoxycholic acidtreatment,27 cases in vitamin D group were given vitamin D 0.02 mg/d,while 27 cases in alprostadil group received 2 mlalprostadil＋10 mlNS（QD,7 times/m）,the combination group was treated with vitamin D＋ alprostadil,dosage of above two groups.The treatment course last for 3 months.The changes of liver function and T lymphocyte subsets,IL-2 and TNF-αwere observed before and after treatment in three groups,and the treatment efficiency and adverse reaction were compared among the groups.[Results]The rate of poor response to ursodeoxycholic acid in conventional dose group and large dose group were respectively 58.4%（45/77）and 48.2%（39/81）,with no statistically significant difference（P〈0.05）.The total bilirubin（TBIL）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,alkaline phosphatase（ALP）and glutamic acid transferase（GGT）of three groups were decreased after treatment,the combination group decreased much more than the other two group,vitamin D group decreased much more than alprostadil group,the differences were statistically significant（P〈0.05）.After treatment,lymphocytes CD8~＋of the 3 gr

关 键 词：维生素D 前列地尔 熊去氧胆酸 原发性胆汁性肝硬化 

分 类 号：R575.2[医药卫生—消化系统]