UDCA联合维生素D治疗原发性胆汁性肝硬化患者外周血T细胞亚群变化及其对疗效的影响  

Changes of peripheral blood T lymphocyte subsets and efficacy of ursodesoxycholic acid and vitam in D combination in treatment of patients with primary biliary cholangitis

作　　者：陈小君 宋洋 

机构地区：[1]广东省深圳市龙岗区第二人民医院内科,518000 [2]深圳市人民医院消化内科

出　　处：《实用肝脏病杂志》2018年第1期80-83,共4页Journal of Practical Hepatology

摘　　要：目的探讨补充外源性维生素D辅助熊去氧胆酸(UDCA)治疗原发性胆汁性肝硬化(PBC)患者外周血T细胞亚群的变化及其效果。方法 2014年1月~2015年12月我院收治的PBC患者92例,采用随机数字表法均分为两组,每组46例。对照组常规应用UDCA治疗,观察组采用口服维生素D联合UDCA治疗。使用美国Roche E-602全自动免疫分析仪及其配套试剂检测外周血25-羟基维生素D[25(OH)D],使用流式细胞术检测外周血CD4^+Treg和Th17细胞水平。结果治疗前两组实验室检测指标水平差异无统计学意义(P>0.05);治疗1年后,观察组外周血25(OH)D为(18.2±6.8)ng/ml,明显高于对照组【(15.1±5.0)ng/ml,P<0.05】,Th17细胞占比为(1.4±0.4)%,明显低于对照组【(2.0±0.5)%,P<0.05】,CD4^+Treg细胞占比为(3.5±0.8)%,明显高于对照组【(3.1±0.4)%,P<0.05】,外周血丙氨酸氨基转移酶(ALT)为(41.8±31.5)U/L,明显低于对照组【(68.8±33.5)U/L,P<0.05】,天门冬氨酸氨基转移酶(AST)为(37.5±30.7)U/L,明显低于对照组【(68.2±35.3)U/L,P<0.05】,碱性磷酸酶(ALP)为(131.7±62.8)U/L,明显低于对照组【(237.7±105.8)U/L,P<0.05】,γ-谷氨酰转肽酶(GGT)为(71.8±35.8)U/L,明显低于对照组【(121.7±41.2)U/L,P<0.05】;治疗前后血清25(OH)D水平与CD4^+Treg细胞占比呈正相关(P<0.05),而CD4^+Treg细胞与GGT和ALP水平呈正相关(P<0.05)。结论补充外源性维生素D有助于改善PBC患者病情,可能与其对CD4^+Treg细胞的激活作用有关。Objective To investigate the changes of peripheral blood T lymphocyte subsets and efficacy of ursodesoxycholic acid （UDCA） and vitamin D combination in treatment of patients with primary biliary cholangitis （PBC）. Methods A total of 92 patients with PBC were randomly divided into two groups in our hospital between January 2014 and December 2015. The patients in control group were treated with UDCA,while the patients in observation group with oral vitamin D and UDCA. The serum levels of 25-hydroxy vitamin D [25 （OH）D],peripheral blood CD4CFreg and Thl7 cells,and liver function index before and after treatment were obtained. Results Before treatment,the differences of all indexes between the two groups were not statistically significantly different （P〉0.05）;At the end of one-year treatment,serum 25（OH）D levels and proportion of CD4＋ Treg cells in the observation group were significant higher （P〈0.05）,while the proportion of TM7 cells,alanine aminotransferas （ALT）, aspartate transaminas （AST） level, alkaline phosphatas （AEP） level, and Y-glutamyltrans- ferase （GGT） levels were significantly lower than in the control group （P〈0.O5）;the proportion of CD4qYeg cells was significantly positively correlated with peripheral 25（OH）D and GGT levels（P〈0.05）. Conclusion Vitamin D supplementation is beneficial for the treatment of PBC patients,which may be related to the activation of CD4＋ Treg cells.

关 键 词：原发性胆汁性肝硬化 维生素D 辅助性 T细胞 治疗 

分 类 号：R575.22[医药卫生—消化系统]