苯扎贝特联合熊去氧胆酸治疗原发性胆汁性肝硬化的临床效果  

Clinical efficacy of combined use of bezafibrate and ursodeoxycholic acid in treating primary biliary cirrhosis

作　　者：张小玉[1] 张红梅[1] 王雷[1] 臧志栋[1] ZHANG Xiaoyu;ZHANG Hongmei;WANG Lei(Therapeutic Center for Liver Cirrhosis,Nanjing Second Hospital,Nanjing 210003,CHINA)

机构地区：[1]南京市第二医院肝硬化治疗中心

出　　处：《江苏医药》2019年第12期1265-1267,1272,共4页Jiangsu Medical Journal

摘　　要：目的探讨苯扎贝特(BF)联合熊去氧胆酸(UDCA)治疗原发性胆汁性肝硬化(PBC)的临床效果及其对外周血单个核细胞(PBMC)中IL-17/Th17比值的影响。方法PBC患者40例均分为两组:对照组口服UDCA 10 mg/kg,每日2次;观察组加用BF 200 mg/kg口服,每日2次;疗程6个月。收集外周血和肝组织标本,采用流式细胞术测定CD4^+T淋巴细胞/Th17比值,ELISA测定血清IL-17和IL-22水平。比较两组治疗前、后肝功能和肝纤维化指标。结果治疗6个月后,观察组肝组织IL-17/Th17比值和血清IL-17、IL-22和TGF-β水平低于对照组(P<0.05)。血清IL-17水平与TBil、AST、GGT和ALP均呈正相关(P<0.01)。治疗6个月后,观察组血清TBil、ALT、ALP和谷氨酰转肽酶(GGT)水平低于对照组(P<0.05)。结论IL-17/Th17比值在PBC的发病机制中具有重要作用。在UDCA基础上,加用BF治疗可更能有效抑制PBC患者炎性细胞因子水平,改善肝功能和肝纤维化。Objective To investigate the clinical efficacy of combined use of bezafibrate and ursodeoxycholic acid in treating primary biliary cirrhosis and its effect on IL-17/Th17 ratio in peripheral blood mononuclear cells.Methods Forty patients with primary biliary cirrhosis were randomly assigned into two groups with 20 cases each.The patients in group A were treated with bezafibrate 200 mg/kg and ursodeoxycholic acid 10 mg/kg orally twice a day for 60 months and those in group B were treated with ursodeoxycholic acid 10 mg/kg orally twice a day alone.Peripheral blood and liver tissue specimens were collected for the detection of IL-17,IL-22 and TGF-B using flow cytometry and ELISA,and serum levels of ALT,ALP,GGT and TBil.The liver function and hepatic fibrosis indexes were compared between the two groups before and after treatment.Results IL-17/Th17 ratio and serum levels of IL-17,IL-22 and TGF-βafter treatment were lower in group A than those in group B(P<0.05)Serum IL-17 level was positively correlated to TBil,AST,GGT and ALP(P<0.01).Serum levels of TBil,ALT,ALP and GGT after treatment were significantly lower in group A than those in group B(P<0.05).Conclusion The Th17/IL-17 ratio plays an important role in the pathogenesis of PBC.On the basis of ursodeoxycholic acid treatment,additionally use of benzafibrate can more effectively inhibit the expression of inflammatory cytokines,improve liver function and liver fibrosis.

关 键 词：苯扎贝特 胆汁性肝硬化 炎性细胞因子 

分 类 号：R575[医药卫生—消化系统]