泼尼松和硫唑嘌呤联合熊去氧胆酸治疗自身免疫性肝炎患者疗效研究  

Combination of ursodeoxycholic acid and prednisone and azathioprine in the treatment of patients with autoimmune hepatitis

作　　者：聂柳 彭罕鸣[1] 廖东亮 Nie Liu;Peng Hanming;Liao Dongliang(Second Department of Gastroenterology,Children's Hospital Affiliated to Tongji Medical College,Huazhong University of science and technology,Wuhan 430000,Hubei Province,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院消化二内科,武汉市430000 [2]武汉市普仁医院肿瘤科

出　　处：《实用肝脏病杂志》2021年第2期224-227,共4页Journal of Practical Hepatology

基　　金：武汉市科技局科研计划项目(编号201806232)。

摘　　要：目的观察应用泼尼松和硫唑嘌呤联合雄去氧胆酸治疗自身免疫性肝炎(AIH)患者的疗效及对血清补体C3和C4水平的影响。方法2017年2月~2019年12月我院消化内科诊治的120例AIH患者被随机分为对照组60例和观察组60例,分别给予泼尼松和硫唑嘌呤治疗或两者联合熊去氧胆酸治疗,平均治疗21.4个月。采用免疫比浊法检测血清免疫球蛋白M(IgM)、IgG和IgA水平,采用散射比浊法检测血清补体C3和C4水平。结果在治疗结束时,观察组血清谷丙转氨酶(ALT)水平为(55.2±6.9)U/L,显著低于对照组【(91.2±12.8)U/L,P<0.05】,血清谷草转氨酶(AST)水平为(59.7±7.5)U/L,显著低于对照组【(101.5±13.5)U/L,P<0.05】,血清碱性磷酸酶(ALP)水平为(122.4±15.7)U/L,显著低于对照组【(138.9±15.2)U/L,P<0.05】,血清谷氨酰转肽酶(GGT)水平为(120.7±10.1)U/L,显著低于对照组【(161.5±20.7)U/L,P<0.05】;观察组血清补体C3水平为(0.6±0.1)g/L,显著低于对照组【(0.8±0.2)g/L,P<0.05】,观察组血清补体C4水平为(0.1±0.1)g/L,显著低于对照组【(0.2±0.1)g/L,P<0.05】;观察组血清IgG水平为(12.5±2.0)g/L,显著低于对照组【(20.4±2.7)g/L,P<0.05】,观察组血清IgM水平为(2.7±0.9)g/L,显著低于对照组【(3.4±1.1)g/L,P<0.05】。结论应用泼尼松龙和硫唑嘌呤联合熊去氧胆汁酸治疗AIH患者可有效降低血清C3和C4水平,改善机体的免疫功能紊乱,改善肝功能指标,近期疗效值得关注。Objective The aim of this study was to observe the efficacy of combination of ursodeoxycholic acid(UDCA)and prednisone and azathioprine in the treatment of patients with autoimmune hepatitis(AIH).Methods 120 AIH patients were recruited in the Department of Gastroenterology in our hospital between February 2017 and December 2019,and were randomly divided into control and observation groups with 60 cases in each group.The patients in the control received prednisone and azathioprine,while those in the observation group received UDCA at base of prednisone and azathioprine therapy.The regimen lasted for 21 months.Serum complement 3(C3),C4,as well as immunoglobulin were detected.Results At the end of the treatment,serum alanine aminotransferase level in the observation group was(55.2±6.9)U/L,significantly lower than【(91.2±12.8)U/L,P<0.05】,serum aspartate aminotransferase level was(59.7±7.5)U/L,significantly lower than【(101.5±13.5)U/L,P<0.05】,serum alkaline phosphatase level was(122.4±15.7)U/L,much lower than【(138.9±15.2)U/L,P<0.05】,and serum glutamyl transpeptidase level was(120.7±10.1)U/L,significantly lower than【(161.5±20.7)U/L,P<0.05】in the control;serum C3 level in the observation was(0.6±0.1)g/L,significantly lower than【(0.8±0.2)g/L,P<0.05】,and serum C4 level was(0.1±0.1)g/L,significantly lower than【(0.2±0.1)g/L,P<0.05】in the control;serum IgG level in the observation group was(12.5±2.0)g/L,significantly lower than【(20.4±2.7)g/L,P<0.05】,and serum IgM level was(2.7±0.9)g/L,significantly lower than【(3.4±1.1)g/L,P<0.05】in the control.Conclusion The administration of ursodeoxycholic acid at base of prednisolone and azathioprine combination in the treatment of patients with AIH could effectively reduce serum C3 and C4 levels,improve immune functions and alleviate liver injury,which needs further investigation.

关 键 词：自身免疫性肝炎 熊去氧胆酸 泼尼松 硫唑嘌呤 补体C3 补体C4 治疗 

分 类 号：R575.1[医药卫生—消化系统]