标准免疫抑制疗法联合异甘草酸镁治疗自身免疫性肝炎患者外周血B细胞和调节性B细胞变化  

Peripheral blood regulatory B cell subset changes in patients with autoimmune hepatitis undergoing magnesium isoglycyrrhizinate and standard immunosuppressive therapy

作　　者：陈雅君 朱婧 李璐[3] 何钦 Chen Yajun;Zhu Jing;Li Lu(Department of Pharmacy,Integrated Chinese and Western Medicine Hospital,Suzhou 215101,Jiangsu Province,China)

机构地区：[1]江苏省苏州市中西医结合医院药剂科,215101 [2]昆山市第四人民医院药剂科 [3]苏州大学附属第三医院检验科

出　　处：《实用肝脏病杂志》2023年第6期835-838,共4页Journal of Practical Hepatology

基　　金：江苏省自然科学基金面上项目(编号:BK20211252)。

摘　　要：目的观察应用标准免疫抑制疗法联合异甘草酸镁治疗自身免疫性肝炎(AIH)患者的疗效及其外周血调节性B细胞的变化。方法2017年4月~2022年4月我院收治的108例AIH患者被分为对照组54例和观察组54例,分别接受标准的免疫抑制治疗方案或在此治疗的基础上加用异甘草酸镁口服治疗半年。采用免疫浊度试验法检测血清免疫球蛋白,使用流式细胞仪检测外周血B细胞和调节性B细胞百分比。结果在治疗半年末,观察组生化学应答率为85.2%,显著高于对照组的66.7%(P<0.05);观察组血清ALT、AST和ALP水平分别为(51.2±7.6)U/L、(46.2±8.6)U/L和(67.4±2.4)U/L,均显著低于对照组【分别为(80.3±8.5)U/L、(75.7±6.4)U/L和(89.7±2.6)U/L,P<0.05】;两组血清IgG、IgM和血清GLO水平与对照组比无显著性统计学差异(P>0.05);观察组外周血CD19^(+)B细胞、CD19^(+)IL-10^(+)B细胞、CD19^(+)CD24^(hi)CD38^(hi)调节性B细胞和CD19^(+)CD24^(hi)CD27^(+)调节性B细胞百分比分别为(7.1±2.6)%、(0.6±0.2)%、(2.9±1.0)%和(5.7±1.3)%,均显著高于对照组【分别为(5.2±1.8)%、(0.4±0.1)%、(2.2±0.9)%和(4.3±1.2)%,P<0.05】,而CD19^(+)CD27^(+)CD38^(++)浆细胞和CD19^(+)CD27^(-)CD38^(-/+)幼稚B细胞百分比分别为(4.2±1.2)%和(56.2±7.9)%,均显著低于对照组【分别为(6.5±1.7)%和(70.5±7.4)%,P<0.05】。结论应用标准的免疫抑制联合异甘草酸镁治疗AIH患者可提高生化学应答率,有助于改善肝功能,可能与对外周血调节性B细胞具有调节作用有关。Objective The aim of this study was to observe the efficacy and peripheral blood regulatory B cell subset changes in patients with autoimmune hepatitis(AIH)undergoing magnesium isoglycyrrhizinate and standard immunosuppressive therapy.Methods 108 patients with AIH were encountered in our hospital between April 2017 and April 2022,and were randomly divided into control(n=54)and observation(n=54)group,receiving standard immunosuppression treatment or oral magnesium isoglycyrrhizinate at base of it for six month.Serum immunoglobulin levels were detected by immunoturbidimetry,and peripheral blood B cell and regulatory B cell subsets were detected by FCM.Results At the end of six-month treatment,the biochemical response rate in the observation group was 85.2%,much higher than 66.7%(P<0.05)in the control;serum ALT,AST and ALP level were(51.2±7.6)U/L,(46.2±8.6)U/L and(67.4±2.4)U/L,all significantly lower than[(80.3±8.5)U/L,(75.7±6.4)U/L and(89.7±2.6)U/L,respectively,P<0.05]in the control;there were no significant differences as respect to serum IgG,IgM and globulin levels between the two groups(P>0.05);the percentages of peripheral blood CD19^(+)B cell,CD19^(+)IL-10^(+)B cell,CD19^(+)CD24^(hi) CD38^(hi) regulatory B cell and CD19^(+)CD24^(hi) CD27^(+)regulatory B cell were(7.1±2.6)%,(0.6±0.2)%,(2.9±1.0)%and(5.7±1.3)%,all significantly higher than[(5.2±1.8)%,(0.4±0.1)%,(2.2±0.9)%and(4.3±1.2)%,respectively,P<0.05],while the percentages of blood CD19^(+)CD27^(+)CD38^(++)plasma cell and CD19^(+)CD27^(-)CD38^(-/+)na ve B cell were(4.2±1.2)%and(56.2±7.9)%,both much lower than[(6.5±1.7)%and(70.5±7.4)%,P<0.05]in the control.Conclusion The administration of standardized immunosuppressant and magnesium isoglycyrrhizinate combination therapy in the treatment of patients with AIH is efficacious,with a promising biochemical response,which might be related to the roles on modulation of peripheral blood regulatory B cells.

关 键 词：自身免疫性肝炎 标准的免疫抑制疗法 异甘草酸镁 调节性B细胞 治疗 

分 类 号：R575.1[医药卫生—消化系统]