中西医结合治疗I型自身免疫性肝炎患者临床疗效研究

Efficacy of western medicine and Chinese traditional medicine in treatment of patients with type I autoimmune hepatitis

目的探讨中西医结合治疗I型自身免疫性肝炎(AIH)患者临床疗效。方法给予13例I型AIH患者胸腺肽、甘草酸二铵和中药方剂:黄芪30 g、、白术10 g、生地黄15 g、山茱萸10 g、白芍15 g、柴胡10 g、当归10 g、郁金10 g、茯苓15 g、薏苡仁15 g、女贞子30 g、牡丹皮10 g、茜草15 g、秦艽10 g、五味子10 g、陈皮6 g、山药15 g,治疗3个月。采用放射免疫法测定透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原肽(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C);使用Navios流式细胞仪检测外周血T细胞亚群;使用西门子BNP Pro Spec全自动特定蛋白分析仪检测血免疫球蛋白。结果治疗后患者血清ALT、AST、GGT、TBIL、ALP、Alb和球蛋白分别为(67.5±12.8)U/L、(48.2±13.6)U/L、(57.2±24.5)U/L、(23.6±5.5)μmol/L、(152.9±35.4)U/L、(32.8±4.4)g/L和(30.6±3.7)g/L,显著低于治疗前【(185.3±51.4)U/L、(198.3±55.2)U/L、(149.3±33.4)U/L、(98.5±26.4)μmol/L、(266.4±40.8)U/L、(37.7±6.1)g/L和(38.4±5.0)g/L,P<0.05】;治疗后血清HA、LN、PC-Ⅲ和Ⅳ-C分别为(179.7±43.6)μg/L、(121.7±35.6)μg/L、(118.5±35.4)μg/L和(143.1±25.8)μg/L,显著低于治疗前【(311.8±72.4)μg/L、(334.2±42.6)μg/L、(253.7±56.4)μg/L和(254.7±42.5)μg/L,P<0.05】;治疗后血清Ig G为(14.52±3.15)g/L,显著低于治疗前【(19.38±3.86)g/L,P<0.05】,但Ig A和Ig M无显著变化;治疗后外周血CD4+、CD8+和CD4+/CD8+比值分别为(0.42±0.04)、(0.30±0.04)和(1.41±0.25),显著高于治疗前【(0.32±0.03)、(0.27±0.02)和(1.20±0.21),P<0.05】;在治疗过程中患者未出现严重的不良反应。结论中西医结合治疗AIH患者临床疗效好,值得临床进一步研究。

Objective To investigate the clinical efficacy of western medicine and Chinese traditional medicine in the treatment of patients with type I autoimmune hepatitis （AIH）. Methods 13 patients with type I AIH were treated with thymosin-α,licorice diammonium and herbal medicine （compound） for 3 months. During the treatment,clinical symptoms and signs,liver function indexes such as alanine aminotransferase （ALT）, aspartate aminotransferase （AST）,γ-glutamyltranspeptidase （GGT）,total bilirubin （TBIL）,alkaline phosphatase （ALP）,albumin （Alb） as well as globulin （Glo）,hepatic fibrosis indexes such as hyaluronic acid （HA）,laminin （LN）,type Ⅲ procollagen （PC-Ⅲ） as well as type Ⅳ collagen （Ⅳ-C）,immunoglobulin （Ig） G,IgA and IgM, and peripheral blood T cell subsets,e.g. CD4＋,CD8＋ and ratio of CD4＋/CD8＋ were observed,and the adverse reactions were recorded. Results At the end of three month treatment,serum ALT,AST,GGT,TBIL,ALP,Alb and Glo levels were （67.5±12.8） U/L,（48.2±13.6） U/L,（57.2±24.5） U/L,（23.6±5.5）μmol/L,（152.9±35.4） U/L, （32.8±4.4） g/L and（30.6±3.7） g/L,respectively,significantly lower than those before treatment [（185.3±51.4） U/L, （198.3±55.2） U/L,（149.3±33.4） U/L,（98.5±26.4）μmol/L,（266.4±40.8） U/L,（37.7±6.1） g/L and （38.4±5.0） g/L, respectively,P〈0.05 for all];serum HA,LN,PC- Ⅲ and Ⅳ-C levels declined [（179.7±43.6）μg/L vs. （311.8±72.4）μg/L,（121.7±35.6）μg/L vs. （334.2±42.6）μg/L,（118.5±35.4）μg/L vs. （253.7±56.4）μg/L and （143.1±25.8） μg/L vs.（254.7±42.5） μg/L,respectively,P〈0.05 for all];Blood IgG levels was significantly decreased compared to that before treatment [（14.52±3.15） g/L vs.（19.38±3.86） g/L,P〈0.05],but blood IgA and IgM levels remained unchanged;Peripheral CD4＋,CD8＋ and ratio of CD4＋/CD8＋ improved [（0.42±0.04） vs. （0.32±0.03）,（0.30±0.04） vs. （0.27±0.02） and （1.41±0.25） vs. （1.20 ±0.21）,respectively,P 〈0.05 for all];No serious adverse reactions was noticed during the treatment. Conclusion Combination of western medicine and Chinese herbal medicine exhibites satisfactory efficacy in the treatment of patients with type I AIH, which warrants further investigation.