熊去氧胆酸联合糖皮质激素治疗原发性胆汁性肝硬化伴自身免疫性肝炎特征的疗效观察

Ursodeoxycholic acid combined with glucocorticoids for treatment of primary biliary cirrhosis with characteristics of autoimmune hepatitis

目的回顾性研究熊去氧胆酸(ursodeoxycholic acid,UDCA)联合糖皮质激素治疗原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)伴自身免疫性肝炎(autoimmune hepatitis,AIH)特征的临床疗效.方法根据不同治疗方案回顾性的将31例PBC伴AIH特征的患者分为单用UDCA组和UDCA联合糖皮质激素组,根据患者肝脏病理炎症(G)、纤维化(S)程度分为两组:炎症程度≤G2,纤维化程度≤S2为病理早期组,炎症程度>G2、纤维化程度>S2为病理晚期组.回顾性分析不同方案治疗前后的血生化指标、免疫球蛋白指标、肝脏组织病理学变化及应答状况等方面的改变.结果治疗后两组生化指标碱性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰转肽酶(γ-glutamyl transferase,GGT)及免疫球蛋白M(immunoglobulin M,IgM)水平均较治疗前有所下降,其中ALP、IgM改善有统计学意义(P<0.05).联合治疗组的谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶、GGT、ALP、球蛋白、免疫球蛋白较基线水平明显改善.不同治疗组在ALT、免疫球蛋白G、ALP的生化学应答率上无统计学意义(P>0.05),但联合治疗组应答率更高.不同病理分期患者ALP应答率有统计学意义(P<0.05).联合治疗组患者的肝组织炎症程度或纤维化的程度及范围及胆管损害较治疗前有明显改善.结论对于PBC伴AIH特征的患者,需尽早明确诊断,建议在UDCA的基础治疗上积极加用糖皮质激素,更好地控制疾病的进展.

AIM To observe the efficacy of ursodeoxycholic acid（UDCA） combined with glucocorticoids in the treatment of primary biliary cirrhosis（PBC）with characteristics of autoimmune hepatitis（AIH）.METHODS Thirty-one patients with PBC with AIH characteristics were divided into two group：a UDCA alone group and a UDCA combined with glucocorticoid group.Blood biochemical indexes before and after treatment were retrospectively analyzed.Immunoglobulin indexes,liver pathological changes,and the status of response to treatment were also observed.RESULTS In both groups,the levels of alkaline phosphatase（ALP）,γ-glutamyl transferase（GGT） and immunoglobulin M（IgM）decreased after therapy,and the improvement of ALP and IgM had statistical significance（P〈0.05）.In the combination group,alanine transaminase,aspartate transaminase,GGT,ALP,globulin,and immunoglobulin obviously improved compared with baseline values.Biochemical responses showed no significant difference between the two groups,although the combination group had a higher response rate.In patients with different pathological stages of disease,ALP response rate was statistically significant（P〈0.05）.The degree and extent of liver inflammation or fibrosis and bile duct damage significantly improved after treatment in the combination group.CONCLUSION For patients with PBC with AIH characteristics,a definitive diagnosis should be achieved as early as possible.UDCA plus glucocorticoid treatment is recommended to better control the progression of the disease.