熊去氧胆酸联合泼尼松及硫唑嘌呤治疗自身免疫性肝炎疗效及对血清免疫球蛋白的影响

Clinical Effect of Ursodeoxycholic Acid Combined with Prednisone and Azathioprine in the Treatment of Autoimmune Hepatitis and Its Effect on Serum Immunoglobulin

目的探讨熊去氧胆酸联合泼尼松及硫唑嘌呤治疗自身免疫性肝炎(AIH)疗效及对血清免疫球蛋白的影响。方法选取医院2014年12月至2016年6月收治的AIH患者116例,按治疗方式的不同分为观察组和对照组,各58例。两组患者均给予泼尼松及硫唑嘌呤免疫抑制剂治疗,观察组患者联合熊去氧胆酸治疗。结果观察组的治疗总有效率为89. 66%,高于对照组的74. 14%(χ2=4. 710,P=0. 030);治疗后,两组患者丙氨酸氨基转移酶(ALT)、天门冬酸氨基转移酶(AST)、血清总胆红素(TBil)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)水平均较治疗前降低,白蛋白(ALB)水平均较治疗前上升(P <0. 05),且观察组ALT,AST,TBil,ALP,γ-GT水平较对照组下降明显(P <0. 05),ALB水平比较无差异(P> 0. 05);两组患者免疫球白蛋白(IgM和IgG)均较治疗前下降(P <0. 05),且观察组优于对照组(P <0. 05);两组患者不良反应总发生率比较(6. 90%比5. 17%)无明显差异(χ2=0. 152,P=0. 697)。结论熊去氧胆酸联合泼尼松及硫唑嘌呤治疗AIH临床疗效显著,可有效改善肝功能,降低血清免疫球蛋白水平,安全、可靠。

Objective To investigate the clinical effect of ursodeoxycholic acid combined with prednisone and azathioprine in the treatment of autoimmune hepatitis(AIH)and its effect on serum immunoglobulin.Methods Totally 116 patients with AHI admitted to our hospital from December 2014 and June 2016 were selected and divided into the observation group and the control group according to the different treatment methods,58 cases in each group.The patients in the two groups were treated with prednisone and azathioprine immunosup pressive agents,on this basis,the patients in the observation group were given ursodeoxycholic acid.Results The total effective rate of the observation group was 89.66%,which was higher than 74.14%of the control group(χ^2=4.710,P=0.030).After treatment,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum total bilirubin(TBil),alkaline phosphatase(ALP),γ-glutamyl transpeptidase(γ-GT)in the two groups were lower than those before treatment,and the levels of ALB in the two groups were higher than those before treatment(P<0.05),and the levels of ALT,AST,TBiL,ALP andγ-GT in the observation group were significantly lower than those in the control group(P<0.05),but there was no significant difference in the level of albumin(ALB)between the two groups(P >0.05).The levels of immunoglobulin(IgM and IgG)in the two groups were lower than those before treatment(P<0.05),and those in the observation group were better than those in the control group(P<0.05).There was no significant difference in the total incidence rate of adverse reactions between the two groups(6.90%vs.5.17%,χ^2=0.152,P=0.697).Conclusion Ursodeoxycholic acid combined with prednisone and azathioprine is effective in the treatment of patients with AIH,it can effectively improve the liver function and reduce the level of serum immunoglobulin,which is safe and reliable.