熊去氧胆酸联合糖皮质激素治疗伴自身免疫性肝炎特征原发性胆汁性胆管炎的效果分析

Effect of Ursodeoxycholic Acid Combined with Glucocorticoid in the Treatment of Primary Biliary Cholangitis with Autoimmune Hepatitis

目的对比观察伴自身免疫性肝炎(autoimmune hepatitis,AIH)特征原发性胆汁性胆管炎(primary biliary cholangitis,PBC)患者采用熊去氧胆酸(UDCA)单药治疗和UDCA联合糖皮质激素治疗的效果差异。方法选取我院2008年12月—2019年12月收治的178例伴AIH特征PBC患者,根据治疗方式的不同分为UDCA联合糖皮质激素组(联合治疗组)33例和UDCA单药治疗组(单药治疗组)145例,比较不同治疗方案的疗效差异,并用Logistic回归分析探讨与治疗应答相关的影响因素。结果2组治疗1年后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)、免疫球蛋白M均显著下降(P<0.05或P<0.01),血清球蛋白(GLB)、免疫球蛋白G(IgG)治疗前后比较差异无统计学意义(P>0.05),但联合治疗组治疗1年后GLB、IgG下降,单药治疗组上升。2组仅GGT、IgG、GLB在部分月份比较差异有统计学意义(P<0.05或P<0.01)。联合治疗组ALP、ALT、IgG生化应答率及组织学缓解率虽均高于单药治疗组,但差异无统计学意义(P>0.05)。多因素Logistic回归分析提示ALP、IgG、抗Ro-52抗体是伴AIH特征PBC患者完全生化应答的影响因素(P<0.05或P<0.01),抗SSA抗体是其组织学缓解的影响因素(P<0.01)。结论UDCA联合糖皮质激素治疗伴AIH特征PBC的效果与UDCA单药治疗无显著差异;对于UDCA单药治疗应答不佳的伴AIH特征PBC患者可考虑联合糖皮质激素治疗。

Objective To compare the efficacy of ursodeoxycholic acid(UDCA)monotherapy and UDCA combined with glucocorticoids in the treatment of primary biliary cholangitis(PBC)with autoimmune hepatitis(AIH).Methods A total of 178 cases of PBC patients with AIH treated in our hospital from December 2008 to December 2019 were selected and divided into UDCA combined with glucocorticoid group(n=33)and UDCA monotherapy group(n=145)according to the different treatment methods.The therapeutic effects of different treatment schemes were compared,and the influencing factors related to treatment response were analyzed by logistic regression analysis.Results After one year of treatment,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-Glutamyl Transferase(GGT)and immunoglobulin M(IgM)in the two groups were significantly decreased(P<0.05 or P<0.01),but there was no significant difference in serum globulin(GLB)and immunoglobulin G(IgG)before and after treatment(P>0.05).However,GLB and IgG were decreased in the combination treatment group at 1 year after treatment,and increased in monotherapy group.Only GGT,IgG and GLB were significantly different between the two groups in some months(P<0.05 or P<0.01).The biochemical response rate and histological remission rate of ALP,ALT and IgG in the combination treatment group were higher than those in the monotherapy group,but the difference was not statistically significant(P>0.05).Multivariate logistic regression analysis showed that ALP,IgG and anti-ro-52 antibody were the influencing factors of complete biochemical response in PBC patients with AIH(P<0.05 or P<0.01),and anti-SSA antibody was the influencing factor of histological response(P<0.01).Conclusion The effect of UDCA combined with glucocorticoid in the treatment of PBC with AIH characteristics is not significantly different from that of UDCA monotherapy.For PBC with AIH characteristics with poor response to UDCA monotherapy,the combination of glucocorticoid can be considered.