甲泼尼龙对巨细胞病毒感染致胆汁淤积性肝炎患儿肝功能和免疫功能的影响

Effects of methylprednisolone on liver function and immune function of children with cholestatic hepatitis caused by cytomegalovirus infection

目的:研究甲泼尼龙对巨细胞病毒(Cytomegalovirus,CMV)感染致胆汁淤积性肝炎患儿肝功能和免疫功能的影响。方法:以2019年7月至2020年7月我院收治的71例CMV感染致胆汁淤积性肝炎患儿,随机分为对照组(n=35)和研究组(n=36),对照组患儿使用常规方案治疗,研究组患儿在对照组基础上联合使用静脉滴注甲泼尼龙1 mg·kg-1治疗。治疗2 w后观察总有效率;并分别采用全自动生化分析、酶联免疫吸附法测定肝功能,如血清总胆红素(Serum Total Bilirubin,TBIL)、总蛋白(Total Protein,TP)、总胆汁酸(Total Bile Acid,TBA)水平;辅助性T细胞(Telper T Cell,CD4^(+))、细胞毒性T细胞(Cytotoxic T Cell,CD8^(+))、CD4^(+)/CD8^(+)水平以及炎症因子,包括白细胞介素-10(Interleukin-10,IL-10)、白细胞介素-12(Interleukin-12,IL-12)、白细胞介素-18(Interleukin-18,IL-18)水平;同时记录患儿下肢浮肿、胃肠道刺激、低血钾等不良反应发生率。结果:研究组患者治疗总有效率显然高于对照组(P<0.05)。治疗2 w后,两组患儿TBIL、TBA、CD8^(+)、IL-10、IL-12、IL-18均较治疗前明显降低(P<0.05),且研究组明显低于同期对照组(P<0.05);两组患儿TP、CD4^(+)、CD4^(+)/CD8^(+)较治疗前均明显升高(P<0.05),且研究组明显高于同期对照组(P<0.05)。治疗2 w内,研究组患儿下肢浮肿、胃肠道刺激、低血钾发生率略高于对照组,但比较差异无统计学意义(P>0.05)。结论:甲泼尼龙治疗CMV感染致胆汁淤积性肝炎患儿能提高治疗总有效率,促进患儿肝功能和免疫功能恢复,缓解机体炎症反应,小剂量短期使用安全性良好。

Objective:To study the effects of methylprednisolone on liver function and immune function in children with cholestatic hepatitis caused by cytomegalovirus(CMV)infection.Methods:A total of 71 children with cholestatic hepatitis caused by CMV infection who were treated in the hospital between July 2019 and July 2020 were enrolled as the research subjects,and randomly divided into control group(n=35)and study group(n=36).The children in the control group were treated with conventional regimen,and the children in the study group were treated with 1 mg·kg-1 of methylprednisolone intravenously on the basis of the control group.The total effective rate was observed after 2 w of treatment.Automatic biochemical analysis instrument and cell meter were used to detect the liver function,including serum total bilirubin(TBIL),total protein(TP)and total bile acid(TBA),immune function,including helper T cell(CD4^(+)),cytotoxic T cell(CD8^(+))and CD4^(+)/CD8^(+)and inflammatory factors,including interleukin-10(IL-10),interleukin-12(IL-12)and interleukin-18(IL-18).The incidence rates of adverse reactions such as lower limb edema,gastrointestinal irritation and hypokalemia were recorded.Results:The total effective rate of treatment in study group was significantly higher than that in control group(P<0.05).After 2 w of treatment,the levels of TBIL,TBA,CD8^(+),IL-10,IL-12 and IL-18 of the two groups of children were significantly decreased compared to before treatment(P<0.05),and the above indicators were significantly lower in study group than those in control group during the same period(P<0.05).The TP,CD4^(+)and CD4^(+)/CD8^(+)of the two groups were significantly increased compared with those before treatment(P<0.05),and the indicators in study group were significantly higher compared with those in control group during the same period(P<0.05).Within 2 w of treatment,the incidence rates of lower limb edema,gastrointestinal irritation and hypokalemia in study group were slightly higher than those in control group(P>0.05).Conclusion:Methylprednisolone can enhance the total effective rate of treatment,promote the recovery of liver function and immune function and relieve the body’s inflammatory response in children patients with cholestatic hepatitis caused by CMV infection,and it has a good safety for short-term low-dose use.