丁二磺酸腺苷蛋氨酸联合熊去氧胆酸治疗原发性胆汁性胆管炎的临床效果

Clinical effect of ademetionine 1,4⁃butanedisulfonate combined with ursodeoxycholic acid on the treatment of primary biliary cholangitis

目的探讨丁二磺酸腺苷蛋氨酸(SAMe)联合熊去氧胆酸(UDCA)治疗原发性胆汁性胆管炎(PBC)的临床效果。方法选取眉山市人民医院2019年1月至2022年7月收治的80例PBC患者,采用随机数字表法分为观察组和对照组,各40例。对照组在常规治疗基础上给予UDCA治疗,观察组在对照组基础上联合SAMe治疗,所有患者均连续治疗24周。比较2组治疗前后肝功能指标、肝纤维化指标、天冬氨酸转氨酶(AST)与血小板比值指数(APRI)、肝脏硬度值(LSM)及免疫球蛋白水平。记录患者临床疗效及不良反应发生情况。结果治疗后,2组AST、碱性磷酸酶、γ⁃谷氨酰转肽酶、总胆红素、层粘连蛋白、透明质酸、Ⅲ型前胶原氨基端肽、Ⅳ型胶原、APRI、LSM、免疫球蛋白G和免疫球蛋白M水平均低于治疗前,且观察组均低于对照组(均P<0.05)。观察组总有效率高于对照组[97.5%(39/40)比85.0%(34/40)](P=0.048)。所有患者治疗期间均未出现严重不良反应。结论SAMe联合UDCA治疗PBC的临床效果较好,可改善患者肝功能和肝纤维化,调节免疫功能,安全性较好。

Objective To investigate the clinical effect of ademetionine 1,4⁃butanedisulfonate(SAMe)combined with ursodeoxycholic acid(UDCA)on the treatment of primary biliary cholangitis(PBC).Methods From January 2019 to July 2022,80 patients with PBC admitted to Meishan City People′s Hospital were selected.They were divided into the observation group and the control group,with 40 cases in each group.The control group was treated with UDCA based on the conventional therapy,the observation group was treated with SAMe based on the control group,and all patients were treated continuously for 24 weeks.The levels of liver function indexes,liver fibrosis indexes,aspartate transaminase(AST)/platelet ratio index(APRI),liver stiffness measurement(LSM)and immunoglobulin were compared between the two groups before and after treatment.The curative effect and adverse reactions of patients were recorded.Results After treatment,levels of AST,alkaline phosphatase,γ⁃glutamyl transpeptidase,total bilirubin,laminin,hyaluronic acid,N⁃terminal peptide of typeⅢprocollagen,typeⅣcollagen,APRI,LSM,immunoglobulin G and immunoglobulin M in both groups were lower than those before treatment,and the levels in the observation group were lower than those in the control group(all P<0.05).The total effective rate in the observation group was higher than that in the control group[97.5%(39/40)vs 85.0%(34/40)](P=0.048).There was no serious adverse reaction in patients during treatment.Conclusions The clinical effect of SAMe combined with UDCA on the treatment of PBC is good,which can significantly improve liver function and liver fibrosis of patients,regulate immune function,and has better safety.