泼尼松联合硫唑嘌呤治疗自身免疫性肝炎患者不同减量方法的效果研究

Different tapering prednisone dose in the treatment of patients with autoimmune hepatitis

目的探讨泼尼松联合硫唑嘌呤缓慢减量与快速减量治疗AIH患者的临床疗效。方法2020年1月~2023年1月我院收治的AIH患者52例,被随机分为观察组26例和对照组26例,两组均接受泼尼松联合硫唑嘌呤治疗,但在起效后观察组采用缓慢减量方式,而对照组采用快速减量方式。采用ELISA法检测血清免疫球蛋白IgG、IgA和IgM,使用流式细胞仪检测外周血淋巴细胞亚群。结果在治疗6个月末,观察组血清ALT和AST水平分别为(32.4±7.5)U/L和(31.9±5.2)U/L,均显著低于对照组【分别为(46.8±10.1)U/L和(43.6±7.7)U/L,P<0.05】;观察组血清IgA、IgM和IgG水平分别为(3.4±0.6)g/L、(3.5±0.8)g/L和(15.3±2.1)g/L,均显著低于对照组【分别为(4.1±0.5)g/L、(4.1±0.6)g/L和(19.8±6.7)g/L,P<0.05】;观察组外周血T淋巴细胞、B淋巴细胞、抑制性/细胞毒性T淋巴细胞百分比和CD4+/CD8+细胞比值分别为(0.7±0.2)%、(12.1±3.5)%、(24.1±3.4)%和(1.2±0.2),显著低于对照组【分别为(0.9±0.2)%、(16.4±5.1)%、(28.4±3.1)%和(1.4±0.3),P<0.05】;观察组不良反应发生率为50.0%,显著高于对照组的7.7%(P<0.05)。结论应用泼尼松联合硫唑嘌呤治疗AIH患者,采用快速减量方式可能较少引起不良反应,但不容易稳定肝功能指标,临床需要权衡利弊,选择合适的减量方法。

Objective This study was conducted to investigate the therapeutic efficacy of prednisone and azathioprine combination in the treatment of patients with autoimmune hepatitis(AIH).Methods There were 52 consecutive patients with AIH recruited in our hospital between January 2020 and January 2023,and they were randomly divided into observation(n=26)and control(n=26).All the patients in the two groups took prednisone and azathioprine combination therapy,the dose of prednisone in the control group was tapered relatively rapidly,while in the combination group was slowly week by week.Serum IgG,IgA and IgM levels were detected by ELISA,and peripheral blood lymphocyte subsets were determined by FCM.Results At the end of sixmonth treatment,serum ALT and AST levels in the observation group were(32.4±7.5)U/L and(31.9±5.2)U/L,both significantly lower than[(46.8±10.1)U/L and(43.6±7.7)U/L,respectively,P<0.05]in the control;serum IgA,IgM and IgG levels were(3.4±0.6)g/L,(3.5±0.8)g/L and(15.3±2.1)g/L,all much lower than[(4.1±0.5)g/L,(4.1±0.6)g/L and(19.8±6.7)g/L,P<0.05]in the control group;the percentages of peripheral blood T lymphocytes,B lymphocytes,inhibitory/cytotoxic T lymphocytes and the ratio of CD4+/CD8+cells were(0.7±0.2)%,(12.1±3.5)%,(24.1±3.4)%and(1.2±0.2),all significantly lower thn[(0.9±0.2)%,(16.4±5.1)%,(28.4±3.1)%and(1.4±0.3),respectively,P<0.05]in the control;the incidence of untoward effects in the observation group was 50.0%,much higher than 7.7%(P<0.05)in the control group.Conclusion The regimen of prednisone and azathioprine combination in treatment of patients with AIH has definite clinical efficacy,while the way of dose tapering needs further investigation.