熊去氧胆酸联合非诺贝特治疗PBC患者血清TGF-β、IFN-γ和IL-10水平变化*

doi:10.3969/j.issn.1672-5069.2020.04.017

摘要/Abstract

摘要： 目的探讨熊去氧胆酸(UDCA)联合非诺贝特治疗原发性胆汁性胆管炎(PBC)患者血清转化生长因子-β(TGF-β)、γ-干扰素(IFN-γ)和白介素-10(IL-10)水平的变化。方法 2016年12月～2018年12月我科诊治PBC患者48例,随机将患者分为观察组(n=24)和对照组(n=24)。给予对照组患者UDCA治疗半年,给予观察组UDCA联合非诺贝特口服治疗半年。采用ELISA法检测血清TGF-β、IFN-γ和IL-10水平。使用FibroTouch行肝脏硬度测定(liver stiffness measurement, LSM)。结果在治疗观察结束时,观察组血清谷丙转氨酶水平为(51.4±23.7)U/L,显著低于对照组【(74.9±21.2)U/L,P<0.05】,谷草转氨酶为(59.5±32.3)U/L,显著低于对照组【(81.3±35.8)U/L,P<0.05】,谷氨酰转肽酶水平为(95.7±31.8)U/L,显著低于对照组【(127.3±50.7)U/L,P<0.05】;观察组血清IFN-γ水平为(57.4±21.3)pg/mL,显著高于对照组【(39.7±23.7)pg/mL,P<0.05】,而血清TGF-β水平为(14.3±4.8)pg/mL,显著低于对照组【(23.6±3.5)pg/mL,P<0.05】;观察组血清免疫球蛋M(IgM)为(2.3±0.4)g/L,显著低于对照组【(3.1±0.9)g/L,P<0.05】, IgG水平为(11.3±1.8)g/L,显著低于对照组【(15.5±1.3)g/L,P<0.05】,IgA水平为(2.7±0.6)g/L,显著低于对照组【(3.5±0.2)g/L,P<0.05】;观察组患者LSM为(10.8±6.5)kPa,与对照组的(9.7±7.7)kPa比,无统计学差异(P>0.05)。结论熊去氧胆酸联合非诺贝特联合治疗PBC患者可以明显改善血生化指标,可能与抑制了免疫球蛋白水平和提高了血清IFN-γ水平有关,其治疗的远期疗效还有待于观察。

关键词: 原发性胆汁性胆管炎, 熊去氧胆酸, 非诺贝特, 转化生长因子-β, γ-干扰素, 白介素-10, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy and serum cytokine level changes of ursodeoxycholic acid (UDCA) and fenofibrate combination in the treatment of patients with primary biliary cholangitis (PBC). Methods Fourty-eight patients with PBC were recruited in this study between December 2016 and December 2018, and were randomly divided into observation (n=24) and control group (n=24). The patients in control group were treated with UDCA at dose of 15 mg.kg^-1·d^-1, and those in the observation were treated with UDCA at the same dose and fenofibrate combination. The regimen lasted for six months. Serum transforming growth factor-β (TGF-β), interferon-γ(IFN-γ) and interleukin-10 (IL-10) levels were detected by ELISA. Liver stiffness measurement (LSM) was detected by FibroTouch. Results At the end of six-month observation, serum ALT level in combination was (51.4±23.7)U/L, significantly lower than 【(74.9±21.2)U/L, P<0.05】, serum AST level was (59.5±32.3)U/L, much lower than 【(81.3±35.8)U/L, P<0.05】, serum GGT level was (95.7±31.8)U/L, significantly lower than 【(127.3±50.7)U/L, P<0.05】 in the control; serum IFN-γ level was (57.4±21.3) pg/mL, significantly higher than 【(39.7±23.7)pg/mL, P<0.05】, while serum TGF-β level was (14.3±4.8)pg/mL, much lower than 【(23.6±3.5)pg/mL, P<0.05】 in the control; serum immunoglobulin M(IgM) was (2.3±0.4)g/L, significantly lower than 【(3.1±0.9)g/L, P<0.05】, serum IgG level was (11.3±1.8)g/L, significantly lower than 【(15.5±1.3)g/L, P<0.05】 and serum IgA level was (2.7±0.6)g/L, significantly lower than 【(3.5±0.2)g/L, P<0.05】 in the control; the LSM was (10.8±6.5)kPa, not significantly different compared to (9.7±7.7)kPa (P>0.05) in the control. Conclusion The combination of ursodeoxycholic acid and fenofibrate in treatment of patients with PBC significantly improves blood biochemical parameters, which might be related to the increased IFN-γ secretion. The long-term prognosis should be observed in the future.

Key words: Primary biliary cholangitis, Ursodeoxycholic acid, Fenofibrate, Transforming growth factor-β, Interferon-γ, Interleukin-10, Therapy

黄丽华, 杨正兵, 谭礼让. 熊去氧胆酸联合非诺贝特治疗PBC患者血清TGF-β、IFN-γ和IL-10水平变化^*[J]. 实用肝脏病杂志, 2020, 23(4): 520-523.

Huang Lihua, Yang Zhengbing, Tan Lirang. Efficacy and serum cytokine level changes of ursodeoxycholic acid and fenofibrate combination in the treatment of patients withprimary biliary cholangitis[J]. Journal of Practical Hepatology, 2020, 23(4): 520-523.

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熊去氧胆酸联合非诺贝特治疗PBC患者血清TGF-β、IFN-γ和IL-10水平变化^*

Efficacy and serum cytokine level changes of ursodeoxycholic acid and fenofibrate combination in the treatment of patients withprimary biliary cholangitis

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