泼尼松龙联合熊去氧胆酸治疗原发性胆汁性肝硬化患者疗效初步研究

doi:10.3969/j.issn.1672-5069.2017.04.016

摘要/Abstract

摘要： 目的评价泼尼松龙联合熊去氧胆酸（UDCA）治疗原发性胆汁肝硬化（PBC）患者的疗效,寻找治疗PBC的有效方案。方法 2010年1月~2015年12月我院治疗的106例PBC患者,随机分为观察组和对照组,每组53例。给予对照组患者UDCA 13~15 mg·kg^-1·d^-1口服,观察组在对照组治疗的基础上再给予泼尼松龙口服并逐步减少激素剂量。在治疗前和治疗后3个月、6个月和12个月,观察患者临床表现和检测血清主要生化指标和免疫球蛋白IgM、IgG、IgA。结果在治疗后,观察组和对照组患者临床症状均有所改善,观察组患者的乏力、皮肤瘙痒症状明显改善（P<0.05）;在治疗后,两组患者血清ALP、GGT和TBIL水平较治疗前均有明显改善（P<0.05）,且两组患者在治疗3个月时上述指标下降较快,观察组改善程度明显优于对照组（P<0.05）,在治疗6个月和12个月时,两组上述指标改善程度不明显（P>0.05）,两组患者血清ALB水平在治疗前后无明显变化（P>0.05）,且在不同治疗时段亦无显著性差异（P>0.05）;治疗后,两组患者血清IgM水平明显下降（P<0.05）,并且在治疗3个月时观察组较对照组下降程度较大,差异显著（P<0.05）,在6个月和12个月时,两组免疫球蛋白水平改善程度差异不明显（P>0.05）,两组患者血清IgA和IgG水平在治疗前后无显著性差异（P>0.05）。结论泼尼松龙联合UDCA在短期内可以改善PBC患者临床表现、主要生化指标以及IgM水平,但其远期疗效还有待观察。

关键词: 原发性胆汁性肝硬化, 熊去氧胆酸, 泼尼松龙, 疗效

Abstract: Objective To evaluate the clinical efficacy of ursodeoxycholic acid （UDCA） and prednisolone combination in the treatment of patients with primary biliary cirrhosis （PBC） and to investigate effective method of treating PBC. Methods 106 patients with PBC in our hospital between January 2010 and December 2015 were randomly divided into two groups. Fifty-three patients with PBC in the control group were treated with oral administration of ursodeoxycholic acid at dose of 13~15 mg·kg^-1·d^-1,and fifty- three patients with PBC in the observation group received oral prednisolone on the basis of UDCA at same dose as in the control group. At presentation and 3 months,6 months and 12 months after treatment,the clinical manifestations of the patients were observed and serum ALP,albumin,and bilirubin levels and serum IgM,IgG and IgA were measured routinely. Results The clinical symptoms improved both in the observation group and control group after treatment,and the patient's fatigue and skin itching significantly improved in the combination group;serum ALP,GGT and bilirubin levels in the two groups were significantly improved after treatment（P<0.05）,and the above indexes decreased rapidly in the two groups after 3 months,and the improvement in the observation group was significantly better than in the control group （P<0.05）;at 6 months and 12 months of treatment,the improvement in the two groups was not obviously different（P>0.05）;There was no significant difference in blood albumin levels between the two groups（P>0.05）;blood IgM levels in both groups significantly decreased after treatment（P<0.05）,and there was a significant difference between the observation group and the control group at 3 months（P<0.05）,while there was no significant difference as respect to blood IgM between the two groups at 6 months and 12 months（P>0.05）;There was no significant difference as respect to blood IgA and IgG levels between the two groups before and after treatment at any time point （P>0.05）. Conclusion The combination of UDCA and prednisolone can in the short term improve the clinical manifestation,the main biochemical indexes and decrease serum IgM levels in PBC patients,which needs further investigation.

Key words: Primary biliary cirrhosis, Ursodeoxycholic acid, Prednisolone, Efficacy

刘复娜, 刘江奎, 沈毅慧. 泼尼松龙联合熊去氧胆酸治疗原发性胆汁性肝硬化患者疗效初步研究[J]. 实用肝脏病杂志, 2017, 20(4): 443-446.

Liu Funa, Liu Jiangkui, Shen Yihui.. Efficacy of ursodeoxycholic acid and prednisolone combination in treatment of patients with primary biliary cirrhosis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(4): 443-446.

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