熊去氧胆酸联合维生素D治疗PBC患者疗效和外周血T淋巴细胞亚群的变化

doi:10.3969/j.issn.1672-5069.2018.06.020

摘要/Abstract

摘要： 目的研究应用维生素D辅助熊去氧胆酸（UDCA）治疗原发性胆汁性肝硬化（PBC）患者的疗效及其对血清25-羟基维生素D3（25-（OH）2-D3）和外周血T淋巴细胞亚群的影响。方法 2013年4月~2016年4月收治的70例PBC患者,采用随机数字表法分为观察组35例和对照组35例,分别给予UDCA或UDCA联合骨化三醇胶丸治疗。采用全自动电化学发光免疫分析法检测血清25-（OH）2-D3,使用流式细胞仪检测外周血T淋巴细胞亚群。结果在治疗1年末,观察组血清25-（OH)2-D3水平为（24.5±4.2） ng/ml,外周血CD8⁺细胞百分比为（29.0±5.2）%,显著高于对照组的（20.2±3.6）ng/ml和（26.3±4.8） %（P<0.05）,CD4⁺细胞百分比和CD4⁺/CD8⁺比值分别为（31.8±5.9）%和（1.1±0.2）,显著低于对照组的[（36.2±6.4） %和（1.4±0.3）,P<0.05];应用巴塞罗那标准考核,观察组对UDCA应答率为85.7%,显著高于对照组的62.9%（P<0.05）;观察组血清二胺氧化酶（DAO）、D-乳酸、谷草转氨酶（AST）和碱性磷酸酶（ALP）水平分别为（3.5±0.6） U/ml、（8.2±1.5） μg/ml、（62.3±11.2） U/L和（317.5±57.3） U/L,显著低于对照组的[（3.9±0.7） U/ml、（9.4±1.7） μg/ml、（76.9±13.9） U/L和（355.4±64.2） U/L,P<0.05]。结论应用维生素D辅助治疗PBC患者可以提高对UDCA的应答率,纠正免疫功能紊乱,保护肠道屏障功能,促进肝功能恢复。

关键词: 原发性胆汁性肝硬化, 熊去氧胆酸, 维生素D, T淋巴细胞亚群, 应答

Abstract: Objective To investigate the changes of peripheral blood 25-（OH）2-D3 levels and peripheral T lymphocyte subsets in patients with primary biliary cirrhosis（PBC） receiving vitamin D supplementation and ursodeoxycholic acid（UDCA） treatment. Methods 70 patients with PBC were recruited in our hospital between April 2013 and April 2016,and they were randomly divided into the observation group and the control group with 35 cases in each group by the random number generated by computer. The patients in control group was treated with UDCA,and those in the observation group was additionally treated with calcitriol soft capsules （vitamin D） at the base of UDCA. The response rate to UDCA were statistically analyzed. Results At the end of one year treatment,serum levels of 25-（OH）2-D3 and blood CD8⁺ cells in the observation group were （24.5±4.2） ng/ml and （29.0±5.2） %,respectively,significantly higher than （20.2±3.6） ng/ml and （26.3±4.8） %,while the percentage of CD4⁺ cells and the ratio of CD4⁺/CD8⁺ cells were （31.8±5.9） % and （1.1±0.2）,significantly lower than [（36.2±6.4） % and（1.4±0.3） in the control,all P<0.05];the response rate to UDCA by Barcelona criteria in the observation group was 85.7%,significantly higher than 62.9% in the control group （P<0.05）;serum diamine oxidase（DAO）,D-lactic acid,aspartate aminotransferase （AST） and alkaline phosphatase （ALP） levels in the observation group were （3.5±0.6） U/ml,（8.2±1.5） g/ml,（62.3±11.2） U/L and（317.5±57.3） U/L,significantly lower than [（3.9±0.7）U/ml,（9.4±1.7） g/ml,（76.9±13.9） U/L and（355.4±64.2） U/L in the control（P<0.05）. Conclusion Vitamin D supplementation can increase the response to UDCA,regulate the abnormal immune functions,protect intestinal barrier functions and promote liver function recovery in patients with PBC.

Key words: Primary biliary cirrhosis, Ursodeoxycholic acid, Vitamin D, T lymphocytes, Therapy

刘映川, 赵鹏程, 游亭, 邓红英, 薛江凤. 熊去氧胆酸联合维生素D治疗PBC患者疗效和外周血T淋巴细胞亚群的变化[J]. 实用肝脏病杂志, 2018, 21(6): 907-910.

Liu Yingchuan, Zhao Pengcheng, You Ting, et al.. Changes of peripheral blood 25-（OH） 2-D3 levels and peripheral T lymphocyte subsets in patients with primary biliary cirrhosis receiving vitamin D supplementation and ursodeoxycholic acid treatment[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(6): 907-910.

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