CAJ | 학술논문

目的观察熊去氧胆酸(UDCA)联合糖皮质激素治疗自身免疫性肝炎(AIH)-原发性胆汁性肝硬化(PBC)重叠综合征的长期疗效.方法对19例AIH-PBC重叠综合征患者根据其初始治疗方案的不同分为初始UDCA联合激素治疗组及初始UDCA单药治疗组,根据患者肝炎病理炎症(G)和纤维化(S)程度分为病理早期组(<G2S2)和病理晚期组(>G2S2),回顾性分析不同时间段加用激素及不同病理分期患者的疗效、生物化学应答状况和组织病理学变化情况.治疗前后数据的比较应用配对样本的t检验(正态分布)或两配对样本的Wilcoxon非参数秩和检验(非正态分布),生物化学应答率比较应用Fisher's精确检验法.结果初始UDCA联合激素治疗组中位治疗时间为10.4(6.0～23.0)个月,治疗后ALT,AST,球蛋白、碱性磷酸酶(ALP)、γ-谷氨酰转移酶及IgG水平较治疗前明显下降(P值均<0.05);初始UDCA单药冶疗8.1(3.0～15.0)个月后,患者生物化学及免疫学指标变化差异无统计学意义(P值均>0.05),加用激素治疗10.6(6.0~24.0)个月后,ALT、AST、球蛋白,ALP及IgG水平较治疗前明显下降(P值均<0.05),与初始UDCA联合激素治疗组的ALT、IgG及ALP生物化学应答率差异无统计学意义(P值均>0.05).5例病理早期AIH-PBC重叠综合征患者出现ALT、IgG及ALP完全应答,不同病理分期患者ALT生物化学应答率差异有统计学意义(P<0.05).3例患者有治疗前后肝活组织病理检查结果,可见汇管区及界板内淋巴细胞及浆细胞的浸润明显减轻,纤维间隔的范围在一定程度有所减小.结论对于诊断为AIH-PBC重叠综合征的患者,建议积极早期应用UDCA与糖皮质激素联合治疗.联合治疗对不同病理分期的患者都有疗效,但早期应用可能获得更佳的生物化学应答及组织学改善.
목적 관찰웅거양담산(UDCA)연합당피질격소치료자신면역성간염(AIH)-원발성담즙성간경화(PBC)중첩종합정적장기료효.방법 대19례AIH-PBC중첩종합정환자근거기초시치료방안적불동분위초시UDCA연합격소치료조급초시UDCA단약치료조,근거환자간염병리염증(G)화섬유화(S)정도분위병리조기조(<G2S2)화병리만기조(>G2S2),회고성분석불동시간단가용격소급불동병리분기환자적료효、생물화학응답상황화조직병이학변화정황.치료전후수거적비교응용배대양본적t검험(정태분포)혹량배대양본적Wilcoxon비삼수질화검험(비정태분포),생물화학응답솔비교응용Fisher's정학검험법.결과 초시UDCA연합격소치료조중위치료시간위10.4(6.0～23.0)개월,치료후ALT,AST,구단백、감성린산매(ALP)、γ-곡안선전이매급IgG수평교치료전명현하강(P치균<0.05);초시UDCA단약야료8.1(3.0～15.0)개월후,환자생물화학급면역학지표변화차이무통계학의의(P치균>0.05),가용격소치료10.6(6.0~24.0)개월후,ALT、AST、구단백,ALP급IgG수평교치료전명현하강(P치균<0.05),여초시UDCA연합격소치료조적ALT、IgG급ALP생물화학응답솔차이무통계학의의(P치균>0.05).5례병리조기AIH-PBC중첩종합정환자출현ALT、IgG급ALP완전응답,불동병리분기환자ALT생물화학응답솔차이유통계학의의(P<0.05).3례환자유치료전후간활조직병리검사결과,가견회관구급계판내림파세포급장세포적침윤명현감경,섬유간격적범위재일정정도유소감소.결론 대우진단위AIH-PBC중첩종합정적환자,건의적겁조기응용UDCA여당피질격소연합치료.연합치료대불동병리분기적환자도유료효,단조기응용가능획득경가적생물화학응답급조직학개선.
Objective To observe the efficacy of ursodeoxycholic acid(UDCA) combined with glucocorticoids in the treatment of autoimmune hepatitis-primary biliary cirrhosis (AIH-PBC) overlap syndrome.Methods 19 patients with AIH-PBC overlap syndrome were divided randomly into two groups: initiate combined group and initiate UDCA-monotherapy group. Biochemical responses and pathological features before and after treatment were analyzed retrospectively with student's t test, Wilcoxon rank sum test and Fisher's exact method. Results In the initiate combination group, biochemical responses in terms of AIH features (ALT decline to normal, IgG < 16 g/L) and PBC features (ALP decline > 40% or to normal) were achieved. In UDCA-monotherapy group, no statistical difference existed in biochemical responses before adding glucocorticoids, whereas the levels of ALT, AST, GLB and IgG decreased significantly when combined with glucocorticoids. No statistical difference of rates of biochemical responses eixted between the two groups, whereas variance could be seen in different pathological stages. Alleviation of inflammatory infiltration after therapy appeared in 3 patients. Conclusion Combination therapy of UDCA with glucocorticoids could be suitable for AIH-PBC overlap syndrome. Early treatment is of benefit for achieving better biochemical response and pathological improvement.