摘要
目的 探究不同剂量熊去氧胆酸治疗原发性胆汁性胆管炎对实检室检查、免疫指标的影响.方法 选取2021年8月至2022年12月在东阳市人民医院巍山分院进行诊治的84例原发性胆汁性胆管炎患者作为研究对象进行回顾性分析,按照随机数字表法分为低剂量组与高剂量组各42例,分别给予低剂量(14～16 mg/kg)及高剂量(29～31 mg/kg)熊去氧胆酸治疗.观察不同剂量熊去氧胆酸治疗的临床效果、实检室检查指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、ALT、血清总胆红素(TBIL)、血清直接胆红素(DBIL)]、氧化应激指标[谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)和超氧化物歧化酶(SOD)]、免疫指标[免疫球蛋白M(IgM)、免疫球蛋白A(IgA)]及不良反应变化.结果 低剂量组有效23例,应答率55％;高剂量组有效10例,应答率24％,低剂量组应答率高于高剂量组(x2=8.435,P＜0.05).治疗后 2 组 ALT、AST、ALP、GGT、TBIL、DBIL 水平低于治疗前(t低剂量组=41.217、38.201、36.206、31.309、9.859、11.262,均 P＜0.01;t 高剂量组=36.334、30.622、30.422、24.247、5.589、4.167,均 P＜0.01),且低剂量组ALT、AST、ALP、GGT、TBIL、DBIL 水平低于高剂量组(t=9.456、12.917、11.166、7.930、7.469、4.854,均 P＜0.01).治疗后低剂量组IgM、IgA水平低于高剂量组(t=2.832、4.561,P＜0.05).治疗后低剂量组GSH-Px、SOD水平高于高剂量组(t=9.195、5.009,P＜0.05),MDA水平低于高剂量组(t=8.397,P＜0.001).低剂量组不良反应发生率5％;高剂量组不良反应发生率19％,低剂量组低于高剂量组(x2=4.087,P=0.043).结论 低剂量熊去氧胆酸治疗原发性胆汁性胆管炎效果较佳,安全性较高,且能够有效改善患者肝功能,减轻氧化应激,提高机体免疫功能.
Abstract
Objective To investigate the effects of different doses of ursodeoxycholic acid on biochemical and immunological indices in the treatment of primary biliary cholangitis.Methods A total of eighty-four patients with primary biliary cholangitis,who were diagnosed and treated in our hospital from August 2021 to December 2022,were selected for retrospective analysis.They were divided into a low-dose group and a high-dose group ac-cording to the random number table method,with 42 patients in each group.The low-dose group received ur-sodeoxycholic acid at a dose of 14～16 mg/kg,while the high-dose group received ursodeoxycholic acid at a dose of 29～31 mg/kg.The clinical effects,biochemical indexes(including alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyl transpeptidase(GGT),serum total bilirubin(TBIL),and serum direct bilirubin(DBIL),oxidative stress indicators[including glutathione peroxidase(GSH-Px),malondialdehyde(MDA),and superoxide dismutase(SOD)],immunological indicators[including immunoglobulin M(IgM)and immunoglobulin A(IgA)],and adverse reactions associated with different dosages of ursodeoxycholic acid treatment were observed.Results The effective rate of the low-dose group was 55％(23 cases were effec-tive),the effective rate of the high-dose group was 24％(10 cases were effective).The effective rate was signifi-cantly higher in the low-dose group than that in the high-dose group(x2=8.435,P＜0.05).The levels of ALT,AST,ALP,GGT,TBIL and DBIL in the two groups after treatment were significantly lower than those before treatment(low-dose group:t=41.217,38.201,36.206,31.309,9.859,11.262,all P＜0.01;high-dose group:t=36.334,30.622,30.422,24.247,5.589,4.167,all P＜0.01).The levels of ALT,AST,ALP,GGT,TBIL and DBIL in the low-dose group were significantly lower than those in the high-dose group(t=9.456,12.917,1 1.166,7.930,7.469,4.854,all P＜0.01).After treatment,the levels of IgM and IgA in the low-dose group were lower than those in the high-dose group(t=2.832.4.561,P＜0.05).After treatment,the levels of GSH Px and SOD in the low-dose group were signif-icantly higher than those in the high-dose group(t=9.195,5.009,P＜0.05),and the levels of MDA were significant-ly lower than those in the high-dose group(t=8.397,P＜0.001).The incidence of adverse reactions in the low-dose group was 5％,while it was 19％in the high-dose group.The incidence of adverse reactions in the low-dose group was significantly lower than that in the high-dose group(x2=4.087,P=0.043).Conclusion Low-dose ursodeoxy-cholic acid is more effective and safe in the treatment of primary biliary cholangitis,and it can effectively improve liver function,reduce oxidative stress and enhance the immune function.
维普
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