清肝利胆方配合非诺贝特对熊去氧胆酸应答不佳的原发性胆汁性胆管炎应答率及Th1/Th2淋巴细胞失衡的影响
|
摘要
目的观察清肝利胆方配合非诺贝特对熊去氧胆酸应答不佳的原发性胆汁性胆管炎(PBC)患者应答率及Th1/Th2淋巴细胞失衡的影响。方法将64例PBC患者随机分为对照组和观察组,每组32例。对照组患者给予熊去氧胆酸及非诺贝特口服,观察组给予熊去氧胆酸、非诺贝特及清肝利胆方口服,疗程均为6个月。检测比较2组治疗前后血清谷丙转氨酸(ALT)、谷草转氨酸(AST)、总胆红素(TBil)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、Th1细胞因子[白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)]和Th2细胞因子(IL-4、IL-10)水平,观察2组患者治疗前后乏力、皮肤瘙痒、腹胀、黄疸、胁痛、口苦6项临床症状评分变化情况,治疗结束后参照Barcelona标准、ParisⅠ标准和ParisⅡ标准评价2组生化应答率。结果治疗后2组血清AST、AST、ALP、GGT、TBil、IgM、IgG、IgA、IL-2、TNF-α、IFN-γ水平均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05);IL-4和IL-10水平均明显升高(P均<0.05),且观察组均明显高于对照组(P均<0.05)。治疗后2组乏力、皮肤瘙痒、腹胀、黄疸、胁痛和口苦症状积分均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05)。治疗后观察组的生化应答率明显高于对照组(P<0.05)。结论清肝利胆方配合非诺贝特可以有效降低对UDCA应答不佳PBC患者的血生化指标,提高应答率,改善症状,可能与其恢复Th1/Th2细胞因子平衡、减轻免疫反应有关。
Objective It is to observe the efficacy of Qinggan Lidan decoction combined with fenofibrate in the treatment of primary biliary cholangitis(PBC) with poor response to ursodeoxycholic acid(UCDA) and its effect on Th1/Th2 lymphocyte imbalance. Methods A total of 64 PBC patients with poor response to UCDA were randomly divided into control group and observation group, 32 patients in each group. Both groups were given UDCA orally, the control group received fenofibrate orally, meanwhile, the observation group received Qinggan Lidan decoction on the basis of the control group, and the courses of treatment were 6 months. The levels of serum alanine(ALT), aspartate(AST), total bilirubin(TBil), alkaline phosphatase(ALP), γ-glutamyltranspeptidase(GGT), immunoglobulin M(IgM), immunoglobulin G(IgG), immunoglobulin A(IgA), Th1 cytokine [interleukin-2(IL-2), tumor necrosis factor-α(TNF-α)), interferon-γ(IFN-γ)] and Th2 cytokines(IL-4, IL-10)) before and after treatment in both groups were observed and compared, the scores of fatigue, skin itching, bloating, jaundice, rib pain mouth bitter were observed before and after treatment, at the end of treatment, the biochemical response rates were evaluated with reference to Barcelona criteria, Paris I criteria, and Paris II criteria in the two groups. Results The levels of serum AST, AST, ALP, GGT, TBil, IgM, IgG and IgA, IL-2, TNF-α and IFN-γ were significantly decreased and IL-4 and IL-10 levels were significantly increased in the two groups after treatment(P<0.05), and the degree of decrease or increase in the observation group was significantly greater than that in the control group(P<0.05). The scores of fatigue, skin itching, bloating, jaundice, rib pain mouth bitter were significantly decreased after treatment in the two groups(P<0.05), and the decrease in the observation group were more significant than that in the control group(P<0.05). The biochemical response rate of the observation group was significantly higher than that of the control group(P<0.05). Conclusion Qinggan Lidan decoction combined with fenofibrate can effectively reduce blood biochemical indexes, improve response rate and improve symptom score in patients with poor response to UDCA PBC, which may be related to restoring Th1/Th2 cytokine balance and alleviating immune response.
Objective It is to observe the efficacy of Qinggan Lidan decoction combined with fenofibrate in the treatment of primary biliary cholangitis(PBC) with poor response to ursodeoxycholic acid(UCDA) and its effect on Th1/Th2 lymphocyte imbalance. Methods A total of 64 PBC patients with poor response to UCDA were randomly divided into control group and observation group, 32 patients in each group. Both groups were given UDCA orally, the control group received fenofibrate orally, meanwhile, the observation group received Qinggan Lidan decoction on the basis of the control group, and the courses of treatment were 6 months. The levels of serum alanine(ALT), aspartate(AST), total bilirubin(TBil), alkaline phosphatase(ALP), γ-glutamyltranspeptidase(GGT), immunoglobulin M(IgM), immunoglobulin G(IgG), immunoglobulin A(IgA), Th1 cytokine [interleukin-2(IL-2), tumor necrosis factor-α(TNF-α)), interferon-γ(IFN-γ)] and Th2 cytokines(IL-4, IL-10)) before and after treatment in both groups were observed and compared, the scores of fatigue, skin itching, bloating, jaundice, rib pain mouth bitter were observed before and after treatment, at the end of treatment, the biochemical response rates were evaluated with reference to Barcelona criteria, Paris I criteria, and Paris II criteria in the two groups. Results The levels of serum AST, AST, ALP, GGT, TBil, IgM, IgG and IgA, IL-2, TNF-α and IFN-γ were significantly decreased and IL-4 and IL-10 levels were significantly increased in the two groups after treatment(P<0.05), and the degree of decrease or increase in the observation group was significantly greater than that in the control group(P<0.05). The scores of fatigue, skin itching, bloating, jaundice, rib pain mouth bitter were significantly decreased after treatment in the two groups(P<0.05), and the decrease in the observation group were more significant than that in the control group(P<0.05). The biochemical response rate of the observation group was significantly higher than that of the control group(P<0.05). Conclusion Qinggan Lidan decoction combined with fenofibrate can effectively reduce blood biochemical indexes, improve response rate and improve symptom score in patients with poor response to UDCA PBC, which may be related to restoring Th1/Th2 cytokine balance and alleviating immune response.
引文
[1] 王立峰,李元元,金磊,等.原发性胆汁性肝硬化的流行病学与自然史变迁[J].临床肝胆病杂志,2015,31(2):165-170
[2] 辛克锋,李莎莎,李铭,等.熊去氧胆酸应答不佳的原发性胆汁性胆管炎的临床特点及早期预测[J].蚌埠医学院学报,2018,43(8):1042-1044
[3] 武李红,韩英.贝特类药物在原发性胆汁性胆管炎中的应用及作用机制[J].临床肝胆病杂志,2016,32(12):2403-2406
[4] 郭涛.中医中药辩证施治在原发性胆汁性肝硬化治疗中的应用[J/CD].临床医药文献电子杂志,2015(8):1447
[5] 贾继东.原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J].肝脏,2015,20(12):960-968
[6] Corpechot C,Abenavoli L,Rabahi N,et al.Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis[J].Hepatology,2008,48(3):871-877
[7] 国家中医药管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:143-151
[8] 施漪雯,尤红.原发性胆汁性胆管炎的诊治进展[J].胃肠病学,2018,23(5):266-270
[9] 李沛然,陈霖,刘爱霞,等.原发性胆汁性肝硬化的实验室指标分析[J].肝脏,2018,23(3):221-223
[10] 陈辰,刘一博,张玮.Th1/Th2与原发性胆汁性胆管炎相关性的研究进展[J].肝脏,2016,21(12):1077-1080
[11] 李春梦,张红,王荔敏,等.原发性胆汁性肝硬化患者血清免疫球蛋白及补体水平检测的临床应用[J].山西医药杂志,2018,47(8):951-953
[12] 施漪雯,尤红.对熊去氧胆酸应答不佳的原发性胆汁性胆管炎治疗策略[J].临床肝胆病杂志,2017,33(11):62-65
[13] 朱红,赵艳玲,赵庆国,等.贝特类药物治疗原发性胆汁性肝硬化的机制和疗效[J].中国医院用药评价与分析,2017,17(1):10-12
[14] 陈莉莉,袁征,邵铭.邵铭教授治疗原发性胆汁性肝硬化经验探析[J].四川中医,2016,34(11):3-5
[15] 袁媛,吴芹,石京山,等.丹参及其主要成分保肝作用的研究进展[J].中国中药杂志,2015,40(4):588-593
[16] 林平,孙倩,王威,等.茵陈有效成分的药理作用及其临床应用的研究进展[J].抗感染药学,2014,11(1):28-31
[17] 蒋征奎,王学方.茯苓皮水提物对四氯化碳诱导大鼠肝纤维化的改善作用[J].中国药房,2017,28(22):3065-3068
[2] 辛克锋,李莎莎,李铭,等.熊去氧胆酸应答不佳的原发性胆汁性胆管炎的临床特点及早期预测[J].蚌埠医学院学报,2018,43(8):1042-1044
[3] 武李红,韩英.贝特类药物在原发性胆汁性胆管炎中的应用及作用机制[J].临床肝胆病杂志,2016,32(12):2403-2406
[4] 郭涛.中医中药辩证施治在原发性胆汁性肝硬化治疗中的应用[J/CD].临床医药文献电子杂志,2015(8):1447
[5] 贾继东.原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J].肝脏,2015,20(12):960-968
[6] Corpechot C,Abenavoli L,Rabahi N,et al.Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis[J].Hepatology,2008,48(3):871-877
[7] 国家中医药管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:143-151
[8] 施漪雯,尤红.原发性胆汁性胆管炎的诊治进展[J].胃肠病学,2018,23(5):266-270
[9] 李沛然,陈霖,刘爱霞,等.原发性胆汁性肝硬化的实验室指标分析[J].肝脏,2018,23(3):221-223
[10] 陈辰,刘一博,张玮.Th1/Th2与原发性胆汁性胆管炎相关性的研究进展[J].肝脏,2016,21(12):1077-1080
[11] 李春梦,张红,王荔敏,等.原发性胆汁性肝硬化患者血清免疫球蛋白及补体水平检测的临床应用[J].山西医药杂志,2018,47(8):951-953
[12] 施漪雯,尤红.对熊去氧胆酸应答不佳的原发性胆汁性胆管炎治疗策略[J].临床肝胆病杂志,2017,33(11):62-65
[13] 朱红,赵艳玲,赵庆国,等.贝特类药物治疗原发性胆汁性肝硬化的机制和疗效[J].中国医院用药评价与分析,2017,17(1):10-12
[14] 陈莉莉,袁征,邵铭.邵铭教授治疗原发性胆汁性肝硬化经验探析[J].四川中医,2016,34(11):3-5
[15] 袁媛,吴芹,石京山,等.丹参及其主要成分保肝作用的研究进展[J].中国中药杂志,2015,40(4):588-593
[16] 林平,孙倩,王威,等.茵陈有效成分的药理作用及其临床应用的研究进展[J].抗感染药学,2014,11(1):28-31
[17] 蒋征奎,王学方.茯苓皮水提物对四氯化碳诱导大鼠肝纤维化的改善作用[J].中国药房,2017,28(22):3065-3068