α体甘草酸制剂治疗轻症自身免疫性肝炎的疗效

发布时间：2018-03-24 02:15

本文选题：α体甘草酸　切入点：β体甘草酸　出处：《郑州大学》2014年硕士论文

【摘要】：研究背景：自身免疫性肝炎(autoimmune hepatitis, AIH)是一种异常自身免疫反应介导的肝实质炎症性病变。主要治疗方法为免疫抑制治疗，有一定的治疗指征，部分轻症AIH患者肝组织内炎症反应较轻，各项指标达不到免疫抑制治疗指征，目前临床上对这部分患者是否给予免疫抑制治疗尚存争议。考虑到免疫抑制治疗不良反应较多，故有必要寻找疗效好、安全性高的非激素类药物。近年来关于α体甘草酸制剂治疗病毒性肝炎、脂肪性肝病、药物性肝损伤等肝病的报道很多，关于其治疗轻症AIH的报道较少。目的：观察α体甘草酸制剂对于轻症AIH炎症活动的控制作用。方法：选择2008年9月至2012年10月我院收治的轻症AIH患者98例（确诊为AIH但未达免疫抑制治疗指征），随机分为试验组和对照组，每组各49例，试验组应用以α体甘草酸为主的甘草酸制剂（以下简称α体甘草酸制剂）治疗，先应用异甘草酸镁注射液连用3周，后改为长期口服甘草酸二铵肠溶胶囊；对照组应用以β体甘草酸为主的甘草酸制剂（以下简称β体甘草酸制剂）治疗，先应用复方甘草酸苷注射液连用3周,后改为长期口服复方甘草酸苷片。两组疗程均为1年。检测两组患者治疗前、治疗后3个月、6个月、12个月的肝功能、免疫学指标；记录治疗过程中发生的不良反应；观察治疗前、治疗后12个月的肝组织学变化。所有数据均应用SPSS17.0统计学软件进行分析，，计量资料的比较采用重复测量资料的方差分析，两组治疗效果的比较采用秩和检验，两组不良反应发生率的比较采用四格表资料的x2检验。结果 1.2组患者治疗后谷丙转氨酶（ALT）、谷草转氨酶（AST）、球蛋白（GLOB）、免疫球蛋白G（IgG）、γ-球蛋白、C反应蛋白（CRP）均下降，补体3（C3）、补体4（C4）均上升，组内时间点间差异有统计学意义（P0.05）。 2.试验组上述指标的改善程度优于对照组，组间比较差异有统计学意义（P0.05）。 3.试验组的总有效率高于对照组（82.9.0%vs61.0%），差异有统计学意义（P0.05）。 4.试验组不良反应发生率低于对照组(4.08%vs16.3%)，差异有统计学意义(P0.05）。结论： 1.α体甘草酸制剂和β体甘草酸制剂均可以改善轻症AIH的肝功能及免疫学指标，对于治疗轻症AIH均有效。 2.α体甘草酸制剂对轻症AIH的疗效优于β体甘草酸制剂。 3.在治疗轻症AIH时，α体甘草酸制剂安全性高于β体甘草酸制剂。
[Abstract]:Background:. Autoimmune hepatitis autoimmune hepatitis (AIHs) is an abnormal autoimmune response mediated inflammatory lesion of liver parenchyma. All the indexes can not reach the indication of immunosuppressive therapy. At present, there is still controversy about whether these patients should be given immunosuppressive therapy. Considering that there are more adverse reactions in immunosuppressive therapy, it is necessary to find a good curative effect. In recent years, there are many reports on the treatment of viral hepatitis, fatty liver disease, drug-induced liver injury and other liver diseases by 伪 -body glycyrrhizic acid preparation, but there are few reports on the treatment of mild AIH. Objective:. To observe the control effect of 伪-body glycyrrhizic acid preparation on inflammatory activity of mild AIH. Methods:. From September 2008 to October 2012, 98 patients with mild AIH were randomly divided into experimental group and control group, with 49 cases in each group. The experimental group was treated with 伪 -glycyrrhizic acid preparation (hereinafter referred to as 伪 -glycyrrhizic acid preparation). Magnesium isoglycyrrhizinate injection was used for 3 weeks, then it was treated by long-term oral administration of diammonium glycyrrhizinate enteric-soluble capsule. The control group was treated with 尾 -glycyrrhizic acid preparation (hereinafter referred to as 尾 -glycyrrhizic acid preparation), and was treated with compound glycyrrhizin injection for 3 weeks. The course of treatment in both groups was one year. The liver function and immunological indexes were measured before treatment, 3 months, 6 months and 12 months after treatment in both groups, and the adverse reactions occurred during the treatment were recorded. The changes of liver histology before and 12 months after treatment were observed. All the data were analyzed by SPSS17.0 statistical software. The quantitative data were compared by the analysis of variance of repeated measurement data, and the results of treatment were compared by rank sum test. The incidence of adverse reactions in the two groups was compared by using the x 2 test of the four-grid data. Results. After treatment, alanine aminotransferase (alt), alanine aminotransferase (alt), glutamic oxalacetic transaminase (AST), globulin Glob (GLOB), immunoglobulin G (IGG), 纬 -globulin C-reactive protein (CRPP) were all decreased, complement 3C _ (3) and complement (4) C _ (4) were increased, and there was significant difference between the two groups (P 0.05). 2. The improvement of the above indexes in the experimental group was better than that in the control group, and the difference between the two groups was statistically significant (P 0.05). 3. The total effective rate of the test group was higher than that of the control group (82.9.0 vs 61.0), and the difference was statistically significant (P 0.05). 4. The incidence of adverse reactions in the trial group was lower than that in the control group (4.08 vs 16.3g / L), and the difference was statistically significant (P 0.05). Conclusion:. 1. Both 伪 -body glycyrrhizic acid preparation and 尾 -body glycyrrhizic acid preparation can improve liver function and immunological indexes of mild AIH, and are effective in the treatment of mild AIH. 2. 伪-glycyrrhizic acid preparation is superior to 尾-glycyrrhizic acid preparation in the treatment of mild AIH. 3. The safety of 伪-glycyrrhizic acid preparation was higher than that of 尾-glycyrrhizic acid preparation in the treatment of mild AIH.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.1

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