熊去氧胆酸联合糖皮质激素对自身免疫性肝炎患者肝功能及外周血CD4+、CD8+水平的影响

Impact of ursodeoxycholic acid combined with glucocorticoids on liver function and peripheral blood CD4+ and CD8+ levels in patients with autoimmune hepatitis

摘要:

目的 探讨熊去氧胆酸（UDCA）联合糖皮质激素对自身免疫性肝炎（AIH）患者肝功能及外周血CD4⁺、CD8⁺水平的影响。方法 选择2021年6月至2024年6月龙岩市第二医院收治的98例AIH患者，按随机数字表法分为两组。对照组（n=49）采用糖皮质激素治疗，研究组（n=49）在对照组基础上联合UDCA治疗。比较两组临床疗效、肝功能、肝纤维化指标以及外周血CD4⁺、CD8⁺水平，并统计不良反应发生情况。结果 研究组治疗总有效率为91.84%（45/49），明显较高于对照组的75.51%（37/49）（P＜0.05）。研究组治疗后谷丙转氨酶（ALT）、谷氨酸转氨酶（AST）、总胆红素（TBIL）、直接胆红素（DBIL）水平分别为（36.82±5.15）U/L、（34.55±4.58）U/L、（32.84±3.34）μmoL/L、（23.54±3.05）μmoL/L，明显较对照组低（P＜0.05）。研究组治疗后透明质酸（HA）、层粘蛋白（LN）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（ⅣC）水平分别为（96.11±227.85）μg/L、（119.42±39.08）μg/L、（100.42±36.97）μg/L、（107.31±20.71）μg/L，明显较对照组低（P＜0.05）。研究组治疗后外周血CD4⁺水平为（36.16±3.27）%，明显较对照组高（P＜0.05）；CD8+水平为（27.23±4.27）%，明显较对照组低（P＜0.05）。两组治疗期间均无明显不良反应发生。结论 AIH患者采用UDCA联合糖皮质激素治疗的效果较好，利于改善患者肝功能，调节患者机体免疫状态，改善外周血CD4⁺、CD8⁺水平，且联合用药安全性较高。

Abstract:

Objective To explore the impact of ursodeoxycholic acid (UDCA) combined with glucocorticoids on liver function and peripheral blood CD4⁺ and CD8⁺ levels in patients with autoimmune hepatitis (AIH).Methods A total of 98 AIH patients admitted to Longyan Second Hospital from June 2021 to June 2024 were included and randomly divided into two groups. The control group (n=49) received glucocorticoid treatment, while the research group (n=49) received glucocorticoid combined UDCA treatment. Clinical efficacy, liver function, liver fibrosis indicators, and peripheral blood CD4⁺ and CD8⁺ levels were compared between the two groups, and adverse reactions were recorded.Results The total effective rate of the research group was 91.84% (45/49), significantly higher than the control group [75.51% (37/49)] (P＜0.05). After treatment, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and direct bilirubin (DBIL) in the research group were (36.82±5.15) U/L, (34.55±4.58) U/L, (32.84±3.34) μmol/L, and (23.54±3.05) μmol/L, respectively, which were significantly lower than those in the control group (P＜0.05). After treatment, the levels of hyaluronic acid (HA), laminin (LN), type III procollagen (PCIII), and type IV collagen (IVC) in the research group were (96.11±227.85) μg/L, (119.42±39.08) μg/L, (100.42±36.97) μg/L, and (107.31±20.71) μg/L, respectively, which were significantly lower than those in the control group (P＜0.05). After treatment, the CD4⁺ level in peripheral blood of the research group was (36.16±3.27)%, significantly higher than that of the control group; and the CD8⁺ level was (27.23±4.27)%, significantly lower than that of the control group (P＜0.05). There were no significant adverse reactions observed during the treatment period in both groups.Conclusion The combination of UDCA and glucocorticoids is effective for the treatment of AIH patients, improving liver function, regulating immune status, and improving peripheral blood CD4⁺ and CD8⁺ levels, with high safety.