标准免疫抑制疗法联合异甘草酸镁对自身免疫性肝炎患者疗效及免疫球蛋白的影响

摘要/Abstract

摘要： 目的探究标准免疫抑制疗法联合异甘草酸镁对自身免疫性肝炎(AIH)患者疗效及免疫球蛋白的影响。方法选取2021年3月到2024年3月我院接收的90例AIH患者,随机分为免疫抑制组(n=45)和异甘草酸镁组(n=45)。免疫抑制组给予标准免疫抑制疗法治疗,异甘草酸镁组在免疫抑制组的基础上联合异甘草酸镁治疗。比较两组治疗疗效、肝功能[TBil、ALT、AST、ALP]、肝纤维化指标[HA、LN、PCⅢ]、免疫球蛋白[IgA、IgG、IgM]及不良反应。结果治疗后,异甘草酸镁组的治疗疗效[93.3%(42/45)]高于免疫抑制组[77.8%(35/45)](P<0.05);异甘草酸镁组的TBil(15.38±1.41 μmol/L)、ALT(56.35±5.21 U/L)、AST(48.44±5.82 U/L)、ALP(69.44±7.67 U/L)水平低于免疫抑制组(17.85±1.78 μmol/L、80.82±8.03 U/L、75.03±7.71 U/L、82.03±9.32 U/L)(P<0.05);异甘草酸镁组的HA(136.43±16.58 μg/L)、LN(147.65±16.65 μg/L)、PCⅢ(126.42±13.77 μg/L)均低于免疫抑制组(174.41±19.56、188.67±21.17、168.85±17.09 μg/L)(P<0.05);异甘草酸镁组的IgA(0.85±0.29 g/L)、IgM(14.73±1.56 g/L)、IgG(1.42±0.22 g/L)均低于免疫抑制组(1.09±0.32、16.10±1.73、1.57±0.31 g/L)(P<0.05);比较异甘草酸镁组的不良反应发生率[8.9%(4/45)]与免疫抑制组[4.4%(2/45)],差异无统计学意义(P>0.05)。结论免疫抑制疗法与异甘草酸镁联用,能显著改善 AIH 患者的治疗效果,并对其免疫球蛋白水平产生积极调节作用。

关键词: 标准免疫抑制疗法, 异甘草酸镁, 自身免疫性肝炎, 免疫球蛋白

Abstract: Objective To explore the effects of standard immunosuppressive therapy combined with magnesium isoglycyrrhizinate on the efficacy and immunoglobulins in patients with autoimmune hepatitis (AIH). Methods A total of 90 patients with AIH admitted to our hospital from March 2021 to March 2024 were selected. They were randomly divided into the immunosuppressive group (n=45) and the magnesium isoglycyrrhizinate group (n=45) by the envelope lottery method. The immunosuppressive group was treated with standard immunosuppressive therapy, and the magnesium isoglycyrrhizinate group was treated with magnesium isoglycyrrhizinate and standard immunosuppressive therapy. Compare the therapeutic effects, liver function [total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP)], liver fibrosis indexes [hyaluronic acid (HA), laminin (LN), type III procollagen (PCⅢ)], immunoglobulin [IgA, IgG, IgM] and adverse reactions between the two groups. Results After treatment, the effective rate of the magnesium isoglycyrrhizinate group [93.3% (42/45)] was higher than that of the immunosuppressive group [77.8% (35/45)] (P<0.05); the levels of TBil (15.38 ± 1.41 μmol/L), ALT (56.35 ± 5.21 U/L), AST (48.44 ± 5.82 U/L), and ALP (69.44 ± 7.67 U/L) in the magnesium isoglycyrrhizinate group were lower than those in the immunosuppressive group (17.85 ± 1.78 μmol/L, 80.82 ± 8.03 U/L, 75.03 ± 7.71 U/L, 82.03 ± 9.32 U/L) (P<0.05); the levels of HA (136.43 ± 16.58 μg/L), LN (147.65 ± 16.65 μg/L), and PCⅢ (126.42 ± 13.77 μg/L) in the magnesium isoglycyrrhizinate group were all lower than those in the immunosuppressive group (174.41 ± 19.56, 188.67 ± 21.17, 168.85 ± 17.09 μg/L) (P<0.05); the levels of IgA (0.85 ± 0.29 g/L), IgM (14.73 ± 1.56 g/L), and IgG (1.42 ± 0.22 g/L) in the magnesium isoglycyrrhizinate group were all lower than those in the immunosuppressive group (1.09 ± 0.32, 16.10 ± 1.73, 1.57 ± 0.31 g/L) (P<0.05); there was no significant difference in the incidence of adverse reactions between the magnesium isoglycyrrhizinate group [8.9% (4/45)] and the immunosuppressive group [4.4% (2/45)] (P>0.05). Conclusion The combination of immunosuppressive therapy and magnesium isoglycyrrhizinate can significantly improve the treatment effect of patients with AIH and have a positive regulatory effect on their immunoglobulin levels.

Key words: Standard immunosuppressive therapy, Magnesium isoglycyrrhizinate, Autoimmune hepatitis, Immunoglobulins

吴安妮, 杜德慧, 吴锐, 邢婧, 吴铄珺. 标准免疫抑制疗法联合异甘草酸镁对自身免疫性肝炎患者疗效及免疫球蛋白的影响[J]. 肝脏, 2025, 30(6): 833-836.

WU An-ni, DU De-hui, WU Rui, XING Jing, WU Shuo-jun. The impact of standard immunosuppressive therapy combined with magnesium isoglycyrrhizinate on the efficacy and immunoglobulins in patients with autoimmune hepatitis[J]. Chinese Hepatolgy, 2025, 30(6): 833-836.

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参考文献

[1] Muratori L, Lohse A W, Lenzi M. Diagnosis and management of autoimmune hepatitis[J]. BMJ, 2023, 380.
[2] Komori A. Recent updates on the management of autoimmune hepatitis[J]. Clin Mol Hepatol, 2021, 27(1): 58.
[3] 张克慧, 李勇. 自身免疫性肝炎病因病理机制研究进展[J]. 辽宁中医药大学学报,2020,22(10):180-185.
[4] 王睿, 王绮夏, 马雄. 自身免疫性肝炎的标准治疗和潜在治疗靶点[J]. 临床肝胆病杂志,2020,36(4):737-742.
[5] 凌佳慧, 倪美鑫, 韩黎黎, 等. 异甘草酸镁治疗自身免疫性肝炎患者血清细胞因子水平变化[J]. 实用肝脏病杂志,2023,26(2):214-217.
[6] 杜颖, 姜志红, 吴雅玲. 雷公藤多甙联合异甘草酸镁治疗儿童自身免疫性肝炎疗效及其对血清IL-17和CXCL10水平的影响[J]. 实用肝脏病杂志,2020,23(3):348-351.
[7] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 自身免疫性肝炎诊断和治疗共识(2015)[J]. 中华肝脏病杂志,2016,24(1):23-35.
[8] 韦瑞, 孙莉. 茵栀黄联合熊去氧胆酸治疗自身免疫性肝炎疗效观察[J]. 湖北中医药大学学报,2022,24(3):35-37.
[9] Sirbe C, Simu G, Szabo I, et al. Pathogenesis of autoimmune hepatitis—Cellular and molecular mechanisms[J]. Int J Mol Sci, 2021, 22(24): 13578.
[10] Pape S, Snijders R J, Gevers T J G, et al. Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group[J]. J Hepatol, 2022, 76(4): 841-849.
[11] 陈雅君, 朱婧, 李璐, 等. 标准免疫抑制疗法联合异甘草酸镁治疗自身免疫性肝炎患者外周血B细胞和调节性B细胞变化[J]. 实用肝脏病杂志,2023,26(6):835-838.
[12] 王雨, 王楠, 王巧侠, 等. 利肝隆联合异甘草酸镁治疗自身免疫性肝炎患者疗效及其对血清趋化因子水平的影响[J]. 实用肝脏病杂志,2020,23(6):821-824.
[13] 魏秀琴, 闫晓霞, 赵宏伟, 等. 异甘草酸镁联合双环醇对自身免疫性肝炎患者的治疗效果[J]. 西北药学杂志,2021,36(2):292-295.
[14] 符馨尹, 林小茹, 郑秀芬, 等. 药物诱导性自身免疫性肝炎与药物性肝损伤和自身免疫性肝炎患者临床特征比较研究[J]. 实用肝脏病杂志,2023,26(4):512-515.
[15] 胡平平, 朱传龙. 不同剂量异甘草酸镁治疗ALT升高慢性肝病疗效的meta分析[J]. 中华肝脏病杂志,2023,31(8):835-841.
[16] 张勇, 唐韵. 异甘草酸镁注射液与还原型谷胱甘肽治疗老年脓毒症相关肝损害患者的临床疗效比较[J]. 老年医学与保健,2022,28(4):732-736.
[17] 常冬冬, 殷荣华, 张燕, 等. 卡瑞利珠单抗对不可切除肝癌DTACE术后肿瘤进展的疗效和安全性[J]. 肝脏,2024,29(4):395-399.
[18] 张超, 柏祥云, 薛凤华. AST/ALT、白蛋白与肝癌患者病理特征及TACE治疗预后的关系[J]. 分子诊断与治疗杂志,2024,16(5):930-934.
[19] 王俊峰, 赵亮, 王俊杰, 等. 脓毒血症肝损伤患者血清TBA、ALP水平与凝血功能特征观察[J]. 肝脏,2022,27(5):593-595.
[20] 卢瑾, 闻名, 唐情容, 等. 血清GP73、CHI3L1表达与慢性乙型肝炎患者肝纤维化及病理变化程度的关系[J]. 实用医学杂志,2024,40(11):1586-1591.