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

目的 探讨应用雷公藤多甙联合异甘草酸镁治疗自身免疫性肝炎(AIH)儿童的疗效及对血清白介素-17(IL-17)和趋化因子10(CXCL10)水平的影响。方法 2018年1月~2019年3月我院儿科收治的AIH患儿57例,随机分为观察组29例和对照组28例。给予对照组异甘草酸镁注射液静脉滴注治疗,观察组在对照组治疗的基础上加用雷公藤多苷片口服治疗,两组均持续治疗8周。采用ELISA法检测血清IL-17、趋化因子8(CXCL8)和CXCL10水平。结果 治疗后,观察组和对照组血清谷草转氨酶(AST)水平分别为(48.4±9.3)U/L和(61.2±12.5) U/L (P＜0.05)、丙氨酸氨基转移酶(ALT)水平分别为(59.3±7.6)U/L和(66.4±9.7)U/L (P＜0.05)、碱性磷酸酶(ALP)水平分别为(60.2±5.1)U/L和(75.7±6.4)U/L(P＜0.05);两组血清免疫球蛋白G(IgG)水平分别为(13.8±2.9)mg/L和(16.3±3.4)mg/L(P＜0.05)、IgA水平分别为(2.4±0.3)mg/L和(2.9±0.5)mg/L(P＜0.05)、IgM水平分别为(2.6±0.3)mg/L和(3.1±0.4)mg/L (P＜0.05);血清IL-17水平分别为(6.8±0.7)ng/ml和(7.3±0.9)ng/ml (P＜0.05)、CXCL8水平分别为(10.4±1.2)pg/ml和(13.8±1.6) pg/ml (P＜0.05)、CXCL10水平分别为(16.3±2.5) pg/ml和(22.6±3.7)pg/m (P＜0.05);治疗后,观察组患儿不良反应发生率为12.5%,与对照组的7.5%比,差异无统计学意义(P＞0.05)。结论 在异甘草酸镁治疗的基础上加用雷公藤多甙治疗儿童AIH疗效较好,安全性高,可有效改善肝功能和免疫功能,降低机体炎症反应,值得临床进一步验证。

Efficacy of tripterygium wilfordii polyglycosides and magnesium isoglycyrrhizinate combination in the treatment of children with autoimmune hepatitis

Objective The aim of this study was to explore the efficacy of combination of tripterygium wilfordii polyglycosides and magnesium isoglycyrrhizinate in the treatment of children with autoimmune hepatitis(AIH)and its effect on serum interleukin--17(IL-17)and chemokin10(CXCL10)levels.Methods 57 children with AIH were enrolled in the Department of Pediatric in our hospital between January 2018 and March 2019,and were randomly divided into observation(n=29)and control group(n=28).The children in the control group were treated with magnesium isoglycyrrhizinate injection intravenously,while those in the observation group were treated with tripterygium wilfordii polyglycosides orally at the basis of treatment mentioned above.Serum IL-17,CXCL8 and CXCL10 levels were detected by ELISA.Results At the end of the regimen,serum AST levels in the observation and control groups were(48.4±9.3)U/L and(61.2±12.50)U/L(P<0.05),serum levels of alkaline phosphatase were(60.2±5.1)U/L and(75.7±6.4)U/L(P<0.05),and serum levels of alanine aminotransferase were(59.3±7.6)U/L and(66.4±9.7)U/L(P<0.05);serum levels of immunoglobulin G were(13.8±2.9)mg/L and(16.3±3.4)mg/L(P<0.05),serum levels of immunoglobulin A were(2.4±0.3)mg/L and(2.9±0.5)mg/L(P<0.05),and serum level of immunoglobulin M were(2.6±0.3)mg/L and(3.1±0.4)mg/L(P<0.05);serum levels of IL-17 were(6.8±0.7)ng/ml and(7.3±0.9)ng/ml(P<0.05),serum level of CXCL8 were(10.4±1.2)pg/ml and(13.8±1.6)pg/ml(P<0.05),and serum levels of CXCL10 were(16.3±2.5)pg/ml and(22.6±3.7)pg/m(P<0.05)between the two groups;during the treatment,the incidence of adverse reactions was 12.5%in the observation group and 7.5%in the control group(P>0.05).Conclusion The combination of tripterygium wilfordii polyglycosides and magnesium isoglycyrrhizinate in the treatment of children with AIH is efficacious and safe,which might improve liver function and immune function tests and reduce inflammatory reaction.