布地奈德与泼尼松分别联合硫唑嘌呤治疗自身免疫性肝炎

目的比较布地奈德联合硫唑嘌呤与泼尼松联合硫唑嘌呤治疗自身免疫性肝炎(AIH)的疗效。方法选择宝鸡市中心医院2015年1月至2018年1月收治的90例AIH患者,随机分为布地奈德组联合硫唑嘌呤与泼尼松组联合硫唑嘌呤,各45例。2组均连续治疗2年。比较2组临床总缓解率、治疗前后的血清ALT、AST、ALP、γ-GT水平与不良反应总发生率。结果布地奈德组临床总缓解率88.89%(40/45),显著高于泼尼松组71.11%(32/45)(P<0.05)。2组治疗2年后的血清ALT、AST、ALP、γ-GT水平均较治疗前显著下降(P<0.05)。布地奈德组治疗后的血清ALT、AST、ALP、γ-GT水平分别为(27.42±5.36)U/L、(29.97±4.52)U/L、(88.11±14.32)U/L、(49.52±7.62)U/L显著低于泼尼松组(P<0.05)。布地奈德组治疗期间不良反应总发生率15.56%(7/45),显著低于泼尼松组35.56%(16/45)(P<0.05)。结论布地奈德联合硫唑嘌呤治疗AIH可获得更高的缓解率,更明显的生物化学指标改善,且不良反应更少,效果优于泼尼松联合硫唑嘌呤。

Study of budesonide or prednisone combined with azathioprine in the treatment of autoimmune hepatitis

Objective To compare the efficacy of budesonide combined with azathioprine and prednisone combined with azathioprine in the treatment of autoimmune hepatitis(AIH).Methods A total of 90 patients with AIH admitted to our hospital from January 2015 to January 2018 were randomly divided into the budesonide group and the prednisone group,45 cases each.The budesonide group was treated with budesonide plus azathioprine,and the prednisone group was treated with prednisone plus azathioprine.Both groups were treated continuously for 2 years.The total clinical remission rate,serum ALT,AST,ALP,γ-GT levels and the total incidence of adverse reactions were compared between the 2 groups.Results The overall clinical remission rate of the budesonide group was 88.89%,which was significantly higher than 71.11%of the prednisone group(P<0.05).The levels of serum ALT,AST,ALP andγ-GT in the 2 groups after 2 years of treatment were significantly lower than those before treatment(P<0.05).The levels of ALT,AST,ALP andγ-GT in the budesonide group were(27.42±5.36)U/L,(29.97±4.52)U/L,(88.11±14.32)U/L,(49.52±7.62)U/L,respectively,which were significantly lower than those in the prednisone group(P<0.05).The overall incidence of adverse reactions during treatment in the budesonide group was 15.56%,which was significantly lower than 35.56%of the prednisone group(P<0.05).Conclusion Budesonide combined with azathioprine in the treatment of AIH can achieve higher remission rate,more obvious improvement of biochemical indicators,and fewer adverse reactions,which is better than prednisone combined with azathioprine.