本文選題：α體甘草酸　切入點(diǎn)：β體甘草酸　出處：《鄭州大學(xué)》2014年碩士論文

【摘要】：研究背景： 自身免疫性肝炎(autoimmune hepatitis, AIH)是一種異常自身免疫反應(yīng)介導(dǎo)的肝實(shí)質(zhì)炎癥性病變。主要治療方法為免疫抑制治療，有一定的治療指征，部分輕癥AIH患者肝組織內(nèi)炎癥反應(yīng)較輕，各項(xiàng)指標(biāo)達(dá)不到免疫抑制治療指征，目前臨床上對(duì)這部分患者是否給予免疫抑制治療尚存爭(zhēng)議�？紤]到免疫抑制治療不良反應(yīng)較多，故有必要尋找療效好、安全性高的非激素類藥物。近年來關(guān)于α體甘草酸制劑治療病毒性肝炎、脂肪性肝病、藥物性肝損傷等肝病的報(bào)道很多，關(guān)于其治療輕癥AIH的報(bào)道較少。 目的： 觀察α體甘草酸制劑對(duì)于輕癥AIH炎癥活動(dòng)的控制作用。 方法： 選擇2008年9月至2012年10月我院收治的輕癥AIH患者98例（確診為AIH但未達(dá)免疫抑制治療指征），隨機(jī)分為試驗(yàn)組和對(duì)照組，每組各49例，試驗(yàn)組應(yīng)用以α體甘草酸為主的甘草酸制劑（以下簡(jiǎn)稱α體甘草酸制劑）治療，先應(yīng)用異甘草酸鎂注射液連用3周，后改為長(zhǎng)期口服甘草酸二銨腸溶膠囊；對(duì)照組應(yīng)用以β體甘草酸為主的甘草酸制劑（以下簡(jiǎn)稱β體甘草酸制劑）治療，先應(yīng)用復(fù)方甘草酸苷注射液連用3周,后改為長(zhǎng)期口服復(fù)方甘草酸苷片。兩組療程均為1年。檢測(cè)兩組患者治療前、治療后3個(gè)月、6個(gè)月、12個(gè)月的肝功能、免疫學(xué)指標(biāo)；記錄治療過程中發(fā)生的不良反應(yīng)；觀察治療前、治療后12個(gè)月的肝組織學(xué)變化。所有數(shù)據(jù)均應(yīng)用SPSS17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析，，計(jì)量資料的比較采用重復(fù)測(cè)量資料的方差分析，兩組治療效果的比較采用秩和檢驗(yàn)，兩組不良反應(yīng)發(fā)生率的比較采用四格表資料的x2檢驗(yàn)。 結(jié)果 1.2組患者治療后谷丙轉(zhuǎn)氨酶（ALT）、谷草轉(zhuǎn)氨酶（AST）、球蛋白（GLOB）、免疫球蛋白G（IgG）、γ-球蛋白、C反應(yīng)蛋白（CRP）均下降，補(bǔ)體3（C3）、補(bǔ)體4（C4）均上升，組內(nèi)時(shí)間點(diǎn)間差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 2.試驗(yàn)組上述指標(biāo)的改善程度優(yōu)于對(duì)照組，組間比較差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 3.試驗(yàn)組的總有效率高于對(duì)照組（82.9.0%vs61.0%），差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 4.試驗(yàn)組不良反應(yīng)發(fā)生率低于對(duì)照組(4.08%vs16.3%)，差異有統(tǒng)計(jì)學(xué)意義(P0.05）。 結(jié)論： 1.α體甘草酸制劑和β體甘草酸制劑均可以改善輕癥AIH的肝功能及免疫學(xué)指標(biāo)，對(duì)于治療輕癥AIH均有效。 2.α體甘草酸制劑對(duì)輕癥AIH的療效優(yōu)于β體甘草酸制劑。 3.在治療輕癥AIH時(shí)，α體甘草酸制劑安全性高于β體甘草酸制劑。
[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 偽 -body glycyrrhizic acid preparation, but there are few reports on the treatment of mild AIH. Objective:. To observe the control effect of 偽-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 偽 -glycyrrhizic acid preparation (hereinafter referred to as 偽 -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), 緯 -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 偽 -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. 偽-glycyrrhizic acid preparation is superior to 尾-glycyrrhizic acid preparation in the treatment of mild AIH. 3. The safety of 偽-glycyrrhizic acid preparation was higher than that of 尾-glycyrrhizic acid preparation in the treatment of mild AIH.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R575.1

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