泼尼松龙联合异甘草酸镁治疗自身免疫性肝炎的疗效及对氧化应激指标的影响

Efficacy of prednisolone combined with magnesium isoglycyrrhizinate in patients with autoimmune hepatitis and its effects on oxidative stress markers

摘要:

目的 评估泼尼松龙联合异甘草酸镁治疗自身免疫性肝炎（AIH）的临床价值及对氧化应激指标的影响。方法 选取2022年1月—2024年12月在中国人民解放军东部战区总医院就诊并确诊为AIH的患者92例，随机分为观察组（泼尼松龙+异甘草酸镁，31例）、标准对照组（泼尼松龙+硫唑嘌呤，31例）和单药基础组（泼尼松龙单用，30例）。比较3组治疗前后肝功能及免疫球蛋白G（IgG）及氧化应激指标的变化，分析临床疗效、激素减量时间、谷丙转氨酶（ALT）恢复正常时间及生化复发情况。结果 治疗24周后，观察组、标准对照组和单药基础组ALT、谷草转氨酶（AST）、总胆红素（TBil）及IgG水平均较治疗前降低（P <0.05）。观察组治疗后ALT、AST、TBil及IgG水平均低于单药基础组（P <0.05）。治疗后，3组丙二醛（MDA）水平均较治疗前降低，超氧化物歧化酶（SOD）及谷胱甘肽过氧化物酶（GSH-Px）水平均较治疗前升高（P <0.05）。治疗后，观察组MDA水平均低于标准对照组及单药基础组，SOD及GSH-Px水平均高于标准对照组及单药基础组（P <0.05）。观察组激素减量时间及ALT恢复正常时间均短于单药基础组，复发时间长于单药基础组（P <0.05）。3组总有效率、生化完全缓解率及生化复发率比较，差异均无统计学意义（P >0.05）。结论 泼尼松龙联合异甘草酸镁治疗AIH可有效改善肝功能和免疫异常状态，加速激素减量，延缓复发，其作用机制可能与改善氧化应激水平有关，可作为AIH辅助治疗的可选方案。

Abstract:

Objective To evaluate the clinical efficacy of prednisolone combined with magnesium isoglycyrrhizinate in patients with autoimmune hepatitis (AIH), its effects on oxidative stress markers, and its efficacy relative to prednisolone combined with azathioprine and prednisolone monotherapy.Methods A total of 92 patients diagnosed with AIH at the General Hospital of the Eastern Theater Command of the Chinese People's Liberation Army between January 2022 and December 2024 were randomly divided into an observation group (prednisolone plus magnesium isoglycyrrhizinate, n = 31), a standard control group (prednisolone plus azathioprine, n = 31), and a monotherapy group (prednisolone alone, n = 30). Changes in liver function, immunoglobulin G (IgG), and oxidative stress markers were compared among the three groups before and after treatment. Clinical efficacy, time to steroid dose reduction, time to normalization of alanine aminotransferase (ALT), and biochemical relapse were also analyzed.Results After 24 weeks of treatment, ALT, aspartate aminotransferase (AST), total bilirubin (TBil), and IgG levels were lower than baseline in all three groups (P < 0.05). Post-treatment ALT, AST, TBil, and IgG levels were lower in the observation group than in the monotherapy group (P < 0.05). After treatment, malondialdehyde (MDA) levels decreased, whereas superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels increased, in all three groups (P < 0.05). Post-treatment MDA levels were lower and SOD and GSH-Px levels were higher in the observation group than in the standard control and monotherapy groups (P < 0.05). The times to steroid tapering and ALT normalization were shorter and the time to relapse was longer in the observation group than in the monotherapy group (P < 0.05). Overall response, complete biochemical remission, and biochemical relapse rates did not differ significantly among the three groups (P > 0.05).Conclusion Prednisolone combined with magnesium isoglycyrrhizinate improves liver function and immune abnormalities in patients with AIH, accelerates steroid tapering, and delays relapse. Its effects may be associated with improved oxidative stress status, supporting its use as an optional adjunctive treatment for AIH.