熊去氧胆酸治疗原发性胆汁性胆管炎效果的评判-现代医学

熊去氧胆酸治疗原发性胆汁性胆管炎效果的评判

单位：空军军医大学西京医院消化内科, 陕西西安 710032

分类号：R453.9

出版年·卷·期（页码）：2019·38·第十一期（1301-1305）

摘要：

目的：采用多种疗效判定标准，分析熊去氧胆酸（UDCA）治疗原发性胆汁性胆管炎（PBC）的临床效果。方法：回顾性研究初次接受UDCA治疗的466例PBC患者，收集患者治疗前和治疗1年内的临床相关资料，对患者治疗后的血清生化指标和生化应答率进行对比分析。结果：UDCA治疗1年后患者总体血清生化指标明显改善，依据不同疗效判定标准所得的生化应答率分别为64.38%（Barcelona标准）、57.73%（Paris 1标准）、44.64%（Paris 2标准）、32.19%（Ehime标准）、54.29%（Momah/Lindor标准）和86.91%（Rotterdam标准），进一步分析发现Paris 1标准、Paris 2标准和Momah/Lindor标准的应答符合率最高。结论：应采用多种标准综合评判UDCA的临床疗效。

Objective: To analyze the clinical efficacy of ursodeoxycholic acid(UDCA) in the treatment of primary biliary cholangitis(PBC) using different criteria to assess response to therapy. Methods: A total of 466 naive PBC patients were retrospectively reviewed. Changes in clinical features and biochemistries after therapy were assessed. Results: After 1 year of UDCA treatment, the overall blood biochemical parameters of the patients were improved significantly. The biochemical response rates according to different criteria were 64.38%(Barcelona criteria), 57.73%(Paris 1 criteria), 44.64%(Paris 2 criteria), 32.19%(Ehime criteria), 54.29%(Momah/Lindor criteria) and 86.91%(Rotterdam criteria) respectively. Further analysis found that the Paris 1, Paris 2 and Momah/Lindor criteria had the highest consistency rates. Conclusion: Multiple criteria should be used in combination to assess the response to UDCA therapy.

参考文献：

[1] ZHANG L N,SHI T Y,SHI X H,et al.Early biochemical response to ursodeoxycholic acid and long-term prognosis of primary biliary cirrhosis:results of a 14-year cohort study[J].Hepatology,2013,58(1):264-272.
[2] CORPECHOT C,CARRAT F,BAHR A,et al.The effect of ursodeoxycholic acid therapy on the natural course of primary biliary cirrhosis[J].Gastroenterology,2005,128(2):297-303.
[3] CORPECHOT C,ABENAVOLI L,RABAHI N,et al.Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis[J].Hepatology,2008,48(3):871-877.
[4] KUMAGI T,GUINDI M,FISCHER S E,et al.Baseline ductopenia and treatment response predict long-term histological progression in primary biliary cirrhosis[J].Am J Gastroenterol,2010,105(10):2186-2194.
[5] PARES A,CABALLERIA L,RODES J.Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic acid[J].Gastroenterology,2006,130(3):715-720.
[6] KUIPER E M M,HANSEN B E,DE VRIES R,et al.Improved prognosis of patients with primary biliary cirrhosis that have a biochemical response to ursodeoxycholic acid[J].Gastroenterology,2009,136(4):1281-1287.
[7] AZEMOTO N,KUMAGI T,ABE M,et al.Biochemical response to ursodeoxycholic acid predicts long-term outcome in Japanese patients with primary biliary cirrhosis[J].Hepatology Research,2011,41(4):310-317.
[8] TRIVEDI P J,LAMMERS W J,VAN BUUREN H R,et al.Stratification of hepatocellular carcinoma risk in primary biliary cirrhosis:a multicentre international study[J].Gut,2016,65(2):321-329.
[9] CORPECHOT C,CHAZOUILLERES O,POUPON R.Early primary biliary cirrhosis:biochemical response to treatment and prediction of long-term outcome[J].J Hepatol,2011,55(6):1361-1367.
[10] AZEMOTO N,ABE M,MURATA Y,et al.Early biochemical response to ursodeoxycholic acid predicts symptom development in patients with asymptomatic primary biliary cirrhosis[J].J Gastroenterol,2009,44(6):630-634.
[11] LAMMERT C,JURAN B,SCHLICHT E,et al.Biochemical response to ursodeoxycholic acid predicts survival in a North American cohort of primary biliary cirrhosis patients[J].Journal of Gastroenterology,2014,49(10):1414-1420.
[12] MOMAH N,SILVEIRA M G,JORGENSEN R,et al.Optimizing biochemical markers as endpoints for clinical trials in primary biliary cirrhosis[J].Liver International,2012,32(5):790-795.
[13] LINDOR K D,GERSHWIN M E,POUPON R,et al.AASLD practice guidelines:primary biliary cirrhosis[J].Hepatology,2009,50(1):291-308.
[14] AZEMOTO N,ABE M,MURATA Y,et al.Early biochemical response to ursodeoxycholic acid predicts symptom development in patients with asymptomatic primary biliary cirrhosis[J].Journal of Gastroenterology,2009,44(6):630-634.
[15] NEVENS F,ANDREONE P,MAZZELLA G,et al.A placebo-controlled trial of obeticholic acid in primary biliary cholangitis[J].N Engl J Med,2016,375(7):631-643.
[16] CORPECHOT C,CHAZOUILL RES O,ROUSSEAU A,et al.A placebo-controlled trial of bezafibrate in primary biliary cholangitis[J].N Engl J Med,2018,378(23):2171-2181.
[17] GHONEM N S,BOYER J L.Fibrates as adjuvant therapy for chronic cholestatic liver disease:its time has come[J].Hepatology,2013,57(5):1691-1693.
[18] SPRINGER J,CAUCH-DUDEK K,O'ROURKE K,et al.Asymptomatic primary biliary cirrhosis:a study of its natural history and prognosis[J].American Journal of Gastroenterology,1999,94:47.
[19] MAHL T C,SHOCKCOR W,BOYER J L.Primary biliary cirrhosis:survival of a large cohort of symptomatic and asymptomatic patients followed for 24 years[J].Journal of Hepatology,1994,20(6):707-713.
[20] CHRISTENSEN E,CROWE J,DONIACH D,et al.Clinical pattern and course of disease in primary biliary cirrhosis based on an analysis of 236 patients[J].Gastroenterology,1980,78(2):236-246.
[21] LOCKE G R 3RD,THERNEAU T M,LUDWIG J,et al.Time course of histological progression in primary biliary cirrhosis[J].Hepatology,1996,23(1):52-56.
[22] SILVEIRA M G,BRUNT E M,HEATHCOTE J,et al.American association for the study of liver diseases endpoints conference:Design and endpoints for clinical trials in primary biliary cirrhosis[J].Hepatology,2010,52(1):349-359.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录