CAJ | 학술논문

熊去氧胆酸治疗不同临床分期原发性胆汁性肝硬化的2年随访观察
웅거양담산치료불동림상분기원발성담즙성간경화적2년수방관찰
A two-year follow-up study on the efficacy of ursodeoxycholic acid on primary biliary cirrhosis in different stages

万方数据

中华肝脏病杂志中華肝髒病雜誌 중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2010年 10期 735-739 ,共5页

朱疆依%李增山%晏伟%王建宏%周新民%王瑞安%黄晓峰%时永全%董旭炀%韩者艺%陈瑜%韩英

주강의%리증산%안위%왕건굉%주신민%왕서안%황효봉%시영전%동욱양%한자예%진유%한영

肝硬化,胆汁性%牛磺熊去氧胆酸%临床分期%生化学应答肝硬化,膽汁性%牛磺熊去氧膽痠%臨床分期%生化學應答
간경화,담즙성%우광웅거양담산%림상분기%생화학응답
Liver cirrhosis,billiary%Truro-ursodeoxycholic acid%Period%Biochemical respond

目的观察熊去氧胆酸(UDCA)对不同临床分期原发性胆汁性肝硬化(PBC)患者的长期疗效.方法 91例PBC患者通过自身对照的方法随访观察2年,观察应用UDCA治疗的2年内不同阶段症状、生化学指标及肝组织学病理变化.计数资料以例数或百分比描述,用配对计数资料的x2检验及重复测量数据的方差分析等方法进行统计学分析.结果 Ⅱ期患者完成治疗后6个月,碱性磷酸酶(ALP)及γ-谷氨酰转肽酶(GGT)水平下降51.9%和67.3%;治疗1年,其生化学应答率为81.25%(巴黎标准)和93.75%(巴塞罗那标准);治疗2年,ALP及GGT下降65.33%和86.75%,IgM水平于治疗1年后由62.5%降至正常;Ⅲ期患者治疗后6个月,ALP及GGT水平下降48.8%和46.6%,治疗1年生化学应答率为36.84%(巴黎标准)和57.89%(巴塞罗那标准),治疗2年ALP及GGT下降76.16%和78.63%,IgM水平于治疗1年后由28.9%降至正常,乏力、黄疸及瘙痒症状有所好转;Ⅳ期患者治疗后6个月,ALP及GGT下降43.65%和33.39%,治疗1年,生化学应答率为30.43%(巴黎标准)和56.52%(巴塞罗那标准),治疗2年,ALP及GGT下降56.84%和53.06%;IgM水平于治疗1年后,17.4%降至正常,黄疸及瘙痒症状也有所好转.11例不同分期PBC患者于治疗前后行肝活组织检查,其中Ⅰ期和Ⅱ期PBC肝脏组织学基本恢复,Ⅲ期及Ⅳ期PBC可见病理学进展,但炎症细胞浸润减轻.结论 UDCA治疗临床Ⅱ期～Ⅳ期的PBC均出现良好的生化学应答,以Ⅱ期应答率最高,并且可改善PBC患者临床症状.对于Ⅰ～Ⅱ期的患者,UDCA治疗可使肝脏组织学恢复,Ⅲ～Ⅳ期患者治疗后虽可见病理学进展,但其炎症细胞浸润明显减轻.提示早期诊断、早期治疗,应用UDCA长期治疗是治疗该病的关键.
목적 관찰웅거양담산(UDCA)대불동림상분기원발성담즙성간경화(PBC)환자적장기료효.방법 91례PBC환자통과자신대조적방법수방관찰2년,관찰응용UDCA치료적2년내불동계단증상、생화학지표급간조직학병리변화.계수자료이례수혹백분비묘술,용배대계수자료적x2검험급중복측량수거적방차분석등방법진행통계학분석.결과 Ⅱ기환자완성치료후6개월,감성린산매(ALP)급γ-곡안선전태매(GGT)수평하강51.9%화67.3%;치료1년,기생화학응답솔위81.25%(파려표준)화93.75%(파새라나표준);치료2년,ALP급GGT하강65.33%화86.75%,IgM수평우치료1년후유62.5%강지정상;Ⅲ기환자치료후6개월,ALP급GGT수평하강48.8%화46.6%,치료1년생화학응답솔위36.84%(파려표준)화57.89%(파새라나표준),치료2년ALP급GGT하강76.16%화78.63%,IgM수평우치료1년후유28.9%강지정상,핍력、황달급소양증상유소호전;Ⅳ기환자치료후6개월,ALP급GGT하강43.65%화33.39%,치료1년,생화학응답솔위30.43%(파려표준)화56.52%(파새라나표준),치료2년,ALP급GGT하강56.84%화53.06%;IgM수평우치료1년후,17.4%강지정상,황달급소양증상야유소호전.11례불동분기PBC환자우치료전후행간활조직검사,기중Ⅰ기화Ⅱ기PBC간장조직학기본회복,Ⅲ기급Ⅳ기PBC가견병이학진전,단염증세포침윤감경.결론 UDCA치료림상Ⅱ기～Ⅳ기적PBC균출현량호적생화학응답,이Ⅱ기응답솔최고,병차가개선PBC환자림상증상.대우Ⅰ～Ⅱ기적환자,UDCA치료가사간장조직학회복,Ⅲ～Ⅳ기환자치료후수가견병이학진전,단기염증세포침윤명현감경.제시조기진단、조기치료,응용UDCA장기치료시치료해병적관건.
Objective To assess the therapeutic effect of primary biliary cirrhosis(PBC) in different stages with ursodeoxycholic acid(UDCA). Methods 91 patients with PBC were divided into 4 periods based on levels of liver test and symptoms. Clinical manifestations, biochemical changes and pathological changes were observed for 2 years on UDCA therapy. Results The levels of alkaline phosphatase (ALP) and glutamyltranspetidase(GGT) at the second PBC period were declined by 51.9% and 67.3% respectively after a 6-month UDCA therapy. The biochemical responses were 81.25% (Paris criteria) and 93.75% (Barcelona criteria). The levels of ALP and GGT at the third PBC period were declined by 48.8% and 46.6% after 6 months of UDCA therapy, and the biochemical responses were 36.84% (Paris criteria) and 57.89% (Barcelona criteria). Symptoms like fatigue, pruritus and jaundice after UDCA therapy were better than before. Same results also appeared at the fourth period. 11 patients in different periods underwent pathological examinations before and after UDCA therapy and no progression found in the first and the second periods, however difference found in the third and the fourth periods with the lymphocyte infiltration was less than before UDCA treatment. Conclusion Good biochemical responds appear in patients at the second, third and forth periods after UDCA therapy, in which the second period is best. Symptoms could be improved after UDCA treatment. Early UDCA therapy is benefit for slowing down the progression of liver pathology.