一贯煎联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的临床观察

目的：观察一贯煎加减治疗妊娠期肝内胆汁淤积症的疗效。方法：52例妊娠期肝内胆汁淤积症患者随机分为治疗组26例和对照组26例,治疗组患者采用一贯煎加减方联合熊去氧胆酸治疗,7d为1个疗程;对照组患者单服熊去氧胆酸,剂量、疗程同治疗组。结果：两组患者的血生化指标及妊娠结局比较,差异有显著性意义（P＜0.05）。结论：一贯煎加减方联合熊去氧胆酸治疗妊娠期肝内胆汁淤积症的疗效明显优于单用熊去氧胆酸组,在改善血生化指标及妊娠结局上有较好效果。     

滋水涵木利胆方联合熊去氧胆酸胶囊治疗原发性胆汁性胆管炎临床研究

目的:观察滋水涵木利胆方联合熊去氧胆酸胶囊治疗原发性胆汁性胆管炎的临床疗效。方法:重庆市中医院肝病科门诊就医的原发性胆汁性胆管炎患者76例,随机分为试验组与对照组,试验组患者采用滋水涵木利胆方联合熊去氧胆酸胶囊治疗,对照组患者单用熊去氧胆酸胶囊,疗程24周,比较2组患者治疗前后中医证候评分、生化指标、肝纤维化、免疫球蛋白IgM、血清胆固醇水平。结果:治疗24周时,与对照组比较,试验组患者中医证候积分明显降低、生化指标(ALT、GGT、ALP)显著改善、肝纤维化指标(HA、CIV)明显下降、血清IgM和总胆固醇水平显著降低,差异均有统计学意义(P<0.05)。结论:滋水涵木利胆方联合熊去氧胆酸胶囊治疗原发性胆汁性胆管炎患者,其疗效优于单用熊去氧胆酸胶囊,可在临床推广应用。     

熊去氧胆酸预防ERCP术后并发症的临床价值

目的：探讨熊去氧胆酸预防内镜逆行胰胆管造影（ERCP）术后并发症的临床治疗价值。方法回顾性分析62例肝胆胰十二指肠疾病患者 ERCP术后的临床资料。熊去氧胆酸组30例采用基础治疗＋常规护肝治疗＋熊去氧胆酸,熊去氧胆酸剂量为500 mg,2次/d口服,疗程28 d。对照组32例采用基础治疗＋常规护肝治疗。比较两组患者术后第3、7、14、28天的临床症状、肝功能、药物不良反应及有效率等。结果 ERCP 术后临床症状改善、肝功能指标熊去氧胆酸组明显优于对照组,差异有统计学意义（P〈0.05）。应用熊去氧胆酸的30例患者中有7例轻度不适的药物反应,可能无关者3例,无关者3例,无法判断1例;无不良事件及严重不良事件的发生,其药效安全可靠。熊去氧胆酸组30例中,显效14例、有效15例、无效1例,有效率96.7%;对照组32例中,显效14例、有效11例、无效7例,有效率78.1%;两组比较,差异有统计学意义（P〈0.05）。结论熊去氧胆酸对 ERCP 术后临床症状的改善、肝功能的恢复及降低术后并发症有明显的临床治疗价值。     

云芝肝泰胶囊辅助熊去氧胆酸片治疗原发性胆汁性肝硬化及对患者免疫学指标的影响

目的探讨云芝肝泰胶囊辅助熊去氧胆酸片治疗原发性胆汁性肝硬化的疗效及对患者免疫学指标的影响。方法选择2013年2月至2014年12月在该院就诊的原发性胆汁性肝硬化患者112例,随机分成两组各56例。对照组:口服熊去氧胆酸治疗。观察组:口服熊去氧胆酸治疗同时口服云芝肝泰胶囊。结果观察组总有效率高于对照组(P0.05)。治疗后,观察组患者皮肤瘙痒、乏力、黄疸、肝区不适症状体征的比例都低于对照组(P0.05)。治疗后,观察组症状积分低于对照组(P0.01),Ⅲ型前胶原(PⅢP)、层黏连蛋白(LN)、血清透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)低于对照组(P0.01),门冬氨酸基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、总胆红素(TBIL)低于对照组(P0.01),Ig M低于对照组(P0.01),内静脉(PV)内径、脾静脉(SV)内径小于对照组(P0.01),PV、SV血流速度高于对照组(P0.01~0.05)。结论云芝肝泰胶囊辅助熊去氧胆酸片治疗原发性胆汁性肝硬化疗效确切,能够显著缓解患者的症状体征,有效调节患者血清肝纤维、肝功能指标,提高患者的免疫抵抗力。     

用熊去氧胆酸治疗时透光胆石钙化

鹅去氧胆酸与熊去氧胆酸均降低胆汁中胆固醇的饱和指数,使胆固醇结石溶解,因熊去氧胆酸的有效剂量较小,且无腹泻等副作用,故一般作首选治疗。但熊去氧胆酸结合物在胆汁中的可溶度较鹅去氧胆酸低,Igimi 等曾推测用熊去氧胆酸治疗时可能出现糖-熊去氧胆酸沉淀物,后者又可能与钙结合,引起钙沉淀。作者报告6例在用熊去氧胆酸治疗时出现胆石钙化,并研究上述可能性。178例透光胆石病人分别用鹅去氧胆酸(122例)或熊去氧胆酸(56例)治疗6个月或更长的时间,全部病例均每隔6个月复查1次口服胆囊造影,胆石的钙化作用由放射学家评定,他们均不知病人是用何种胆酸治疗。结果用熊去氧胆酸治疗的56例有6例发生胆石     

熊去氧胆酸对节制饮食防治大鼠肥胖高脂血症性脂肪性肝炎的影响

目的 探讨熊去氧胆酸对节制饮食防治肥胖、高脂血症性脂肪性肝炎的影响。方法３５只ＳＤ大鼠持续１０周高脂饮食后，分为３组。模型组（ｎ＝１０）继续给子高脂饮食；低热卡饮食组（ｎ＝１０）恢复普通饮食，但仅给正常需要量的１／３，２周后处死；熊去氧胆酸组（ｎ＝１５）在 ＬＣＤ的同时经口给予熊去氧胆酸（２５０ｍｇ·ｋｇ－１·ｄ－１）。另设９只普通饮食饲养大鼠作正常对照。结果 与正常组相比，模型组大鼠体章、肝重明显增加、血脂和转氨酶升高，肝组织学检查示脂肪性肝炎；与模型组相比，低热年饮食组大鼠体重、肝重及肝组织脂肪变显著减轻，但血脂紊乱和肝组织炎症坏死改善并不明显；而熊去氧胆酸组血脂异常和ＡＳＴ以及肝组织炎症坏死程度均较低热卡饮食组减轻。结论 熊去氧胆酸有助于促进节食减肥大鼠血脂和脂肪性肝炎的康复。     

熊去氧胆酸对胆总管结石合并肝生化异常患者ERCP术后肝功能的影响

目的探讨熊去氧胆酸对胆总管结石合并肝功能损伤患者经内镜逆行胰胆管造影术(ERCP)术后肝功能恢复与复发率的影响。方法选取本院2016年2月—2018年1月收治的120例胆总管结石合并肝功能损伤患者,随机分为ERCP+熊去氧胆酸组与ERCP组,各60例。2组均采用ERCP治疗,ERCP+熊去氧胆酸组术后口服熊去氧胆酸250 mg/次、3次/d,共4周。比较2组术后4周的血清天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素,术后第8天的鼻胆管引流胆汁中胆固醇、总胆汁酸浓度,随访1年的累积复发率。结果术后4周,ERCP+熊去氧胆酸组血清天冬氨酸转氨酶为(63.5±11.0)U/L,显著低于ERCP组[(82.0±15.3)U/L,P0.001];丙氨酸转氨酶为(59.9±10.8)U/L,显著低于ERCP组[(74.9±12.1)U/L,P0.001];总胆红素为(44.16±8.5)U/L,显著低于ERCP组[(56.3±9.7)U/L,P0.001]。术后第8天,ERCP+熊去氧胆酸组中胆固醇浓度为(5.4±0.8)mmol/L,显著低于ERCP组[(6.7±0.9)mmol/L,P0.001];总胆汁酸浓度为(87.5±10.6)mmol/L,显著高于ERCP组[(60.2±8.3)mmol/L,P0.001]。ERCP+熊去氧胆酸组随访12个月的累积复发率为3.45%,显著低于ERCP组的16.07%(P0.05)。结论熊去氧胆酸有利于改善胆总管结石合并肝功能损伤患者ERCP术后的胆汁转运,避免继发性肝内胆汁淤积,促进肝功能指标恢复,并降低结石复发风险。     

熊去氧胆酸对肝内胆汁淤积大鼠多药耐药相关蛋白2的影响及意义

目的：制备大鼠肝内胆汁淤积模型,检测熊去氧胆酸干预前后多药耐药相关蛋白2（MRP2）表达的变化。方法：采用Wistar雄性大鼠灌服α-荼基异硫氰酸酯（ANIT）制备肝内胆汁淤积模型,分别以生理盐水、地塞米松、熊去氧胆酸干预大鼠5天后,检测肝功能,并取肝脏,采用实时荧光定量RT—PCR方法检测肝组织MRP2基因mRNA水平．Western—blot检测肝组织内MRP2蛋白水平。结果：与生理盐水组大鼠相比,地塞米松组和熊去氧胆酸组肝功能检测总胆红素、直接胆红素显著降低（P〈0．01）,肝组织MRP2基因mRNA水平、蛋白水平显著升高（P〈0．01）。结论：地塞米松和熊去氧胆酸均能降低胆红素水平,其作用机制可能与两种药物上调MRP2基因表达有关。     

熊去氧胆酸纳米混悬剂治疗乙型肝炎肝硬化GGT升高的临床疗效

目的观察熊去氧胆酸纳米混悬剂治疗GGT持续升高的乙型肝炎肝硬化患者的疗效。方法 80例乙型肝炎肝硬化患者随机分为治疗组和对照组,对照组给予常规保肝治疗,治疗组在对照组的基础上加用熊去氧胆酸纳米混悬剂口服治疗,分别检测2组治疗后第2周和第4周时血清GGT水平。结果 2组不同时间点血清GGT水平差异有统计学意义,治疗组在治疗第2周和第4周时,血清GGT下降速度更快。结论熊去氧胆酸纳米混悬剂能快速、有效地降低乙型肝炎肝硬化患者持续升高的血清GGT水平。     

不同方案治疗原发性胆汁性肝硬化合并干燥综合征的临床研究

 目的 观察不同方案治疗原发性胆汁性肝硬化（PBC）合并干燥综合征（SS）的疗效。方法 选PBC合并SS患者79例,分为3组:单用熊去氧胆酸组（U组,29例）、熊去氧胆酸+泼尼松龙组（UP组,37例）、熊去氧胆酸+硫唑嘌呤组（UA组,13例）,观察不同治疗方案的疗效。 结果3种方案对PBC合并SS患者的乏力、瘙痒均有明显改善,但组间比较差异无统计学意义（P值均＞0.05）;3种方案治疗后ALT、AST、碱性磷酸酶（ALP）、γ-谷氨酰转移酶、TBil、DBil、IgG、IgM均有明显下降,组内比较差异有统计学意义（P值均＜0.05）,但组间比较差异无统计学意义（P值均＞0.05）。结论 PBC合并SS以肝脏受累为主要表现时应以治疗PBC为主,熊去氧胆酸联合糖皮质激素或硫唑嘌呤治疗未发现优于单用熊去氧胆酸。     

Combined ursodeoxycholic acid and glycyrrhizin therapy for chronic hepatitis C virus infection: a randomized controlled trial in 170 patients.

OBJECTIVE AND DESIGN: To assess the efficacy and safety of combination therapy using ursodeoxycholic acid with glycyrrhizin for chronic hepatitis C virus infection, we conducted a prospective randomized controlled trial of glycyrrhizin (group G) compared with glycyrrhizin plus ursodeoxycholic acid (group G+U) in 170 patients. METHODS: All patients had elevated serum aminotransferase levels over 6 months before entry into the trial. Glycyrrhizin was administered to both groups for 24 weeks, and in group G+U, ursodeoxycholic acid (600 mg/day) was administered orally as well. RESULTS: Serum aspartate transaminase and alanine transaminase concentrations significantly decreased during treatment in both groups, but serum gamma-glutamyl transpeptidase concentrations fell significantly only in group G+U. Concentrations of all three enzymes fell significantly more in group G+U than in group G, and had normalized in more cases when the trial ended at 24 weeks. However, levels of HCV viraemia did not change during the trial in either group. Multiple regression analysis linked only the treatment regimen, not HCV-related factors or liver histology, to the degree of serum enzyme reduction. No adverse effects were noted in either group. CONCLUSIONS: The combined therapy with ursodeoxycholic acid and glycyrrhizin is safe and effective in improving liver-specific enzyme abnormalities, and may be an alternative to interferon in chronic hepatitis C virus infection, especially for interferon-resistant or unstable patients.     

HBV携带结核患者抗结核治疗中肝功能变化的临床分析

目的研究乙肝病毒携带结核患者抗结核治疗对肝功能的影响。方法选择我院住院的活动性肺结核患者338例,其中乙肝病毒携带肺结核患者36例,无乙肝病毒携带肺结核患者302例,对抗结核治疗中肝功能变化进行回顾性分析。结果HBV携带结核患者有30.6%出现肝损害,而对照组只有15.9%。HBV阳性组在治疗前ALT分层统计,A组(男≤30U/L,女19≤U/L)与B组(男31～40U/L,女20～40U/L),抗结核治疗后发生肝损害分别为24.1%、57.1%。A、B两组有显著性差异。结论乙肝病毒携带结核患者抗结核治疗易出现肝损害,肝功能ALT正常值上限(ULN)采用男30U/L,女19U/L较目前男女均为40U/L更为安全可靠。     

Effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients infected with hepatitis B virus

AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments of anti-tuberculosis. METHODS: Forty-seven TB patients with HBV infection and 170 TB patients without HBV infection were divided into HPBE(S) and HLAMKO treatment groups. Liver function tests before and after the treatments were performed once in 2 wk or monthly, and their clinical manifestations were recorded. RESULTS: The rate of hepatotoxicity occurred in 26 (59%) TB patients with HBV during anti-TB treatment, higher than that in 40 (24%) TB patients without HBV. Hepatotoxicity occurred in 66 out of 217 patients, and the incidence of liver dysfunction was 46.1% in HPBE(S) group, significantly higher than that in HLAMKO group (12.7%) (P<0.01). CONCLUSION: TB patients with HBV should choose HLAMKO treatment because of fewer hepatotoxicity.     

抗结核治疗对携带HBV的肺结核病患者肝功能的影响

目的　探讨抗TB治疗过程中HBV携带与肝功能损害的关系 ,比较HPBE(S)和HLAMKO两种化疗方案对肝功的影响。方法　选择HBV携带的TB患者 47例 ,非HBV携带的TB患者 170例 ,随机分成HPBE(S)和HLAMKO两个治疗组 ,于治疗前和治疗后每 2wk检测肝功能 ,并观察临床症状。结果　 47例HBV携带的TB患者发生肝功损害 2 6例 ( 5 9% ) ,明显高于非HBV携带者40例 ( 2 4% ) ;在所有 2 17例患者中 ,不同程度肝功能损害者共 66例 ( 3 0 4% ) ,其中应用HPBE(S)方案组 115例发生肝损害 5 3例( 4 6 1% ) ,HLAMKO方案组 10 5例发生肝功异常者 13例 ( 12 7% )。结论　HBV携带的TB患者应选肝损害小的HLAMKO抗结核治疗方案 ,同时应用保肝药物     

五酯胶囊防治抗结核药物肝损害的临床观察

目的　观察五酯胶囊对抗结核药物所致肝损害的防治效果。方法 初治肺结核179例,给予2HRZS(E)/4～10HR抗结核治疗,治疗组96例,全程加服五酯胶囊;对照组83例,全程加服葡醛内酯。结果 治疗组出现肝损害7例(7.3%),其中HBsAg阳性患者出现肝损害5例(11.4%);对照组出现肝损害32例(38.6%),其中HBsAg阳性患者出现肝损害20例(52.6%)。两组差异显著(P<0.01)。HBsAg、HBeAg阳性患者在抗结核治疗中肝功能更容易受损害。结论 五酯胶囊在防治抗结核药物所致肝损害的发生是有效的,尤其是HBsAg阳性的结核病患者。     

护肝治疗对乙肝表面抗原携带的肺结核病人的作用分析

目的对HBsAg阳性的初治肺结核化疗病人采用护肝与不护肝处理,了解护肝药对肺结核病人的治疗作用。方法将初治浸润型肺结核经化疗病人HBsAg(-)200例、HBsAg( )180例分组采用护肝与不护肝治疗,对比分析肝功能的损害及副作用。结果HBsAg( )肺结核病人不用护肝治疗肝功能损害及并发症严重,HBsAg(-)患者及护肝HBsAg( )病人肝功能损害及并发症均较轻微”结论及时规范护肝治疗对HBsAg( )肺结核病人的治疗必不可少。     

熊去氧胆酸治疗药物性肝病62例疗效观察

目的 观察熊去氧胆酸治疗药物性肝病的临床疗效.方法 将我院130例药物性肝病随机分为对照组(68例)和治疗组(62例),对照组给予甘草酸二铵、还原型谷胱甘肽、多烯磷酯酰胆碱,治疗组在对照组的基础上,加用熊去氧胆酸12～15 mg·kg-1 ·d-1,口服分三次,两组疗程均为4周.监测治疗前,2周、4周肝功能变化和观察临床疗效.结果 治疗组在肝功能改善方面明显优于对照组(P＜0.01),治疗组和对照组临床疗效比较,差异有统计学意义(P＜0.01).结论 熊去氧胆酸治疗药物性肝病确有较好疗效.     

Ursodeoxycholic acid therapy in cystic fibrosis-associated liver disease: a dose-response study.

Previous studies from our groups have demonstrated improvements in biochemical markers of liver function when cystic fibrosis patients with associated liver disease were administered oral ursodeoxycholic acid. The magnitude of the response was somewhat less than that found when comparable doses (10 to 15 mg/kg body wt/day) of ursodeoxycholic acid are given to other liver disease patients; this may be explained by the bile acid malabsorption that is characteristic of the disease. For this reason a dose-response study was carried out in nine cystic fibrosis patients with liver disease to establish whether improved efficacy could be obtained with higher doses. Ursodeoxycholic acid in doses of 5, 10 and 15 mg/kg body wt/day was given orally for consecutive 2-mo periods in a replicated Latin-square design. After this, all patients received 20 mg/kg body wt/day. Liver function, individual serum bile acids and biliary bile acid composition were determined at entry and at the end of each treatment period. Our data demonstrate that the magnitude of the biochemical improvement in serum liver enzymes was significantly greater with higher doses of ursodeoxycholic acid; at 20 mg/kg body wt/day it was similar to that reported for patients with other liver diseases administered lower doses. Biliary ursodeoxycholic acid enrichment increased with increasing doses, attaining 42% +/- 6% of the total biliary bile acids with the highest dose. Fasting serum ursodeoxycholic acid concentrations increased during ursodeoxycholic acid administration but were variable and correlated poorly with the dose of ursodeoxycholic acid administered, whereas no correlation was found between serum ursodeoxycholic acid concentration and the proportion of ursodeoxycholic acid in bile.(ABSTRACT TRUNCATED AT 250 WORDS)     

The biochemical and histopathological effects of ursodeoxycholic acid and metronidazole on total parenteral nutrition-associated hepatic dysfunction: an experimental study

BACKGROUND/AIMS: Total parenteral nutrition causes many complications such as cholestasis. Ursodeoxycholic acid is used for the treatment of several cholestatic problems. Metronidazole was investigated before for preventing some components of total parenteral nutrition-associated hepatic dysfunction. This study was designed to investigate the effects of ursodeoxycholic acid alone and ursodeoxycholic acid + metronidazole combination on total parenteral nutrition-associated cholestasis. METHODOLOGY: Eighteen rabbits were divided into three groups as follows: group A received a standard formula of total parenteral nutrition only, group B received total parenteral nutrition + ursodeoxycholic acid (3 mg/kg/day), and group C were given total parenteral nutrition + ursodeoxycholic acid + metronidazole (25 mg/kg/day) for eight days, respectively. Several parameters of liver function tests were compared among these groups. These were transaminases, alkaline phosphatase, total bilirubin, total cholesterol, triglycerides, and serum bile acids. Liver histology was detected in each group at the end of the experiment. RESULTS: In group A, total parenteral nutrition administration resulted in remarkably higher serum values of transaminases, alkaline phosphatase, total cholesterol, total bilirubin, triglycerides, and free bile acids whereas ursodeoxycholic acid administration showed important improvements in the serum values of these parameters in group B animals. The metronidazole group showed nearer or similar laboratory values with group B, but significant differences appeared in bilirubin values (P < 0.05) among these groups. Liver histology presented marked differences between group A and group B. Steatosis formed the main component of liver histology in 4 animals out of 6 in group A. Contrary to this, all of the specimens showed normal liver structure except one in group B. In the third group we did not see better morphology than in group B. CONCLUSIONS: These results suggested that oral ursodeoxycholic acid therapy during total parenteral nutrition reduces bilirubin levels and improves the other indicators of cholestasis and helps prevent disturbances of liver histology. When it is combined with metronidazole a significant decrease in bilirubin levels has been gained. With the help of ursodeoxycholic acid we can provide enterohepatic circulation of bile acids and regulate lipid metabolism. Metronidazole can be an antibiotic of choice during total parenteral nutrition when needed.