熊去氧胆酸治疗原发性胆汁性肝硬化的临床观察

目的总结非肝硬化期原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)的临床特点,评价熊去氧胆酸(UDCA)的疗效。方法回顾性分析60例非肝硬化期PBC患者治疗前及应用UDCA治疗12个月后的症状、体征、生化免疫学指标及肝脏瞬时弹性指标。结果本组患者临床分期为Ⅱ期31例,Ⅲ期29例。临床症状以黄疸(48.3%)、乏力(46.7%)、皮肤瘙痒(45.0%)为主。60例患者血清碱性磷酸酶(ALP)和γ-谷氨酰转肽酶(γ-GT)均升高,总胆红素(TBIL)升高29例(48.3%),丙氨酸氨基转移酶(ALT)及天冬氨酸氨基转移酶(AST)升高23例(38.3%),均为轻度升高;血清IgM升高58例(96.7%),抗线粒体抗体(AMA)阳性60例(100.0%),M2亚型阳性55例(91.7%)。经过UDCA规范治疗12个月后,ALT、AST、TBIL、ALP、γ-GT、IgA、IgM、IgG较治疗前均明显改善(P﹤0.05)。其中55例达到巴塞罗那生化应答标准,37例达到巴黎生化应答标准。Ⅱ期应答率高于Ⅲ期、巴塞罗那标准评价PBC患者的生化学应答率高于巴黎标准(P均﹤0.05)。治疗12个月后患者肝脏瞬时弹性指标较治疗前明显改善[(6.7±3.1)kPa vs.(7.8±3.8)kPa,P0.05]。结论 PBC多见于中年女性,以乏力、黄疸、瘙痒为常见症状,血清ALP、γ-GT和IgM水平升高,AMA和(或)AMA-M2亚型阳性有助于PBC诊断。UDCA治疗能有效改善患者病情,对PBC早期患者治疗效果更加明显。

A clinical observation of sixty primary biliary cirrhosis patients with ursodeoxycholic acid treatment

Objective To study the clinical feature of primary biliary cirrhosis(PBC) and to observe the efficacy by taking ursodeoxycholic acid (UDCA) treatment of 12 months. Methods General status, clinical manifestations and laboratory findings of 60 patients with PBC were analyzed. All patients were given UDCA for one year. Results Among 60 patients, 55 were females. The most frequent symptoms were jaundice(48.3%), fatigue(46.7%) and pruritus(45.0%). Serum alkaline phosphatase (ALP) and glutamyl transpetidase(γ-GT) levels were elevated in all patients. Twenty-nine patients (48.3%) had a total bilirubin level≥20 μmol/L, 23 patients(38.3%)had ALT /AST levels≥40 U/L. Fifty-eight patients(96.7%) had elevated serum IgM and all patients were anti-mitochondrial antibody positive and 55 patients (91.7%) were AMA-M2 positive. Thirty-one patients belonged to clinical Phase Ⅱ, 29 patients belonged to clinical Phase Ⅲ. When 60 patients finished the treatment with UDCA for one year, values of ALT、AST、TBIL、ALP、γ-GT、IgA、IgM and IgG were improved significantly. Fifty-five patients reached the Barcelona biochemical response standard, 37 patients reached Paris biochemical response criteria. The response rate of Phase Ⅱ in patients was better than Phase Ⅲ. Biochemical response rate of Barcelona standard evaluation was better than Paris standard(P < 0.05). The Fibroscan was improved significantly after treatment[ (6.7±3.1) kPa vs. (7.8±3.8)kPa, P < 0.05]. Conclusion PBC is mostly found in middle-aged women. The most frequent symptoms are pruritus,jaundice and fatigue. Elevated serum ALP and γ-GT levels together with positive AMA/AMA-M2 can help to diagnose PBC. Treatment with UDCA effectively improve the patient’s biochemical markers.