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熊去氧胆酸联合甘草酸二铵治疗原发性胆汁性胆管炎的效果观察
Clinical effect of ursodeoxycholic acid combined with diammonium glycyrrhizinate in treatment of primary biliary cholangitis
文章发布日期:2019年05月13日  来源:  作者:张玉果,赵素贤,李文聪,等  点击次数:370次  下载次数:74次

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【摘要】:目的对比熊去氧胆酸(UDCA)联合甘草酸二铵与单用UDCA治疗原发性胆汁性胆管炎(PBC)的生化学应答和肝脏硬度变化情况。方法选取2014年1月-2016年3月就诊于河北医科大学第三医院中西医结合肝病科的PBC患者66例,均行FibroTouch检测,以肝脏硬度值表示肝纤维化程度,对比分析UDCA联合甘草酸二铵与单用UDCA治疗PBC患者4、12、24和48周的肝生化学应答和治疗24、48周后肝脏硬度值变化情况。两组间计量资料比较采用两独立样本t检验,治疗前后生化学指标及肝脏硬度值比较采用配对t检验。结果UDCA联合甘草酸二铵治疗组与单用UDCA对照组比较,联合治疗组AST水平在治疗后4周[(38.4±15.4)U/L vs (61.6±28.8)U/L, t=2.684, P=0.012]、12周[(36.4±12.6)U/L vs (58.1±24.8)U/L, t=2.953, P=0.006)]、24周[(37.0±8.5)U/L vs (52.9±17.2)U/L, t=3.134, P=0.004]、48周[(34.9±7.9)U/L vs (48.6±12.7)U/L, t=3.242, P=0.003]均显著低于对照组;联合治疗组ALP水平在治疗24周[(91.6±15.1)U/L vs (137.3±55.6)U/L, t=2.970, P=0.006]、48周[(71.3±14.7)U/L vs (128.7±45.5)U/L, t=4.503, P<0.001]均 显著低于对照组。对照组、联合治疗组肝脏硬度值治疗后24周[(12.9±6.8)kPa vs (13.9±7.6)kPa, t=4.814, P<0.001;(13.4±7.0)kPa vs (15.8±9.7)kPa, t=3.031, P=0.010)]、48周[(12.6±6.4)kPa vs (13.9±7.6)kPa, t=3.928, P=0.010;(12.0±5.7)kPa vs (15.8±9.7)kPa, t=3.044, P=0.010)]均较治疗前显著降低;但两组之间肝脏硬度值在治疗24周、48周无显著差异(P值均>005)。结论UDCA联合甘草酸二铵治疗PBC可改善患者的血清生化学应答反应,优于单用UDCA治疗,两组治疗24周、48周肝脏硬度值较治疗前有显著下降,有利于病情稳定。FibroTouch在PBC患者定期随访监测时对判断肝纤维化有无进展有一定的应用价值。
【Abstract】:ObjectiveTo investigate the clinical effect of ursodeoxycholic acid (UDCA) alone or in combination with diammonium glycyrrhizinate on biochemical response and liver stiffness measurement (LSM) in the treatment of primary biliary cholangitis (PBC). MethodsA total of 66 patients with PBC who visited Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, from January 2014 to March 2016 were enrolled. The FibroTouch test was performed, and LSM was used to indicate the degree of liver fibrosis. The patients treated with UDCA and diammonium glycyrrhizinate (treatment group) and those treated with UDCA alone (control group) were compared in terms of liver biochemical response at 4, 12, 24, and 48 weeks of treatment and LSM at 24 and 48 weeks of treatment. The independent samples t-test was used for comparison of continuous data between two groups, and the paired t-test was used for comparison of biochemical parameters and LSM before and after treatment. ResultsCompared with the control group, the treatment group had a significantly lower level of aspartate aminotransferase at 4, 12, 24, and 48 weeks of treatment (4 weeks: 38.4±15.4 U/L vs 61.6±28.8 U/L, t=2.684, P=0.012; 12 weeks: 36.4±12.6 U/L vs 58.1±24.8 U/L, t=2.953, P=0.006; 24 weeks: 37.0±8.5 U/L vs 52.9±17.2 U/L, t=3.134, P=0.004; 48 weeks: 34.9±7.9 U/L vs 48.6±12.7 U/L, t=3.463, P=0.002), as well as a significantly lower level of alkaline phosphatase at 24 and 48 weeks of treatment (24 weeks: 91.6±15.1 U/L vs 137.3±55.6 U/L, t=2970, P=0.006; 48 weeks: 71.3±14.7 U/L vs 128.7±45.5 U/L, t=4.503, P<0.001). There was a significant reduction in LSM at 24 and 48 weeks of treatment in the control group (24 weeks: 12.9±6.8 kPa vs 13.9±7.6 kPa, t=4.814, P<0.001; 48 weeks: 126±6.4 kPa vs 13.9±7.6 kPa, t=3.928, P=0.010) and the treatment group (24 weeks: 13.4±7.0 kPa vs 15.8±9.7 kPa, t=3031, P=0.010; 48 weeks: 12.0±5.7 kPa vs 15.8±9.7 kPa, t=3.044, P=0.010); however, there was no significant difference in LSM between the control group and the treatment group at 24 and 48 weeks of treatment (all P>005). ConclusionIn patients with PBC, UDCA combined with diammonium glycyrrhizinate can improve serum biochemical response and has a better clinical effect than UDCA alone. Both groups have a significant reduction in LSM at 24 and 48 weeks of treatment, suggesting that UDCA combined with diammonium glycyrrhizinate can help to maintain disease stability.
【关键字】:原发性胆汁性胆管炎; 熊去氧胆酸; 甘草酸二铵
【Key words】:primary biliary cholangitis; ursodeoxycholic acid; diammonium glycyrrhizinate
【引证本文】:ZHANG YG, ZHAO SX, LI WC, et al. Clinical effect of ursodeoxycholic acid combined with diammonium glycyrrhizinate in treatment of primary biliary cholangitis[J]. J Clin Hepatol, 2019, 35(6): 1322-1325. (in Chinese)
张玉果, 赵素贤, 李文聪, 等. 熊去氧胆酸联合甘草酸二铵治疗原发性胆汁性胆管炎的效果观察[J]. 临床肝胆病杂志, 2019, 35(6): 1322-1325.

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