原发性胆汁性胆管炎的熊去氧胆酸生化应答预测及中西医结合治疗

王晓静; 刘尧; 王宪波

doi:10.3969/j.issn.1001-5256.2020.01.004

原发性胆汁性胆管炎的熊去氧胆酸生化应答预测及中西医结合治疗

DOI: 10.3969/j.issn.1001-5256.2020.01.004

首都医科大学附属北京地坛医院中西医结合中心

基金项目:

国家中医药管理局区域中医肝病诊疗中心建设项目；国家“十三五”科技重大专项(2018ZX10723203)；首都卫生发展科研专项(2018-1-2172)；北京市科学技术委员会资助(Z191100006619033)；国家重大疑难疾病中西医临床协作试点项目；

详细信息

中图分类号: R575.7
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出版历程
- 收稿日期: 2019-12-20
- 出版日期: 2020-01-20

Biochemical response and integrated traditional Chinese and Western medicine therapy for primary biliary cholangitis

Department of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University

Research funding:

摘要

摘要: 原发性胆汁性胆管炎(PBC)是免疫介导的慢性进展性的肝内胆汁淤积性疾病,熊去氧胆酸(UDCA)的治疗可明显改善PBC患者的预后,但仍存在一定的UDCA应答不佳的人群,是目前导致疾病进展的主要危险因素。多个基于生化应答的评估模型及评分系统已应用于临床用于筛选应答不佳者。中西医结合治疗PBC在临床上显示了很好的前景,在改善PBC患者症状、肝脏生化及纤维化指标,提高生化应答率等方面有一定优势,但在临床研究设计、疗效判定等方面尚需要进一步完善。
- 原发性胆汁性胆管炎 /
- 生化学应答 /
- 中西医结合疗法
Abstract: Primary biliary cholangitis(PBC) is an immune-mediated chronic and progressive intrahepatic cholestasis disease. Treatment with ursodeoxycholic acid(UDCA) can significantly improve the prognosis of patients with PBC,but some patients still have poor response to UDCA,which is the main risk factor for disease progression. Several evaluation models and scoring systems based on biochemical response have been applied to screen out patients with poor response in clinical practice. Integrated traditional Chinese and Western medicine therapy for PBC has certain advantages in improving the symptoms,liver biochemistry,fibrosis indices,and biochemical response rate of PBC patients and thus holds promise for clinical application; however,further improvement is needed for experimental design and efficacy evaluation.
- primary biliary cholangitis /
- biochemical response /
- TCM WM therapy

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参考文献(40)

[1] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Infectious Diseases,Chinese Medical Association. Consensus on the diagnosis and management of primary biliary cirrhosis(cholangitis)(2015)[J]. J Clin Hepatol,2015,31(12):1980-1988.(in Chinese)中华医学会肝病学分会，中华医学会消化病学分会，中华医学会感染病学分会．原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J]．临床肝胆病杂志，2015,31(12):1980-1988.

[2] LINDOR KD,BOWLUS CL,BOYER J,et al. Primary biliary cholangitis:2018 practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology,2019,69(1):394-419.

[3] HIRSCHFIELD GM,DYSON JK,ALEXANDER GJM,et al. The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines[J]. Gut,2018,67(9):1568-1572.

[4] European Association for the Study of the Liver. EASL Clinical Practice Guidelines:The diagnosis and management of patients with primary biliary cholangitis[J]. J Hepatol,2017,67(1):145-172.

[5] HARMS MH,LAMMERS WJ,THORBURN D,et al. Major hepatic complications in ursodeoxycholic acid-treated patients with primary biliary cholangitis:Risk factors and time trends in incidence and outcome[J]. Am J Gastroenterol,2018,113(2):254-264.

[6] CARBONE M,MELLS GF,PELLS G,et al. Sex and age are determinants of the clinical phenotype of primary biliary cirrhosis and response to ursodeoxycholic acid[J]. Gastroenterology,2013,144(3):560-569.

[7] MARSCHALL HU,HENRIKSSON I,LINDBERG S,et al. Incidence,prevalence,and outcome of primary biliary cholangitis in a nationwide Swedish population-based cohort[J]. Scientific reports,2019,9(1):11525.

[8] CHEN S,DUAN W,LI M,et al. Prognosis of 732 ursodeoxycholic acid-treated patients with primary biliary cholangitis:A single center follow-up study from China[J]. J Gastroenterol Hepatol,2019,34(7):1236-1241.

[9] CHEUNG AC,LAMMERS WJ,MURILLO PEREZ CF,et al.Effects of age and sex of response to ursodeoxycholic acid and transplant-free survival in patients with primary biliary cholangitis[J]. Clin Gastroenterol Hepatol,2019,17(10):2076-2084.

[10] YOO JJ,CHO EJ,LEE B,et al. Prognostic value of biochemical response models for primary biliary cholangitis and the additional role of the neutrophil-to-lymphocyte ratio[J]. Gut Liver,2018,12(6):714-721.

[11] CHEUNG KS,SETO WK,FUNG J,et al. Prognostic factors for transplant-free survival and validation of prognostic models in chinese patients with primary biliary cholangitis receiving ursodeoxycholic acid[J]. Clin Transl Gastroenterol,2017,8(6):e100.

[12] HUANG C,HAN W,WANG C,et al. Early prognostic utility of Gp210 antibody-positive rate in primary biliary cholangitis:A meta-analysis[J]. Disease markers,2019,2019:9121207.

[13] NAKAMURA M,KOMORI A,ITO M,et al. Predictive role of anti-gp210 and anticentromere antibodies in long-term outcome of primary biliary[J]. Hepatol Res,2007,37(3):412-419.

[14] TAKANO K,SAEKI C,OIKAWA T,et al. IgM response is a prognostic biomarker of primary biliary cholangitis treated with ursodeoxycholic acid and bezafibrate[J]. J Gastroenterol Hepatol,2019.[Epub ahead of print]

[15] MURILLO PEREZ CF,HIRSCHFIELD G,CORPECHOT C,et al. Fibrosis stage is an independent predictor of outcome in primary biliary cholangitis despite biochemical treatment response[J]. Aliment Pharmacol Ther,2019,50(10):1127-1136.

[16] LIU X,XU H,ZHAN M,et al. The potential effects of diabetes mellitus on liver fibrosis in patients with primary biliary cholangitis[J]. Med Sci Monit,2019,25:6174-6180.

[17] NI P,MEN R,SHEN M,et al. Concomitant Sjgren’s syndrome was not associated with a poorer response or outcomes in ursodeoxycholic acid-treated patients with primary biliary cholangitis[J]. Can J Gastroenterol Hepatol,2019,2019:7396870.

[18] ANGULO P,DICKSON ER,THERNEAU TM,et al. Comparison of three doses of ursodeoxycholic acid in the treatment of primary biliary cirrhosis:A randomized trial[J]. J Hepatol,1999,30(5):830-835.

[19] CORPECHOT C,CARRAT F,POUJOL-ROBERT A,et al.Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis[J].Hepatology,2012,56(1):198-208.

[20] LAMMERS WJ,HIRSCHFIELD GM,CORPECHOT C,et al.Development and validat ion of a scoring system to predict outcomesof patients with primary biliary cirrhosis receiving ursodeox ycholic acid therapy[J]. Gastroenterology,2015,149(7):1804-1812.

[21] CARBONE M,SHARP SJ,FLACK S,et al. The UKPBC risk scores:Derivation and validat ion of a scoring system for long-term prediction of end-stage liver disease in primary biliary cirrhosis[J]. Hepatology,2016,63(3):930-950.

[22] EFE C,TA爦ILAR K,HENRIKSSON I,et al. Validation of risk scoring systems in ursodeoxycholic acid-treated patients with primary biliary cholangitis[J]. Am J Gastroenterol,2019,114(7):1101-1108.

[23] CHEN J,XUE D,GAO F,et al. Influence factors and a predictive scoring model for measuring the biochemical response of primary biliary cholangitis to ursodeoxycholic acid treatment[J]. Eur J Gastroenterol Hepatol,2018,30(11):1352-1360.

[24] HIRSCHFIELD GM,MASON A,LUKETIC V,et al. Efficacy of obeticholic acid in patients with primary biliary cirrhosis and inadequate response to ursodeoxycholic acid[J]. Gastroenterology,2015,148(4):751-761.

[25] KOWDLEY KV,LUKETIC V,CHAPMAN R,et al. A randomized trial of obeticholic acid monotherapy in patients with primary biliary cholangitis[J]. Hepatology,2018,67(5):1890-1902.

[26] CHEN JL,YANG X,ZHANG Q,et al. Effect of ursodeoxycholic acid with traditional Chinese medicine on biochemical response in patients with primary biliary cholangitis:A realworld cohort study[J]. Chin J Hepatol,2018,26(12):909-915.(in Chinese)陈佳良，杨雪，张群，等．熊去氧胆酸联合中药治疗对原发性胆汁性胆管炎患者生物化学应答的影响:一项基于真实世界的队列研究[J]．中华肝脏病杂志，2018,26(12):909-915.

[27] ZHANG RM,ZHANG T,WU JH,et al. Clinical effect of liversoothing,cholagogic,spleen-strengthening,and bloodactivating therapy combined with ursodeoxycholic acid in treatment of primary biliary cholangitis[J]. Fujian Med J,2019,41(2):27-30.(in Chinese)张如棉，章亭，吴剑华，等．疏肝利胆健脾活血法联合熊去氧胆酸治疗原发性胆汁性胆管炎的临床疗效[J]．福建医药杂志，2019,41(2):27-30.

[28] WU XX,LI X,DANG ZQ,et al. Efficacy of Shugan Lidan Tang combined ursodeoxycholic acid in treating early and midterm primary biliary cirrhosis[J]. Chin J Exp Med Formul,2018,24(12):175-181.(in Chinese)吴秀霞，李鲜，党中勤，等．疏肝利胆汤加减联合熊去氧胆酸治疗早、中期原发性胆汁性肝硬化的临床观察[J]．中国实验方剂学杂志，2018,24(12):175-181.

[29] ZENG WW,WU XJ. Effect of Hugan Zhuyu decoction combined with ursodeoxycholic acid on immunoglobulin and T lymphocyte subsets in patients with primary biliary cirrhosis[J].Chin J Gen Pract,2019,17(3):464-467.(in Chinese)曾武武，吴学杰．护肝逐瘀汤联合熊去氧胆酸对原发性胆汁性肝硬化患者免疫球蛋白及T淋巴细胞亚群的影响[J]．中华全科医学，2019,17(3):464-467.

[30] XIAO LH,HU XY. Clinical effect of Lidan Yanggan prescription combined with ursodeoxycholic acid capsules in treatment of primary biliary cirrhosis[J]. Beijing J Tradit Chin Med,2018,37(6):553-555,561.(in Chinese)肖玲辉，扈晓宇．利胆养肝方联合熊去氧胆酸胶囊治疗原发性胆汁性肝硬化临床观察[J]．北京中医药，2018,37(6):553-555,561.

[31] XIA XY,SHI Y. Efficacy of Qinggan Lidan decoction combined with fenofibrate in the treatment of primary cholangitis with poor response to ursodeoxycholic acid and its effect on Th1/Th2lymphocyte imbalance[J]. Mod J Integr Tradit Chin West Med,2019,28(21):2313-2316,2322.(in Chinese)霞晓燕，石勇．清肝利胆方配合非诺贝特对熊去氧胆酸应答不佳的原发性胆汁性胆管炎应答率及Th1/Th2淋巴细胞失衡的影响[J]．现代中西医结合杂志，2019,28(21):2313-2316,2322.

[32] LIN L,YU XF,CHEN GL. Clinical effect of Qiwei Huaxian decoction combined with ursodeoxycholic acid in treatment of stage II/III primary biliary cirrhosis with spleen deficiency and blood stasis[J]. Tradit Chin Med J,2015,14(5):50-52.(in Chinese)林立，俞晓芳，陈国良．七味化纤汤联合熊去氧胆酸治疗Ⅱ、Ⅲ期脾虚血瘀型原发性胆汁性肝硬化的临床观察[J]．中医药通报，2015,14(5):50-52.

[33] HUANG LY,ZHOU ZH,SUN XH,et al. Clinical efficacy of Biejiaruangan compound tablets in treatment of primary biliary cirrhosis[J]. J Clin Hepatol,2015,31(2):181-184.(in Chinese)黄凌鹰，周振华，孙学华，等．复方鳖甲软肝片治疗原发性胆汁性肝硬化的临床疗效评价[J]．临床肝胆病杂志，2015,31(2):181-184.

[34] JIANG XY,WU WJ,OU Y. Clinical effect of Fuzheng Huayu capsules combined with ursodeoxycholic acid in treatment of primary biliary cholangitis[J]. Med Forum,2019,23(25):3667-3668.(in Chinese)江晓燕，吴文杰，欧旸．扶正化瘀胶囊合并熊去氧胆酸对原发性胆汁性胆管炎的治疗效果观察[J]．基层医学论坛，2019,23(25):3667-3668.

[35] GAO F,XUN J,JIAO JL,et al. Clinical effect of Fuzheng Huayu capsules combined with ursodeoxycholic acid capsules in treatment of primary biliary cirrhosis[J]. J Shanxi Med Coll Contin Educ,2015,25(6):17-19.(in Chinese)高峰，荀健，焦记丽，等．扶正化瘀胶囊联合熊去氧胆酸胶囊治疗原发性胆汁性肝硬化的临床观察[J]．山西职工医学院学报，2015,25(6):17-19.

[36] XI Q,SONG CR,LIU YZ,et al. Study on treatment of primary biliary cirrhosis by Jianpi Huoxue Decocition combined with ursodeoxycholic acid capsules[J]. Mod J Integr Tradit Chin West Med,2016,25(3):242-244,283.(in Chinese)席奇，宋春荣，刘亚珠，等．健脾活血方联合熊去氧胆酸胶囊治疗原发性胆汁性肝硬化的研究[J]．现代中西医结合杂志，2016,25(3):242-244,283.

[37] CHEN XQ,CAO HF. Regulatory effect of Lidan Qushi prescription on peripheral blood T lymphocyte subsets in patients with primary biliary cirrhosis with liver-gallbladder dampheat[J]. J Sichuan Tradit Chin Med,2018,36(11):103-105.(in Chinese)陈秀清，曹海芳．利胆祛湿方对肝胆湿热型原发性胆汁性肝硬化患者外周血T细胞亚群的调节作用[J]．四川中医，2018,36(11):103-105.

[38] JIANG XY,TANG HH,WEI CS,et al. Treatment of 31 cases of primary biliary cholangitis with ruangan decoction combined with ursodeoxycholic acid[J]. Mod Tradit Chin Med,2018,38(6):33-35,39.(in Chinese)姜小艳，唐海鸿，魏春山，等．软肝汤联合熊去氧胆酸治疗原发性胆汁性胆管炎31例[J]．现代中医药，2018,38(6):33-35,39.

[39] YANG L,LI Y,YUAN XX,et al. Effect of Yangyin Tongluo Decoction on primary biliary cholangitis and its influence on cytokines[J]. Chin J Integr Trad West Med Dig,2017,25(9):646-650,655.(in Chinese)杨磊，李莹，袁星星，等．养阴通络汤对原发性胆汁性胆管炎临床疗效及对细胞因子的影响[J]．中国中西医结合消化杂志，2017,25(9):646-650,655.

[40] GAN X,ZHAO XF,LIN H,et al. Efficacy of Qingying Huoxue decoction in treating primary biliary cirrhosis with liver-gallbladder dampness-heat syndrome and effect on Th17/Treg balance in peripheral blood[J]. Chin J Exp Med Formul,2016,22(11):161-164.(in Chinese)甘霞，赵新芳，林红，等．清营活血汤对原发性胆汁性肝硬化肝胆湿热型的疗效以及对外周血Th17/Treg平衡的影响[J]．中国实验方剂学杂志，2016,22(11):161-164.

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