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原发性胆汁性胆管炎并发高脂血症的研究现状
DOI: 10.3969/j.issn.1001-5256.2021.01.049
作者贡献声明：冯丽娜、张晓雪、黄剑洁、马博负责资料准备, 资料收集与分析；冯丽娜负责撰写论文；温晓玉、陈满秋、金清龙负责修改论文。
Research advances in primary biliary cholangitis with hyperlipidemia
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摘要: 血脂紊乱是原发性胆汁性胆管炎(PBC)最常见的并发症之一。回顾了PBC并发高脂血症的脂质谱、相关心血管疾病风险与治疗的研究现状。不同于其他肝病，PBC并发高脂血症具有独特的脂质谱，且随病情进展动态演变。一般不认为动脉粥样硬化及心血管疾病发病风险增加。对于有治疗指征的人群，建议首选他汀类药物。未来还需要更多深入的系统性研究以明确其诊治及管理流程。Abstract: Dyslipidemia is one of the most common complications of primary biliary cholangitis (PBC). This article reviews the latest research on lipid profile, the risk of cardiovascular diseases, and treatment of PBC with hyperlipidemia. Different from other liver diseases, PBC with hyperlipidemia has a unique lipid profile, which changes dynamically with disease progression. It is generally not considered that there are increased risks of atherosclerosis and cardiovascular disease. For those who have indications for treatment, statins are recommended as the first choice. In the future, more in-depth systematic studies are needed to clarify its diagnosis, treatment, and management processes.
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Key words:
- Liver Cirrhosis, Biliary /
- Hyperlipidemia /
- Hypercholesterolemia
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[1] BIZZARO N, COVINI G, ROSINA F, et al. Overcoming a "probable" diagnosis in antimitochondrial antibody negative primary biliary cirrhosis: Study of 100 sera and review of the literature[J]. Clin Rev Allergy Immunol, 2012, 42(3): 288-297. DOI: 10.1007/s12016-010-8234-y [2] YAMAGIWA S, KAMIMURA H, TAKAMURA M, et al. Autoantibodies in primary biliary cirrhosis: Recent progress in research on the pathogenetic and clinical significance[J]. World J Gastroenterol, 2014, 20(10): 2606-2612. DOI: 10.3748/wjg.v20.i10.2606 [3] TSUNEYAMA K, BABA H, MORIMOTO Y, et al. Primary biliary cholangitis: Its pathological characteristics and immunopathological mechanisms[J]. J Med Invest, 2017, 64(1.2): 7-13. DOI: 10.2152/jmi.64.7 [4] CAREY EJ, ALI AH, LINDOR KD. Primary biliary cirrhosis[J]. Lancet, 2015, 386(10003): 1565-1575. DOI: 10.1016/S0140-6736(15)00154-3 [5] NEMES K, ÅBERG F, GYLLING H, et al. Cholesterol metabolism in cholestatic liver disease and liver transplantation: From molecular mechanisms to clinical implications[J]. World J Hepatol, 2016, 8(22): 924-932. DOI: 10.4254/wjh.v8.i22.924 [6] PRIVITERA G, SPADARO L, MARCHISELLO S, et al. Abnormalities of lipoprotein levels in liver cirrhosis: Clinical relevance[J]. Dig Dis Sci, 2018, 63(1): 16-26. DOI: 10.1007/s10620-017-4862-x [7] GYLLING H, FÄRKKILÄ M, VUORISTO M, et al. Metabolism of cholesterol and low- and high-density lipoproteins in primary biliary cirrhosis: Cholesterol absorption and synthesis related to lipoprotein levels and their kinetics[J]. Hepatology, 1995, 21(1): 89-95. [8] LONGO M, CROSIGNANI A, BATTEZZATI PM, et al. Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis[J]. Gut, 2002, 51(2): 265-269. DOI: 10.1136/gut.51.2.265 [9] GUO K, ZHOU ZH. Research progress of relationship between apolipoprotein B and atherosclerotic cardiovascular disease[J]. Adv Cardiovasc Dis, 2018, 39(6): 877-880. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XXGB201806002.htm郭凯, 周尊海. 载脂蛋白B与动脉粥样硬化性心血管疾病研究进展[J]. 心血管病学进展, 2018, 39(6): 877-880. https://www.cnki.com.cn/Article/CJFDTOTAL-XXGB201806002.htm [10] BORÉN J, WILLIAMS KJ. The central role of arterial retention of cholesterol-rich apolipoprotein-B-containing lipoproteins in the pathogenesis of atherosclerosis: A triumph of simplicity[J]. Curr Opin Lipidol, 2016, 27(5): 473-483. DOI: 10.1097/MOL.0000000000000330 [11] CATAPANO AL, GRAHAM I, de BACKER G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR)[J]. Atherosclerosis, 2016, 253: 281-344. DOI: 10.1016/j.atherosclerosis.2016.08.018 [12] LOAEZA-DEL CASTILLO AM, GAYTÁN-SANTILLÁN A, LÓPEZ-TELLO A, et al. Patterns of serum lipids derangements and cardiovascular risk assessment in patients with primary biliary cholangitis[J]. Ann Hepatol, 2019, 18(6): 879-882. DOI: 10.1016/j.aohep.2019.07.006 [13] SEIDEL D, ALAUPOVIC P, FURMAN RH. A lipoprotein characterizing obstructive jaundice. I. Method for quantitative separation and identification of lipoproteins in jaundiced subjects[J]. J Clin Invest, 1969, 48(7): 1211-1223. DOI: 10.1172/JCI106085 [14] SOROKIN A, BROWN JL, THOMPSON PD. Primary biliary cirrhosis, hyperlipidemia, and atherosclerotic risk: A systematic review[J]. Atherosclerosis, 2007, 194(2): 293-299. DOI: 10.1016/j.atherosclerosis.2006.11.036 [15] FELLIN R, MANZATO E. Lipoprotein-X fifty years after its original discovery[J]. Nutr Metab Cardiovasc Dis, 2019, 29(1): 4-8. DOI: 10.1016/j.numecd.2018.09.006 [16] DOYCHEVA I, CHEN C, PAN JJ, et al. Asymptomatic primary biliary cirrhosis is not associated with increased frequency of cardiovascular disease[J]. World J Hepatol, 2011, 3(4): 93-98. DOI: 10.4254/wjh.v3.i4.93 [17] WAH-SUAREZ MI, DANFORD CJ, PATWARDHAN VR, et al. Hyperlipidaemia in primary biliary cholangitis: Treatment, safety and efficacy[J]. Frontline Gastroenterol, 2019, 10(4): 401-408. DOI: 10.1136/flgastro-2018-101124 [18] KATTAH L, GÓMEZ A, GUTIÉRREZ S, et al. Hypercholesterolemia due to lipoprotein X: Case report and thematic review[J]. Clin Med Insights Endocrinol Diabetes, 2019, 12: 1179551419878687. http://www.researchgate.net/publication/336176639_Hypercholesterolemia_Due_to_Lipoprotein_X_Case_Report_and_Thematic_Review [19] CHANG PY, LU SC, SU TC, et al. Lipoprotein-X reduces LDL atherogenicity in primary biliary cirrhosis by preventing LDL oxidation[J]. J Lipid Res, 2004, 45(11): 2116-2122. DOI: 10.1194/jlr.M400229-JLR200 [20] SURAWEERA D, FANOUS C, JIMENEZ M, et al. Risk of cardiovascular events in patients with primary biliary cholangitis-systematic review[J]. J Clin Transl Hepatol, 2018, 6(2): 119-126. http://www.ncbi.nlm.nih.gov/pubmed/29951355 [21] PHATLHANE DV, ZEMLIN AE. Severe hypercholesterolemia mediated by lipoprotein X in a patient with cholestasis[J]. Ann Hepatol, 2015, 14(6): 924-928. DOI: 10.5604/16652681.1171785 [22] BRANDT EJ, REGNIER SM, LEUNG EK, et al. Management of lipoprotein X and its complications in a patient with primary sclerosing cholangitis[J]. Clin Lipidol, 2015, 10(4): 305-312. DOI: 10.2217/clp.15.23 [23] MO ZC, OU HX, YI GH. Research advances on roles of apoAⅠin biogenesis of high density lipoproteins[J]. Progr Biochem Biophys, 2015, 42(9): 788-795. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SHSW201509002.htm莫中成, 欧含笑, 易光辉. 载脂蛋白A-Ⅰ在高密度脂蛋白生物合成中的作用研究进展[J]. 生物化学与生物物理进展, 2015, 42(9): 788-795. https://www.cnki.com.cn/Article/CJFDTOTAL-SHSW201509002.htm [24] BARUCH Y, BROOK JG, EIDELMAN S, et al. Increased concentration of high density lipoprotein in plasma and decreased platelet aggregation in primary biliary cirrhosis[J]. Atherosclerosis, 1984, 53(2): 151-162. DOI: 10.1016/0021-9150(84)90191-6 [25] SU TC, HWANG JJ, KAO JH. Hypercholesterolemia in primary biliary cirrhosis[J]. N Engl J Med, 2007, 357(15): 1561-1562. DOI: 10.1056/NEJMc071467 [26] O'KANE MJ, LYNCH PL, CALLENDER ME, et al. Abnormalities of serum apo A1 containing lipoprotein particles in patients with primary biliary cirrhosis[J]. Atherosclerosis, 1997, 131(2): 203-210. DOI: 10.1016/S0021-9150(97)06108-X [27] RIGAMONTI F, CARBONE F, MONTECUCCO F, et al. Serum lipoprotein (a) predicts acute coronary syndromes in patients with severe carotid stenosis[J]. Eur J Clin Invest, 2018, 48(3): e12888. DOI: 10.1111/eci.12888 [28] GREGORY WL, GAME FL, FARRER M, et al. Reduced serum lipoprotein(a) levels in patients with primary biliary cirrhosis[J]. Atherosclerosis, 1994, 105(1): 43-50. DOI: 10.1016/0021-9150(94)90006-X [29] TACIKOWSKI T, MILEWSKI B, DZIENISZEWSKI J, et al. Comparative analysis of plasma lipoprotein components assessed by ultracentrifugation in primary biliary cirrhosis and chronic hepatitis[J]. Med Sci Monit, 2000, 6(2): 325-329. http://europepmc.org/abstract/MED/11208331 [30] FLOREANI A, VARIOLA A, NIRO G, et al. Plasma adiponectin levels in primary biliary cirrhosis: A novel perspective for link between hypercholesterolemia and protection against atherosclerosis[J]. Am J Gastroenterol, 2008, 103(8): 1959-1965. DOI: 10.1111/j.1572-0241.2008.01888.x [31] CASH WJ, MCCANCE DR, YOUNG IS, et al. Primary biliary cirrhosis is associated with oxidative stress and endothelial dysfunction but not increased cardiovascular risk[J]. Hepatol Res, 2010, 40(11): 1098-1106. DOI: 10.1111/j.1872-034X.2010.00717.x [32] FLOREANI A, CAZZAGON N, FRANCESCHET I, et al. Metabolic syndrome associated with primary biliary cirrhosis[J]. J Clin Gastroenterol, 2015, 49(1): 57-60. DOI: 10.1097/MCG.0000000000000029 [33] BALAN V, DICKSON ER, JORGENSEN RA, et al. Effect of ursodeoxycholic acid on serum lipids of patients with primary biliary cirrhosis[J]. Mayo Clin Proc, 1994, 69(10): 923-929. DOI: 10.1016/S0025-6196(12)61815-1 [34] BRAGA MF, GRACE MG, LENIS J, et al. Efficacy and safety of ursodeoxycholic acid in primary, type Ⅱa or Ⅱb hypercholesterolemia: A multicenter, randomized, double-blind clinical trial[J]. Atherosclerosis, 2009, 203(2): 479-482. DOI: 10.1016/j.atherosclerosis.2008.08.001 [35] KURIHARA T, AKIMOTO M, ABE K, et al. Experimental use of pravastatin in patients with primary biliary cirrhosis associated with hypercholesterolemia[J]. Clin Ther, 1993, 15(5): 890-898. http://europepmc.org/abstract/med/8269456 [36] RITZEL U, LEONHARDT U, NÄTHER M, et al. Simvastatin in primary biliary cirrhosis: Effects on serum lipids and distinct disease markers[J]. J Hepatol, 2002, 36(4): 454-458. http://www.ncbi.nlm.nih.gov/pubmed/11943414 [37] STOJAKOVIC T, PUTZ-BANKUTI C, FAULER G, et al. Atorvastatin in patients with primary biliary cirrhosis and incomplete biochemical response to ursodeoxycholic acid[J]. Hepatology, 2007, 46(3): 776-784. http://www.ncbi.nlm.nih.gov/pubmed/17668874 [38] STANCA CM, BACH N, ALLINA J, et al. Atorvastatin does not improve liver biochemistries or Mayo Risk Score in primary biliary cirrhosis[J]. Dig Dis Sci, 2008, 53(7): 1988-1993. DOI: 10.1007/s10620-007-0003-2 [39] SPELIOTES EK, BALAKRISHNAN M, FRIEDMAN LS, et al. Treatment of dyslipidemia in common liver diseases[J]. Clin Gastroenterol Hepatol, 2018, 16(8): 1189-1196. http://europepmc.org/abstract/MED/29684459 [40] ALLA V, ABRAHAM J, SIDDIQUI J, et al. Autoimmune hepatitis triggered by statins[J]. J Clin Gastroenterol, 2006, 40(8): 757-761. http://europepmc.org/abstract/med/16940892 [41] STOJAKOVIC T, CLAUDEL T, PUTZ-BANKUTI C, et al. Low-dose atorvastatin improves dyslipidemia and vascular function in patients with primary biliary cirrhosis after one year of treatment[J]. Atherosclerosis, 2010, 209(1): 178-183. http://www.sciencedirect.com/science/article/pii/S0021915009007114 [42] CASH WJ, O'NEILL S, O'DONNELL ME, et al. Randomized controlled trial assessing the effect of simvastatin in primary biliary cirrhosis[J]. Liver Int, 2013, 33(8): 1166-1174. http://europepmc.org/abstract/med/24134772 [43] GU Y, YANG X, LIANG H, et al. Comprehensive evaluation of effects and safety of statin on the progression of liver cirrhosis: A systematic review and meta-analysis[J]. BMC Gastroenterol, 2019, 19(1): 231. [44] DAY AP, FEHER MD, CHOPRA R, et al. The effect of bezafibrate treatment on serum alkaline phosphatase isoenzyme activities[J]. Metabolism, 1993, 42(7): 839-842. http://www.sciencedirect.com/science/article/pii/002604959390056T [45] WEI J, WU XR. Current ststus of research on fibrates in treatment of primary biliary cholangitis[J]. J Clin Hepatol, 2020, 36(2): 442-445. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.02.046卫晶, 武希润. 贝特类药物治疗原发性胆汁性胆管炎的研究现状[J]. 临床肝胆病杂志, 2020, 36(2): 442-445. DOI: 10.3969/j.issn.1001-5256.2020.02.046 [46] WANG L, SUN KS, HAN ZY, et al. Clinical effect of fenofibrate combined with ursodeoxycholic acid in treatment of primary biliary cholangitis patients with poor response to ursodeoxycholic acid alone[J]. J Clin Hepatol, 2018, 34(11): 2368-2372. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.11.020王璐, 孙可帅, 韩者艺, 等. 非诺贝特联合熊去氧胆酸治疗单用熊去氧胆酸应答不佳的原发性胆汁性胆管炎患者的效果评价[J]. 临床肝胆病杂志, 2018, 34(11): 2368-2372. DOI: 10.3969/j.issn.1001-5256.2018.11.020 [47] CHEUNG AC, LAPOINTE-SHAW L, KOWGIER M, et al. Combined ursodeoxycholic acid (UDCA) and fenofibrate in primary biliary cholangitis patients with incomplete UDCA response may improve outcomes[J]. Aliment Pharmacol Ther, 2016, 43(2): 283-293. http://smartsearch.nstl.gov.cn/paper_detail.html?id=8a84bc52d078400c073643939788181c [48] RABAR S, HARKER M, O'FLYNN N, et al. Lipid modification and cardiovascular risk assessment for the primary and secondary prevention of cardiovascular disease: Summary of updated NICE guidance[J]. BMJ, 2014, 349: g4356. DOI: 10.1136/bmj.g4356 [49] 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. [50] ZHANG XL, ZHU QQ, ZHU L, et al. Safety and efficacy of anti-PCSK9 antibodies: A meta-analysis of 25 randomized, controlled trials[J]. BMC Med, 2015, 13: 123. DOI: 10.1186/s12916-015-0358-8 [51] GIBBS JP, SLATTER JG, EGBUNA O, et al. Evaluation of evolocumab (AMG 145), a fully human anti-PCSK9 IgG2 monoclonal antibody, in subjects with hepatic impairment[J]. J Clin Pharmacol, 2017, 57(4): 513-523. DOI: 10.1002/jcph.832 [52] SINAKOS E, ABBAS G, JORGENSEN RA, et al. Serum lipids in primary sclerosing cholangitis[J]. Dig Liver Dis, 2012, 44(1): 44-48. DOI: 10.1016/j.dld.2011.07.020 -
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