熊去氧胆酸治疗胆汁淤积性肝病研究进展

胆汁淤积性肝病以胆汁酸代谢异常和肝内胆汁淤积为特征 ,病情进行性发展 ,终致肝硬化、肝衰和死亡 ,临床治疗棘手。近年发现熊去氧胆酸 (Ｕｒ ｓｏｄｅｏｘｙｃｈｏｌｉｃＡｃｉｄ ,ＵＤＣＡ)有较好疗效。通过从药理机制到临床疗效的一系列研究 ,目前已积累了一定资料。1　胆汁酸的代谢和胆汁淤积性肝病胆汁酸是胆汁的主要成分 ,分为初级胆汁酸 (胆酸、鹅去氧胆酸 )和次级胆汁酸 (去氧胆酸、石胆酸 )。由鹅去氧胆酸衍生的ＵＤＣＡ是正常胆汁酸池中一个很小的组分 (<5 % )。大多数慢性胆汁淤积性肝病由肝内外胆管进行性丧失或破坏而引起。胆…     

熊去氧胆酸在胆汁淤积性肝病中的作用机制和治疗指征

熊去氧胆酸(UDCA,3α,7β二羟基-5β-胆烷酸)是三级胆酸,可出现在胆汁中,但浓度极低,仅占总胆汁酸的3%.UDCA具有多重药理作用,其治疗肝病和胆汁淤积疾病主要是通过亲水性、有细胞保护作用和无毒性的UDCA来相对地替代疏水性、去污剂样的毒性胆汁酸,促进肝细胞的分泌和免疫调节作用来完成的[1].     

熊去氧胆酸治疗老年人胆汁淤积型药物性肝损伤临床疗效分析

目的探讨熊去氧胆酸治疗老年人胆汁淤积型药物性肝损伤的临床疗效。方法将72例近3月内使用过抗肿瘤化疗药物、抗痨药物、抗真菌药物、抗抑郁症药物、抗甲状腺代谢药物、抗癫痫药物、雷公藤等所致老年人胆汁淤积型肝损害随机分为两组。对照组34例,接受甘草酸二铵、门冬氨酸钾镁、还原型谷胱甘肽等护肝、退黄、降酶治疗。治疗组38例在对照组护肝、退黄、降酶治疗的基础上加熊去氧胆酸（UDCA）治疗。均连用6周。结果治疗组治疗后血清TBil、ALP、GGT下降明显,与对照组治疗后比较差异有统计学意义（P〈0．05）。结论对于老年人胆汁淤积型药物性肝损伤患者可考虑给予UDCA治疗,能够促进黄疸消退,加快病情恢复。     

熊去氧胆酸在胆汁淤积性肝病中的应用

熊去氧胆酸是一种亲水性胆汁酸,最初应用于溶解胆固醇结石,近年来,随着对其药物特性的认识,已广泛的应用于各种肝病的治疗。此文就熊去氧胆酸在胆汁淤积性肝病的应用作一综述。     

熊去氧胆酸联合 S-腺苷蛋氨酸治疗药物性胆汁淤积型肝损伤

目的：评价熊去氧胆酸联合 S-腺苷蛋氨酸治疗药物性胆汁淤积型肝损伤的疗效。方法回顾性分析69例药物诱导胆汁淤积型肝损伤患者的使用损肝药物种类,诊断分型采用药物性肝损伤国际共识的量化评分系统。根据不同治疗方案分成2组,治疗组37例,采用熊去氧胆酸联合 S-腺苷蛋氨酸治疗;对照组32例,采用其他护肝药物。对两组患者临床表现和肝功能改善进行对比分析。结果两组经治疗后临床症状、体征和肝脏生化指标较治疗前有显著改善,但治疗组在皮肤瘙痒改善和皮肤黄染消退更好,治疗2周皮肤瘙痒改善率为93．9％,皮肤黄染消退率4周达78．4％,分别高于对照组75．9％和59．4％（分别 P ＝0．011,P ＝0．037）,血清 TBil、ALP、γ-GT 和 TBA 水平下降优于对照组（分别P ＜0．01,P ＜0．05,P ＜0．01,P ＜0．01）。结论熊去氧胆酸和 S-腺苷蛋氨酸是治疗药物诱导胆汁淤积型肝损伤的有效药物,两药联合治疗效果更佳。     

熊去氧胆酸治疗肝病研究进展

熊去氧胆酸为亲水性胆汁酸，具利胆，保护肝细胞和免疫调节等重点特性，近年试用于治疗各种类型的肝病，积累了一些资料，对其作用也有了新的认识。本文就熊去氧胆酸治疗慢性胆汁郁积及部分实质性肝病的作用及机制作一综述。     

熊去氧胆酸治疗胆汁淤积型戊型肝炎临床分析

目的 观察熊去氧胆酸(UDCA)治疗淤胆型戊型肝炎的疗效.方法 47例淤胆型戊型肝炎患者被分为UDCA治疗组23例和对照组24例,UDCA组在常规保肝基础上给予UDCA治疗.结果 本研究中,UDCA组患者年龄为61.9±12.9岁,显著大于对照组(50.8±11.2岁,P＜0.05);治疗前UDCA组总胆红素水平为234.2±128.2μmol/L,显著高于对照组(136.9±105.3μmol/L,P＜0.05),白蛋白水平为34.3±4.6g/L,显著低于对照组(37.9±4.9g/L,P＜0.05);UDCA组住院天数长于对照组(30.8±13.9天对24.9±11.5天),但差异无统计学意义(P＞0.05);两组患者均痊愈出院.结论 对于年龄大、胆红素水平高的胆汁淤积型戊型肝炎患者可考虑给予UDCA治疗,能够加快病情恢复.     

熊去氧胆酸治疗妊娠期肝内胆汁淤积症患者疗效研究*

目的 探讨应用熊去氧胆酸（UDCA）治疗妊娠期肝内胆汁淤积症（ICP）患者的疗效及其安全性。方法 2015年3月~2018年4月我院收治的ICP患者70例,被随机分为观察组35例和对照组35例,分别给予常规治疗和UDCA治疗4周。采用高效液相色谱串联质谱法检测血清胆汁酸谱,包括石胆酸（LCA）、UDCA、鹅去氧胆酸（CDCA）、胆酸（CA）、甘氨胆酸（GCA）、牛磺石胆酸（TLCA）和总胆酸（TCA）。结果 在治疗结束时,观察组和对照组瘙痒评分分别为（1.1±0.3）对（2.3±0.8）,差异显著（P<0.05）;血清ALT水平分别为（25.7±10.0） U/L对（85.1±24.3） U/L,AST分别为（22.6±10.3） U/L对（84.3±11.3） U/L,TBIL分别为（21.6±3.8） μmol/L对（30.5±5.4）μmol/L,差异显著（P<0.05）;血清UDCA分别为（3.2±0.1） μmol/L对（2.5±0.2） μmol/L,CA水平分别为（1.2±0.1） μmol/L对（2.4±0.2） μmol/L,GCA分别为（1.6±0.2） μmol/L对（2.8±0.5） μmol/L,TCA分别为（1.2±0.3） μmol/L对（4.2±0.9） μmol/L,差异显著（P<0.05）;观察组早产、产后出血和新生儿窒息等不良结局发生率显著低于对照组（17.1%对51.4%,P<0.05）。结论 应用UDCA治疗ICP患者能显著减轻症状,改善肝功能指标,且无明显的不良后果。     

熊去氧胆酸治疗原发性胆汁性肝硬化研究进展

原发性胆汁性肝硬化（PBC）是一种慢性肝内胆汁淤积性疾病．好发于中年女性。PBC最常见的死因为肝功能衰竭，这曾是肝移植的首要指征，但有效的治疗已减少了这类患者对肝移植的需求，并使其预期寿命得以延长.熊去氧胆酸（UDCA）是目前较为公认的治疗PBC的药物．但仍存在很大争议。本文就UDCA治疗PBC的作用机制、临床疗效依据、临床应用等方面的研究进展作一综述。     

熊去氧胆酸治疗慢性肝病的应用进展

熊去氧胆酸 (ｕｒｓｏｄｅｏｘｙｃｈｏｌｉｃａｃｉｄ ,ＵＤＣＡ)最早是从中国黑熊胆汁中分离出来的 ,八十年代起开始试用于临床 ,具有重要的生物学特性。近年来 ,其利胆、保护肝细胞 ,尤其是免疫调节作用越来越受到重视 ,并广泛用于治疗胆汁淤积性肝病。本文主要对近年来ＵＤＣＡ在慢性肝病中的研究及应用进展作一简要综述。胆汁酸代谢　　胆汁酸是胆汁有机溶质的主要成分。肝脏是合成胆汁酸的唯一器官 ,胆固醇是其合成的前体。正常人胆汁含有初级胆汁酸和次级胆汁酸。前者由肝脏合成 ,包括胆酸和鹅脱氧胆酸 ,后者由初级胆汁酸在肠道细菌…     

Treatment of cholestatic liver diseases; the role of ursodeoxycholic acid]

Ursodeoxycholic acid (UDCA) allows symptomatic treatment of cholestatic liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, intrahepatic biliary atresia, and cholestasis of cystic fibrosis. Patients should be treated at an early stage of the disease in order to prevent progression to cirrhosis. Since UDCA has no toxic effects longterm treatment with this substance is possible without the risk of undesired side effects. In patients with primary biliary cirrhosis and rapid progression of the disease, UDCA may be combined with an immunosuppressive substance (i.e. cyclosporin). In primary sclerosing cholangitis, biliary atresia and cholestasis of cystic fibrosis, UDCA at present seems the only treatment of which a benefit for the patients can be expected. In endstage disease liver transplantation is indicated. The role of UDCA in chronic hepatitis and alcohol induced liver disease needs to be clarified in further studies. Whether the improvement of laboratory tests in such patients indicates amelioration of the course of disease, still is unclear.     

Use of ursodeoxycholic acid in liver diseases

Ursodeoxycholic acid is currently the only established drug for the treatment of chronic cholestatic liver diseases. It has cytoprotective, anti-apoptotic, membrane stabilizing, anti-oxidative and immunomodulatory effects. Prolonged administration of ursodeoxycholic acid in patients with primary biliary cirrhosis (PBC) is associated with survival benefit and a delaying of liver transplantation. There is evidence that it might even prevent progression of the histologic stage of PBC. It also has a beneficial effect on primary sclerosing cholangitis, intrahepatic cholestasis of pregnancy, liver disease associated with cystic fibrosis, chronic graft versus host disease, total parenteral nutrition associated cholestasis and various pediatric cholestatic liver diseases. In the present review the current knowledge about the mechanisms of the action and role of ursodeoxycholic acid in the treatment of various liver diseases has been discussed.     

Bile acid abnormalities in cholestatic liver diseases

There is ample reason to believe that UDCA is the drug of choice in cholestatic liver diseases. It is possible that UDCA has to be administered for prolonged periods to see appreciable reversal in liver damage. Nevertheless, the amelioration of symptoms and improvement in nutrition of patients are equally important. Disabling symptoms such as pruritus are often brought under control, and quality of life improves. Clearly the goal for UDCA therapy is to slow the rate of disease progression, lessen the mortality risk, and improve the quality of life in patients. It is possible that a combination therapy would be more beneficial than UDCA alone. Initial results of administering UDCA with colchicine have shown no improvement in liver histology; however, administration of UDCA together with a strong anti-inflammatory drugs may be helpful to halt immune destruction of liver cells.     

Mechanisms of action and therapeutic efficacy of ursodeoxycholic acid in cholestatic liver disease

Ursodeoxycholic acid (UDCA) is widely used for the treatment of cholestatic liver diseases. Multiple mechanisms of action of UDCA have been described aiming at one or more of the pathogenetic processes of cholestatic liver diseases: (1) protection of injured cholangiocytes against toxic effects of bile acids, (2) stimulation of impaired biliary secretion, (3) stimulation of detoxification of hydrophobic bile acids, and (4) inhibition of apoptosis of hepatocytes. Through one or more of these mechanisms, UDCA slows the progression of primary biliary cirrhosis and improves a number of other cholestatic disorders.