难治性原发性胆汁性肝硬化治疗进展The recent advances in the treatment of refractory primary biliary cirrhosis
周新源;田耀洲;
摘要(Abstract):
原发性胆汁性肝硬化的治疗中,熊去氧胆酸(UDCA)是唯一被证实对其有效的药物。但部分患者对UDCA不完全应答,其预后较差。经研究证实,这类患者可通过以下4种方法改善预后:1)UDCA联合布地奈德、调脂类药、法尼酯衍生物X受体激动剂、S-腺苷蛋氨酸;2)利妥昔单抗;3)间充质干细胞移植;4)民族医药治疗。由此,对于UDCA应答不佳的患者,提供了新的治疗选择。
关键词(KeyWords): 肝硬化;胆汁淤积;熊去氧胆酸
基金项目(Foundation): 国家自然科学基金资助项目(81373766)
作者(Author): 周新源;田耀洲;
Email:
DOI: 10.13463/j.cnki.jlzyy.2014.11.031
参考文献(References):
- [1]秦华,白石山.原发性胆汁性肝硬化的治疗进展[J].临床肝胆病杂志,2013,29(9):719-721.
- [2]Nguyen D L,Juran B D,Lazaridis K N,et al.Primary biliary cirrhosis[J].Best Pract Res Clin Gastroenterol,2010,24(5):647-654.
- [3]段维佳,贾继东.2009年欧洲肝病学会胆汁淤积性肝病的诊治指南[J].临床肝胆病杂志,2009,25(6):403-406.
- [4]Rautiainen H,Karkkainen P,Karvonen A L,et al.Budesonide combined with UDCA to improve liver histology in primary biliary cirrhosis:a three-year randomized trial[J].Hepatology,2005,41(4):747-752.
- [5]Angulo P,Jorgensen R A,Keach J C,et al.Oral budesonide in the treatment of patients with primary biliary cirrhosis with a suboptimal response to ursodeoxycholic acid[J].Hepatology,2000,31(2):318-323.
- [6]Hempfling W,Grunhage F,Dilger K,et al.Pharmacokinetics and pharmacodynamic action of budesonide in early and late stage primary biliary cirrhosis[J].Hepatology,2003,38(1):196-202.
- [7]Honda A,Ikegami T,Nakamuta M,et al.Anticholestatic effects of bezafibrate in patients with primary biliary cirrhosis treated with ursodeoxycholic acid[J].Hepatology,2013,57(5):1931-1941.
- [8]Takeuchi Y,Ikeda F,Fujioka S,et al.Additive improvement induced by bezafibrate in patients with primary biliary cirrhosis showing refractory response to ursodeoxycholic acid[J].J Gastroenterol Hepatol,2011,26(9):1395-1401.
- [9]Han X F,Wang Q X,Liu Y,et al.Efficacy of fenofibrate in Chinese patients with primary biliary cirrhosis partially responding to ursodeoxycholic acid therapy[J].J Dig Dis,2012,13(4):219-224.
- [10]王倩,姚宝康.原发性胆汁性肝硬化的药物治疗研究进展[J].临床肝胆病杂志,2014,30(5):462-465.
- [11]杨梦晗,尤红.熊去氧胆酸治疗原发性胆汁性肝硬化生化应答标准及治疗研究进展[J].实用肝脏病杂志,2013,16(2):169-171.
- [12]韩英,朱疆依.原发性胆汁性肝硬化的治疗[J].实用肝脏病杂志,2013,16(2):102-104.
- [13]Fiorucci S,Cipriani S,Mencarelli A,et al.Farnesoid X receptor agonist for the treatment of liver and metabolic disorders:focus on 6-ethyl-CDCA[J].Mini Rev Med Chem,2011,11(9):753-762.
- [14]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南[J].胃肠病学,2011,16(6):351-366.
- [15]金树.S-腺苷蛋氨酸联合熊去氧胆酸治疗原发性胆汁性肝硬化的疗效观察[J].安徽医学,2011,32(12):2039-2040.
- [16]Dhirapong A,Lleo A,Yang G X,et al.B cell depletion therapy exacerbates murine primary biliary cirrhosis[J].World J Gastroenterol,2012,18(30):3938-3940.
- [17]Tsuda M,Moritoki Y,Lian Z X,et al.Biochemical and immunologic effects of rituximab in patients with primary biliary cirrhosis and an incomplete response to ursodeoxycholic acid[J].Hepatology,2012,55(2):512-521.
- [18]Polido-pereira J,Rodrigues A M,Canhao H,et al.Primary biliary cirrhosis in a rheumatoid arthritis patient treated with rituximab,a case-based review[J].Clin Rheumatol,2012,31(2):385-389.
- [19]Deuse T,Stubbendorff M,Tang-Quan K.Immunogenicity and immunomodulatory properties of umbilical cord lining mesenchymal stem cells[J].Cell Transplant,2011,20(5):655-67.
- [20]Fan C G,Zhang Q J,Zhou J R.Therapeutic potentials of mesenchymal stem cells derived from human umbilical cord[J].Stem Cell Rev,2011,7(1):195-207.
- [21]Parekkadan B,Poll D,Suganuma K,et al.Mesenchymal stem cell-derived molecules reverse fulminant hepatic failure[J].PLoS ONE,2007,2(9):e941.
- [22]Mohamadnejad M,Alimoghaddam K,Mohyeddinbonab M,et al.Phase 1 trial of autologous bone marrow mesenchymal stem cell transplantation in patients with decompensated liver cirrhosis[J].Arch Iranian Med,2007,10(4):459-466.
- [23]王红霞,金实.金实教授治疗原发性胆汁性肝硬化经验[J].吉林中医药,2011,31(1):37-38.
- [24]李再玲,徐光福.针药结合治疗原发性胆汁性肝硬化[J].长春中医药大学学报,2013,29(4):625-626.
- [25]田耀洲,宣佶,曹鹏,等.化肝通络方对原发性胆汁性肝硬化的抗纤维化作用及机制探讨[C]//第二十五届全国中西医结合消化系统疾病学术会议论文集,南昌:中国中西医结合学会消化系统疾病专业委员会,2013.
- [26]薛娟,彭蕴茹,丁永芳,等.藏药郎庆阿塔对肝纤维化大鼠胶原代谢的影响[J].中国实验方剂学杂志,2012,18(24):260-265.
- [27]彭蕴茹,丁永芳,罗宇慧,等.藏药郎庆阿塔治疗肝纤维化的实验研究[J].中国实验方剂学杂志,2012,18(11):189-194.