Iser J H, Dowling H, Mok H Y, Bell G D
N Engl J Med. 1975 Aug 21;293(8):378-83. doi: 10.1056/NEJM197508212930804.
We treated 70 patients with gallstones with chenodeoxycholic acid over 3 1/2 years and analyzed the factors influencing the outcome of therapy. This treatment was unsuccessful in 11 patients with radiopaque gallstones and in seven with nonfunctioning gallbladders, but 64 per cent with radiolucent gallstones treated for six months or more showed partial or complete gallstone dissolution, and of those whose bile became unsaturated with cholesterol, 100 per cent had evidence of dissolution. In patients with partial or complete gallstone dissolution, the mean post-treatment biliary cholesterol saturation index--0.78 +/- 0.04 (S.E.M.)--was significantly less (P less than 0.001), and the dose of chenodeoxycholic acid (14.4 +/- 1.0 mg per kilogram of body weight per day) significantly more (P less than 0.025) than in those whose gallstones did not change (1.15 +/- 0.04 and 10.6 +/- 1.2 respectively). In patients with radiolucent gallstones, the dose of chenodeoxycholic acid should be based on body weight; 14 to 15 mg per kilogram of body weight per day effectively lowers the saturation index and dissolves gallstones.
在3年半的时间里，我们用鹅去氧胆酸治疗了70例胆结石患者，并分析了影响治疗效果的因素。对于11例不透X线胆结石患者和7例胆囊无功能患者，这种治疗未成功，但64%的透X线胆结石患者接受治疗6个月或更长时间后显示部分或完全胆结石溶解，并且在胆汁中胆固醇变为不饱和的患者中，100%有溶解迹象。在部分或完全胆结石溶解的患者中，治疗后平均胆汁胆固醇饱和指数为0.78±0.04（标准误），显著低于（P<0.001）胆结石未变化患者（分别为1.15±0.04和10.6±1.2），而鹅去氧胆酸剂量（每天每千克体重14.4±1.0毫克）显著高于（P<0.025）胆结石未变化患者。对于透X线胆结石患者，鹅去氧胆酸剂量应根据体重确定；每天每千克体重14至15毫克可有效降低饱和指数并溶解胆结石。
