Matsuzaki Y, Tanaka N, Osuga T, Aikawa T, Shoda J, Doi M, Nakano M
Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
Am J Gastroenterol. 1990 Jan;85(1):15-23.
Ursodeoxycholic acid (UDCA) was administered to 10 patients diagnosed as having primary biliary cirrhosis (PBC) after liver biopsy. Eight patients were anicteric, and two were icteric cases. One patient was in stage I, seven were in stage II, one in stage I-III, and one in stage III-IV of Scheuer's classification. Six hundred milligrams of UDCA were administered orally after meals three times daily to all of the patients for more than 1 yr. The period of UDCA administration ranged from 6 to 41 months. The major findings are as follows: 1) in six out of seven patients with pruritus, itching disappeared 1 month after administration of UDCA; 2) both serum alkaline phosphatase and gamma-glutamyltranspeptidase levels began decreasing significantly the first month after the onset of UDCA treatment, and continued decreasing throughout the treatment; 3) GOT and GPT levels also decreased significantly during the administration of UDCA, compared with before-treatment levels; 4) in one icteric patient with portal hypertension, although serum biliary enzyme levels improved after treatment, serum bilirubin level got worse, and the patient died of esophageal variceal hemorrhage. In another icteric case, biliary and bilirubin levels improved slightly after treatment; 5) antimitochondrial antibody titer decreased in four cases, but IgM levels and other immunological parameters were not changed; 6) serum UDCA increased significantly during UDCA treatment; in particular, glyco-UDCA occupied up to 40% of the total bile acid and CDC decreased to 25%; 7) portal inflammation activity decreased in all five patients who had undergone follow-up liver biopsy, more than 1 yr after UDCA administration--bridging fibrosis decreased in three cases; and 8) no side effects were observed in any of the cases. Although large-scale, randomized, controlled, double-blind tests are necessary, it is speculated that the long-term administration of UDCA is a safe and effective treatment for the improvement of biliary enzyme levels and pruritus in anicteric PBC.
对10例经肝活检确诊为原发性胆汁性肝硬化（PBC）的患者给予熊去氧胆酸（UDCA）治疗。8例患者无黄疸，2例有黄疸。根据Scheuer分类，1例患者处于I期，7例处于II期，1例处于I - III期，1例处于III - IV期。所有患者均每日3次餐后口服600毫克UDCA，疗程超过1年。UDCA给药时间为6至41个月。主要结果如下：1）7例瘙痒患者中有6例在服用UDCA 1个月后瘙痒消失；2）血清碱性磷酸酶和γ-谷氨酰转肽酶水平在UDCA治疗开始后的第1个月开始显著下降，并在整个治疗过程中持续下降；3）与治疗前水平相比，在服用UDCA期间谷草转氨酶（GOT）和谷丙转氨酶（GPT）水平也显著下降；4）1例有门静脉高压的黄疸患者，尽管治疗后血清胆汁酶水平有所改善，但血清胆红素水平恶化，该患者死于食管静脉曲张出血。在另一例黄疸患者中，治疗后胆汁和胆红素水平略有改善；5）4例抗线粒体抗体滴度下降，但IgM水平和其他免疫参数未改变；6）在UDCA治疗期间血清UDCA显著升高；特别是，甘氨胆酸UDCA占总胆汁酸的比例高达40%，而鹅去氧胆酸（CDC）降至25%；7）在服用UDCA 1年多后接受随访肝活检的所有5例患者中，门静脉炎症活动均下降，3例桥接纤维化减少；8）所有病例均未观察到副作用。尽管需要进行大规模、随机、对照、双盲试验，但据推测，长期服用UDCA是改善无黄疸PBC患者胆汁酶水平和瘙痒的一种安全有效的治疗方法。
