Stiehl A, Rudolph G, Raedsch R, Möller B, Hopf U, Lotterer E, Bircher J, Fölsch U, Klaus J, Endele R
Department of Internal Medicine, University of Heidelberg, FRG.
Hepatology. 1990 Sep;12(3 Pt 1):492-7. doi: 10.1002/hep.1840120308.
Ursodeoxycholic acid treatment of patients with primary biliary cirrhosis may lead to relief of pruritus and improvement of biochemical liver tests. The changes in serum and urinary bile acids induced by ursodeoxycholic acid treatment were studied. After 29 patients with primary biliary cirrhosis were treated with ursodeoxycholic acid (750 to 1,000 mg/day) for 6 to 12 mo because of an increase in ursodeoxycholic acid, total plasma bile acids increased from 30.5 +/- 6 mumol/L (mean +/- S.E.M.) to 52.7 +/- 11.7 mumol/L (p less than 0.01). The increase in total plasma bile acids correlated significantly with concentrations of plasma bile acid before treatment (p less than 0.01). The concentrations of endogenous bile acids decreased, mainly because of a decrease of cholic acid. During treatment, glycine conjugation increased and taurine conjugation decreased, whereas sulfation and glucuronidation of bile acids were unchanged. In 10 patients with primary biliary cirrhosis in stages III and IV, urinary excretion of bile acids was also studied. After treatment, ursodeoxycholic acid and its 3-beta isomer and C-1-hydroxylated and C-6-hydroxylated derivatives were also excreted. During treatment, urinary excretion of endogenous bile acids decreased. The increase of ursodeoxycholic acid and the decrease of endogenous bile acids may both be related to the improvement of biochemical liver tests in precirrhotic stages of the disease. In cirrhosis, endogenous bile acids in plasma remained high and changes in liver tests were small.
熊去氧胆酸治疗原发性胆汁性肝硬化患者可能会缓解瘙痒症状并改善肝脏生化指标。本研究了熊去氧胆酸治疗引起的血清和尿胆汁酸变化。29例原发性胆汁性肝硬化患者因熊去氧胆酸增加，接受熊去氧胆酸（750至1000毫克/天）治疗6至12个月，血浆总胆汁酸从30.5±6微摩尔/升（平均值±标准误）增至52.7±11.7微摩尔/升（P<0.01）。血浆总胆汁酸的增加与治疗前血浆胆汁酸浓度显著相关（P<0.01）。内源性胆汁酸浓度降低，主要是因为胆酸减少。治疗期间，甘氨酸结合增加，牛磺酸结合减少，而胆汁酸的硫酸化和葡萄糖醛酸化未发生变化。对10例处于III期和IV期的原发性胆汁性肝硬化患者的尿胆汁酸排泄情况也进行了研究。治疗后，熊去氧胆酸及其3-β异构体以及C-1-羟基化和C-6-羟基化衍生物也会排出。治疗期间，内源性胆汁酸的尿排泄减少。熊去氧胆酸的增加和内源性胆汁酸的减少可能都与疾病肝硬化前期肝脏生化指标的改善有关。在肝硬化阶段，血浆中的内源性胆汁酸仍保持较高水平，而肝脏指标的变化较小。
