Kurmanova G M, Kurmanova K B, Sadykova Sh S
Eksp Klin Gastroenterol. 2015(8):99-104.
With the purpose to estimate the efficiency of ursodeoxycholic acid (UDCA) in standard antiviral therapy (SAT) of chronic hepatitis C or/and B 580 patients with the chronic virus hepatitis enrolled in this study. During 48 weeks patients with hepatitis B and B+D received peg-interferon, and patients with C and B+C hepatitis received combined peg-interferon and ribavirin. 1st group of 300 patients (B--130, C--96, B+C--73, B+D--10; 190 men, 110 women, middle age of 32.9 ± 10.1 years) additionally took UDCA not less than 6 months. The 2nd group of 280 patients (B--133, C--98, D+C--26, B+D--14; 172 men, 108 women, middle age of 35.9 ± 7.5 years) took only SAT. ALT, AST, bilirubin, γ-glutamiltranspeptidase, alkaline phosphatase levels, and blood analysis were evaluated. Due to UDCA normalization of the raised ALT and AST levels was observed by 6th week of SAT in 50 patients (from 80 patients with initially raised ALT and AST) of 1st group. ALT and AST levels reached norm in 1st group by 12th week whereas in 60 (21.4%) patients of 2nd group ALT, AST remained raised. Cholestasis remained at 30% of patients in the 1st group by the beginning of SAT and in 35.7% of patients in the 2nd. By 12th week cholestasis was observed only at 3.3% of patients of 1st group (32.1%--in the 2nd group). By 24th week the raised level of bilirubin remained in 7.1 % of patients in the 2nd group whereas in 1st group cholestasis was only at 1 patient. Decrease of hemoglobin level by 12th week of treatment within 110-100 g/l was observed at 10% of patients in 1 group, at 17.9%--in the 2nd. By 24th week anemia was observed only in 2nd group (1st group--0%; 2nd group--14.3%). Decrease in platelets level in the first 2 months of treatment was in both groups, but normalization of their quantity went earlier in 1st group. By 12th week of treatment level of platelets in all patients receiving UDCA was higher than 120,000/ml (3.6%--in the 2nd group). UDCA within SAT of hepatitis B and C allowed to reach the biochemical answer (ALT and AST level normalization) in earlier terms, and to better control of cholestasis. In UDCA group were less frequency of hematologic side effects of peginterferon and peginterferon+ribavirin.
本研究纳入了580例慢性病毒性肝炎患者,旨在评估熊去氧胆酸(UDCA)在慢性丙型肝炎或/和乙型肝炎标准抗病毒治疗(SAT)中的疗效。在48周的治疗期间,乙型肝炎和乙型+丁型肝炎患者接受聚乙二醇干扰素治疗,丙型肝炎和乙型+丙型肝炎患者接受聚乙二醇干扰素联合利巴韦林治疗。第一组300例患者(乙型肝炎130例、丙型肝炎96例、乙型+丙型肝炎73例、乙型+丁型肝炎10例;男性190例,女性110例,平均年龄32.9±10.1岁)额外服用UDCA不少于6个月。第二组280例患者(乙型肝炎133例、丙型肝炎98例、丁型+丙型肝炎26例、乙型+丁型肝炎14例;男性172例,女性108例,平均年龄35.9±7.5岁)仅接受标准抗病毒治疗。评估了谷丙转氨酶(ALT)、谷草转氨酶(AST)、胆红素、γ-谷氨酰转肽酶、碱性磷酸酶水平以及血液分析结果。在第一组最初ALT和AST水平升高的80例患者中,50例患者在标准抗病毒治疗第6周时,由于服用UDCA,ALT和AST升高水平恢复正常。第一组患者在第12周时ALT和AST水平恢复正常,而第二组60例(21.4%)患者的ALT和AST仍处于升高状态。在标准抗病毒治疗开始时,第一组30%的患者存在胆汁淤积,第二组为35.%。到第12周时,第一组仅3.3%的患者出现胆汁淤积(第二组为32.1%)。到第24周时,第二组7.1%的患者胆红素水平仍升高,而第一组仅1例患者出现胆汁淤积。治疗第12周时,第一组10%的患者血红蛋白水平降至110 - 100 g/l,第二组为17.9%。到第24周时仅在第二组观察到贫血(第一组为0%;第二组为14.3%)。两组患者在治疗的前两个月血小板水平均下降,但第一组血小板数量恢复正常的时间更早。到治疗第12周时,所有服用UDCA患者的血小板水平均高于120,000/ml(第二组为3.6%)。在乙型和丙型肝炎的标准抗病毒治疗中加用UDCA可使生化指标(ALT和AST水平恢复正常)更早达到,并能更好地控制胆汁淤积。在UDCA组中,聚乙二醇干扰素和聚乙二醇干扰素+利巴韦林的血液学副作用发生率较低。