Jorgensen R A, Dickson E R, Hofmann A F, Rossi S S, Lindor K D
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gut. 1995 Jun;36(6):935-8. doi: 10.1136/gut.36.6.935.
Ursodeoxycholic acid (UDCA) leads to biochemical and clinical improvement in many patients with primary biliary cirrhosis (PBC); although, the response is variable. This study compared UDCA treated patients with complete normalisation of biochemical functions to those without such improvement. Of the 65 patients receiving UDCA, 12 (19%) showed normalisation of liver biochemical functions at two years. The remaining 53 patients showed a less complete response. Mean (SD) alkaline phosphatase and total serum bilirubin values were significantly lower at entry in the patients whose liver biochemistry tests normalised (912 (732) U/l v 1417 (1021) U/l, p = 0.003, and 0.7 (12.1 (5.2) mumol/l v 38.9 (48.5) mumol/l, p = 0.0002, respectively), and percentage of UDCA in biliary bile acid was higher (56.3 (9.5)% v 38.3 (21.1)%, p = 0.03). Patients with biochemically and histologically less severe disease, and greater enrichment of biliary bile with UDCA, are more likely to respond favourably to the drug. The main objective of continued study will be to find out if normal liver biochemical functions can retard disease progression. The association of greater UDCA enrichment with complete biochemical responses suggests that higher doses of UDCA should be evaluated.
熊去氧胆酸（UDCA）可使许多原发性胆汁性肝硬化（PBC）患者出现生化指标改善和临床症状缓解；不过，反应存在个体差异。本研究比较了生化功能完全恢复正常的UDCA治疗患者与未出现此类改善的患者。在接受UDCA治疗的65例患者中，12例（19%）在两年时肝脏生化功能恢复正常。其余53例患者的反应则不太完全。肝脏生化指标恢复正常的患者在入组时碱性磷酸酶和总血清胆红素的均值（标准差）显著更低（分别为912（732）U/L对1417（1021）U/L，p = 0.003；以及0.7（1.2）（5.2）μmol/L对38.9（48.5）μmol/L，p = 0.0002），且胆汁中UDCA的百分比更高（56.3（9.5）%对38.3（21.1）%，p = 0.03）。生化和组织学上病情较轻且胆汁中UDCA富集程度更高的患者更有可能对该药物产生良好反应。继续研究的主要目的将是确定肝脏生化功能正常是否能延缓疾病进展。UDCA富集程度更高与完全生化反应之间的关联表明应评估更高剂量的UDCA。
