Leuschner U
Dept. of Gastroenterology, Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany.
Scand J Gastroenterol Suppl. 1994;204:40-6. doi: 10.3109/00365529409103624.
In a total of 1004 patients in 11 controlled trials, treatment with ursodeoxycholic acid (UDCA) 8-15 mg/kg bodyweight per day led to a decrease of pruritus in 30-60% of cases, a decrease in aminotransferases and cholestasis-indicating enzymes in serum by 20-80%, and a decrease of serum bilirubin by 3-40%. A statistically significant improvement in liver histology was found in only two of these studies; in three others there was a positive trend. In three more trials histology was not examined, and in three studies there was no improvement. In the four studies investigating the time elapsed before liver transplantation and the number of deaths, only one definitely found that this was prolonged by UDCA, although in two of the other three there was a positive trend. During treatment, UDCA constitutes 30-50% of the total bile acids in bile and serum; however, its influence on the toxic bile acids is debatable. Cholic acid decreases, but deoxycholic acid and chenodeoxycholic acid are reduced to a lesser degree. UDCA therapy has now been practiced for 12 years and all authors consider the treatment to be safe, but the mode of action of UDCA is still unknown.
在11项对照试验的总共1004例患者中，每天使用8 - 15mg/kg体重的熊去氧胆酸（UDCA）进行治疗，使30% - 60%的病例瘙痒症状减轻，血清中的转氨酶和胆汁淤积指示酶降低20% - 80%，血清胆红素降低3% - 40%。在这些研究中，仅有两项发现肝脏组织学有统计学上的显著改善；另外三项有积极趋势。另有三项试验未检查组织学情况，还有三项研究未发现改善。在四项调查肝移植前时间及死亡人数的研究中，只有一项明确发现UDCA可延长此时间，尽管其他三项中的两项有积极趋势。治疗期间，UDCA在胆汁和血清中总胆汁酸中占30% - 50%；然而，其对有毒胆汁酸的影响仍有争议。胆酸减少，但脱氧胆酸和鹅去氧胆酸减少程度较小。UDCA治疗现已应用12年，所有作者都认为该治疗是安全的，但UDCA的作用方式仍不清楚。
