Lindor K D, Lacerda M A, Jorgensen R A, DeSotel C K, Batta A K, Salen G, Dickson E R, Rossi S S, Hofmann A F
Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 1998 Sep;93(9):1498-504. doi: 10.1111/j.1572-0241.1998.00470.x.
Ursodeoxycholic acid (UDCA) improves liver biochemistries and enriches the bile with UDCA in patients with primary biliary cirrhosis. The aim of this study was to determine whether the degree of enrichment of bile correlated with that of serum and whether either of these measures correlated with improvement in measures of liver disease.
In a randomized study, biliary and serum bile acid analyses were performed at entry and after 2 yr of UDCA or placebo.
The percentage of ursodeoxycholic acid in bile increased by 42% in the UDCA group (n = 61) compared with 8% in the placebo group (n = 57) (p < 0.0001). Measurement of serum bile acids in 32 patients (18 ursodeoxycholic acid, 14 placebo) indicated that at 2 yr, ursodeoxycholic acid comprised 65% of serum bile acids in the treated group and 7% in the placebo group. Agreement between bile and serum was fair (r = 0.75, p < or = 0.00002) because in some patients, plasma but not biliary bile acids were enriched with UDCA. Changes in biliary ursodeoxycholic acid correlated significantly but weakly with the changes in serum alkaline phosphatase, AST, bilirubin, and in Mayo risk score. Correlations between changes in serum bile acid composition and biochemical measures of disease activity were even weaker.
The measurement of biliary bile acids is superior to that of serum bile acids for assessing the compliance and changes in the circulating bile acids in patients receiving ursodeoxycholic acid for the treatment of primary biliary cirrhosis. Furthermore, measures to further increase the proportion of ursodeoxycholic acid in circulating bile acids should be explored.
熊去氧胆酸（UDCA）可改善原发性胆汁性肝硬化患者的肝脏生化指标，并使胆汁中富含UDCA。本研究旨在确定胆汁中UDCA的富集程度是否与血清中的富集程度相关，以及这两种指标是否与肝脏疾病指标的改善相关。
在一项随机研究中，在入组时以及使用UDCA或安慰剂治疗2年后进行胆汁和血清胆汁酸分析。
UDCA组（n = 61）胆汁中熊去氧胆酸的百分比增加了42%，而安慰剂组（n = 57）增加了8%（p < 0.0001）。对32例患者（18例使用熊去氧胆酸，14例使用安慰剂）的血清胆汁酸测量表明，在2年时，治疗组血清胆汁酸中熊去氧胆酸占65%，安慰剂组占7%。胆汁和血清之间的一致性尚可（r = 0.75，p ≤ 0.00002），因为在一些患者中，血浆而非胆汁中的胆汁酸富含UDCA。胆汁中熊去氧胆酸的变化与血清碱性磷酸酶、AST、胆红素以及梅奥风险评分的变化显著但微弱相关。血清胆汁酸组成变化与疾病活动生化指标之间的相关性更弱。
对于评估接受熊去氧胆酸治疗原发性胆汁性肝硬化患者的依从性和循环胆汁酸变化，胆汁胆汁酸测量优于血清胆汁酸测量。此外，应探索进一步提高循环胆汁酸中熊去氧胆酸比例的措施。
