原发性胆汁性胆管炎的诊治现状与挑战

王璐; 韩英

doi:10.3969/j.issn.1001-5256.2021.10.001

原发性胆汁性胆管炎的诊治现状与挑战

DOI: 10.3969/j.issn.1001-5256.2021.10.001

王璐,
韩英^,

空军军医大学西京医院消化内科，西安 710032

详细信息

通信作者:
韩英，hanying@fmmu.edu.cn

中图分类号: R575.22
计量
- 文章访问数: 918
- HTML全文浏览量: 186
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- 被引次数: 0
出版历程
- 收稿日期: 2021-08-22
- 录用日期: 2021-08-22
- 出版日期: 2021-10-20

Diagnosis and treatment of primary biliary cholangitis: Current status and challenges

Lu WANG,
Ying HAN^,

Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Xi'an 710032, China

摘要

摘要: 原发性胆汁性胆管炎是一种女性多发的自身免疫性肝病。主要特征为血清抗线粒体抗体阳性，肝内小胆管进行性、非化脓性、炎症性破坏。目前的认识是遗传和环境的共同作用下，慢性免疫损伤和胆管上皮相互作用的结果。一线治疗药物为熊去氧胆酸。对不耐受或应答不佳者，可以考虑联合二线药物法尼酯X受体激动剂奥贝胆酸，过氧化物酶体增殖物激活受体激动剂贝特类也被视为二线替代药物。患者的基线特征(如年轻、男性和疾病晚期)和血生化指标(特别是胆红素和碱性磷酸酶)被用于疾病风险分层和疗效评估。对瘙痒和乏力等症状的管理也不容忽视。
- 肝硬化, 胆汁性 /
- 诊断 /
- 治疗学
Abstract: Primary biliary cholangitis is an autoimmune liver disease often observed in women, with the main features of positive antimitochondrial antibodies in serum and progressive non-pyogenic inflammatory destruction of small intrahepatic bile ducts. At present, primary biliary cholangitis is considered the result of interaction between chronic immune injury and biliary epithelium under the combined effect of inheritance and environment. Ursodeoxycholic acid is the first-line drug for primary biliary cholangitis; for patients who cannot tolerate ursodeoxycholic acid or have suboptimal response, the second-line drug obeticholic acid, an FXR agonist, can be considered, and the peroxisome proliferator-activated receptor agonists fibrates can be regarded as second-line alternative drugs. Baseline characteristics (such as young age, male sex, and advanced disease) and blood biochemical parameters (especially bilirubin and alkaline phosphatase) are used for disease risk stratification and response evaluation. Management of the symptoms such as pruritus and weakness cannot be ignored.
- Liver Cirrhosis, Biliary /
- Diagnosis /
- Therapeutics

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