熊去氧胆酸治疗中重度药物性肝损伤的疗效分析  

The efficacy of Ursodeoxycholic acid therapy on moderate or severe drug-induced liver injury

作　　者：孙双双[1] 吴银霞[1] 王晓今[2] 倪鎏达[2] 姜婷[2] 金银鹏[1] 施莉琴[2] 周丰[2] 李莉[2] 李震宇[2] 臧祖胜[2] 陈成伟[2] 傅青春[2] 

机构地区：[1]贵阳医学院,550004 [2]上海解放军第八五医院,200235

出　　处：《肝脏》2015年第2期101-105,共5页Chinese Hepatology

摘　　要：目的回顾性分析熊去氧胆酸(UDCA)治疗中重度药物性肝损伤(Drug induced liver injury,DILI)的疗效。方法采用同期非随机对照方法进行回顾性研究。依照国际严重不良反应协会(iSAEC)关于DILI的生化学诊断标准,筛选出近五年明确判断为中重度DILI患者79例,其中,治疗组37例,采用常规保肝降酶加UDCA治疗,对照组42例,采用常规保肝降酶治疗。观察治疗前后两组临床症状及生化指标的变化,并分析临床分型对UDCA临床疗效的影响。计量资料采用t检验,计数资料采用χ2检验。结果两组基线的主要指标均有可比性,治疗后各项生化指标均明显好转,第2周开始治疗组的总胆红素(TBil)、直接胆红素(DBil)下降差值明显大于对照组(P<0.05),胆汁酸下降差值于第3周明显大于对照组(P=0.018)。TBil、DBil和胆汁酸的动态曲线提示治疗组各指标的下降速度快于对照组(P<0.05)。肝细胞型DILI患者中,两组TBil、DBil、GGT和胆汁酸的动态曲线均存在统计学意义,治疗组下降斜率明显大于对照组(P<0.05)。结论 UDCA可加快中重度DILI患者TB、DB、胆汁酸和GGT的恢复,在肝细胞型病例中疗效可能更好,但需持续治疗2周以上。Objective To investigate the efficacy of ursodeoxycholic acid therapy on moderate or severe drug-induced liver injury（DILI）.Methods A retrospective non-randomly case-control study was carried out.According to the International Serious Adverse Events Consortium（iSAEC）phenotype standardization project for DILI,79 cases with moderate or severe DILI were enrolled,including two groups：the treatment group（37 cases with liver-protecting and transaminase-lowering treatment together with UDCA）and the control group（42 cases without UDCA）.Clinical signs,symptoms and biochemical indicators of two groups were compared to analyze the effect of UDCA on the clinical phenotypes.For statistical analyses,χ2 and unpaired t-tests were used.Results Liver function improved after treatment in both groups.In the biochemical aspects of liver function,levels of total bilirubin（TBil）and direct bilirubin（DBil）in the treatment group was significantly better than those in control group at week 2 treatment（P〈0.05）,and there was significant difference in total bile acid（TBA）in the treatment group than that in control group at week 3 treatment（P=0.018）.Dynamic curves of these biochemical indictors pointed out that the treatment group had the more remarkable improvement.There were statically significant differences in dynamic curves of TBil,DBil,gamma-glutamyl transpeptidase（GGT）,TBA in hepatocellular-type DILI between two groups（P〈0.05）.Conclusion UDCA is effective in the treatment of moderate or severe DILI through promoting TBil,DBil,TBA,GGT,especially for the hepatocellular-type with UDCA treatment more than 2 weeks.

关 键 词：药物性肝损伤 熊去氧胆酸 常规治疗 

分 类 号：R575[医药卫生—消化系统]