原发性硬化性胆管炎20例临床分析

目的分析原发性硬化性胆管炎(PSC)的临床特点以及治疗手段,为该病的防治提供理论依据。方法选取收治的20例原发性硬化性胆管炎的患者,对其临床表现、影像学检查、实验室检查、病理组织学特点以及治疗效果作回顾性分析。结果患者的临床表现主要有乏力、纳差、皮肤瘙痒、黄疸、肝脾肿大。肝功能主要为ALP、GGT升高,所有患者中ALP、GGT均升高,其中ALP平均升高4倍,而GGT平均升高6倍。MRCP以及ERCP见胆管不均匀、肝外/内胆管扩张,胆总管狭窄。肝穿病理见胆管周围纤维化改变、基底膜增厚改变。治疗以熊去氧胆酸为基础药物,18例患者的临床症状有较大程度的改善,化验指标有所下降。伴有肝硬化、腹水的2例患者疗效不佳,自动出院。结论原发性硬化性胆管炎起病隐匿,而尽早诊断、积极的治疗和预防控制措施是影响预后与控制病例增加的重要因素。

Objective To analyze the primary sclerosing cholangitis（PSC） of the clinical features and therapeutic means for prevention and cure of this disease and provide a theoretical basis.Methods In our hospital cases of primary sclerosing cholangitis patients,the clinical manifestation,imaging examination,laboratory examination,histopathological features and the effect of treatment were retrospectively analyzed.Results The main clinical manifestations of fatigue,anorexia,skin pruritus,jaundice and hepatosplenomegaly.Liver function mainly in ALP,GGT elevated in all patients in the ALP,GGT increased,the average ALP and GGT increased 4 times,with an average increase of 6 times.MRCP and ERCP duct is not uniform,beaded changes,segmental stenosis of bile duct and thin and rigid.Liver pathological see peribiliary fibrosis,thickening of the basement membrane changes.Treatment with ursodeoxycholic acid based drugs,18 cases of patients with clinical symptoms were improved greatly,laboratory index decreased.Conclusion Primary sclerosing cholangitis onset occult,active treatment and prevention and control measures of influencing prognosis and control cases increased the important factors.