熊去氧胆酸治疗老年原发性胆汁性肝硬化的临床研究

Clinical study of the treatment with Ursodeoxycholic acid in the elderly patients with primary biliary cirrhosis

目的探讨老年原发性胆汁肝硬化（PBC）的临床特征、诊断和治疗效果。方法将66例诊断为PBC的病人分为老年组40例，中年组26例，比较两组的临床表现、生化免疫指标（碱性磷酸酶：ALP、谷氨酰转肽酶：GGT、抗线粒体抗体：AMA）。两组病例均给予口服熊去氧胆酸（UDCA：优思弗）治疗，服药8W后比较疗效。结果90％病人因体检发现ALP、GGT升高就诊，治疗前两组患者的ALP、GGT升高程度差异无统计学意义（P〉0．05）。非特异性皮肤瘙痒是老年PBC患者的主要表现，中年组患者中88．5％无症状，明显高于老年组的37．5％；口服优思弗8W后，两组ALP、GGT均较治疗前明显程度降低（P〈0．05）。老年组中3例肝硬化患者服用优思弗后，其症状、体征及ALP、GGT均无改善，2例死亡。服药后两组患者乏力、皮肤瘙痒症状均无改善，影像学也无变化。结论：（1）PBC早期缺乏特异症状；（2）AMA对PBC诊断有重要意义，ALP、GGT的升高早于黄疸、肝肿大出现。（3）应重视体检中无法解释的ALP、GGT异常升高。（4）UDCA对早期原发性胆汁肝硬化疗效满意。（5）老龄可能是影响PBC患者预后的因素之一。

Objective To study the clinical features, the ways of diagnosis and the therapeutic outcome in elderly patients with primary biliary cirrhosis （PBC）. Methods 66 patients diagnosesd as PBC were divided into 2 groups： 40 cases in elderly group, 26 cases in middle-aged group. Their clinical features and the levels of serum ALP, GGT, serum AMA were evaluated and compared. All patients took UDCA （Ursodeoxycholic acid）. The therapeutic effect were assessed and compared after taking drugs for 8 weeks. Results 90% patients went to the clinic because of increase in the levels of ALP and GGT. There was no significant difference in the increased levels of ALP and GGT between the 2 groups （P 〉 0.05）. Unspecific skin ichy was the main symptom in elderly patients. 88.5 % patients in the middle-aged group had no symptoms, much more than that in the elderly group （37.5 %）. The levels of ALP and GGT were significantly decreased in both groups after taking UDCA for 8 weeks. The 3 cases with liver cirrhosis had no improvement either in symptoms or in laboratory test after taking UDCA for 8 weeks. Conclusions There＇ s no specific symptoms or signs in the early stage of PBC. AMA is an important factor in the diagnosis of PBC. Patients always show high ALP and GGT before jaundice, ascites or liver enlargement. Unreasonable ascending of ALP and GGT should be paid more attention. UDCA is useful to the patients with PBC in early stage, but no response to those in advanced stage. Age may be one of the factors for the prognosis of PBC.