胆汁淤积的发病机制和诊治现状

Current Status of Cholestasis:Pathogenesis,Diagnosis and Treatment

临床常见的胆汁淤积可由多种疾病引起,胆汁生成的任何因素异常、胆汁对肝细胞的损伤和破坏致肝细胞坏死等一系列病理变化可引起肝内、肝外胆汁淤积,其发病机制涉及胆盐转运蛋白、ABC转运蛋白和遗传等因素,其中核受体机制在此过程发挥关键作用。随着生化和影像技术的进步,其诊断水平有所提高。但在治疗方面,除疗效确切的熊去氧胆酸外,目前虽已报道了很多天然和合成的核受体激动剂和拮抗剂可能亦有治疗作用,但有待更大规模、随机、对照临床研究验证。

Cholestasis, the commonly seen syndrome in clinical practice, can be caused by many diseases. Intra- and extrabepatic cholestasis can be caused by various pathological changes including liver cell necrosis, impaired production and excretion of bile which in turn resulting in hepatocyte damage. The mechanistic insights involve bile salt transporters, ATP-binding cassette transport proteins, heredity and so on, in which the nuclear hormone receptor plays a pivotal role. With the advancement in biochemical and imaging techniques, the diagnostic capability increased significantly. Although advances have been achieved in the management of cholestasis, ursodexycholic acid （UDCA） is still the only effective treatment available. Although lots of natural and synthetic agonists and antagonists of nuclear hormone receptor have been reported to be potentially effective, yet more extensive, randomized and controlled clinical studies remain to be needed.