熊去氧胆酸联合非诺贝特治疗胆汁性肝硬化的疗效观察

Efficacy of ursodeoxycholic acid combined with fenofibrate in the treatment of primary biliary cirrhosis

目的评价熊去氧胆酸(UDCA)联合非诺贝特对UDCA反应不佳的胆汁性肝硬化(PBC)患者的疗效。方法选择熊去氧胆酸治疗1年疗效不佳的PBC患者14例,给予UDCA 15 mg/(kg·d),加非诺贝特0.16 g口服,治疗3个月。观察治疗前后患者症状、体征和肝功能生化指标的变化。结果治疗3个月后,71.4%(10/14)的PBC患者乏力症状明显减轻,57.1%(8/14)的患者皮肤瘙痒缓解,85.7%(12/14)的患者腹胀减轻,71.4%(10/14)的患者尿色变浅。治疗后较治疗前总胆红素[(43.1±19.6)μmol/L vs.(65.3±21.5)μmol/L]、直接胆红素[(38.3±11.0)μmol/L vs.(49.6±15.3)μmol/L]、总胆固醇[(5.36±1.82)mmol/L vs.(8.63±1.58)mmol/L]、γ-谷氨酰转肽酶[(155.6±86.3)U/L vs.(421.3±123.4)U/L]、碱性磷酸酶[(196.2±101.5)U/L vs.(395.1±156.3)U/L]、丙氨酸氨基转移酶[(42.5±18.9)U/L vs.(58.3±23.8)U/L]、天冬氨酸氨基转移酶[(40.3±25.6)U/L vs.(53.3±23.7)U/L]明显下降(P均<0.05);胆碱酯酶及白蛋白较前有上升,但差异无统计学意义(P>0.05)。结论对UDCA疗效不佳的PBC患者,UDCA联合非诺贝特可能有效改善患者的症状、体征及肝功能生化指标。

Objective To observe the clinical effects of ursodeoxycholic acid （UDCA） combined with fenofibrate in patients with primary biliary cirrhosis （PBC） partially responding to UDCA only therapy. Methods Fourteen patients with PBC partially responding to UDCA only therapy were treated with UDCA [15mg/（kg＆#183;d）,2/d, oral] combined with fenofibrate （0.16g, 1/d,oral） for 3 months.The changes of clinical symptoms and physical signs were observed.The relevant biochemical indicators were detected before and after the treatment. Result Clinical symptoms and physical signs improved after treatment. There were 71.4% of patients improved in fatigue, 57.1% relieved in pruritus, 85.7% relieved in abdominal distension, 71.4% lighted in urine color. The levels of biochemical indicators after theray were improved than those of before therapy,such as T-BIL [（43.1±19.6）μmol/L vs. （65.3±21.5）μmol/L], D-BIL [（38.3±11.0）μmol/L vs. （49.6±15.3）μmol/L], TC[（5.36±1.82）mmol/L vs. （8.63±1.58）mmol/L], GGT [（155.6±86.3）U/L vs. （421.3±123.4）U/L]、ALP[（196.2±101.5）U/L vs. （395.1±156.3）U/L]、 ALT[（42.5±18.9）U/L vs. （58.3±23.8）U/L]、 AST[（40.3±25.6）U/L vs. （53.3±23.7）U/L], the differences were statistically significant（P〈0.05）. Conclusion UDCA combined with fenofibrate for patients with PBC partially responding to UDCA only therapy is effective.