胆汁酸性腹泻的诊治进展

Progression in the diagnosis and treatment of Bile acid diarrhea

胆汁酸性腹泻(BAD)是由过量的胆汁酸进入结肠引起。但人们对该腹泻病因的认识仍然比较局限。目前临床上将75Se-牛磺胆酸潴留试验(75Se HCAT)为诊断BAD的首选方法,其他方法包括血清中7α-羟基-4-胆甾烯-3-酮(C4)、血清成纤维细胞生长因子19(FGF19)和粪便中胆汁酸的检测,以及胆汁酸多价螯合剂(BAS)的诊断性治疗。以考来烯胺为主的BAS为BAD的一线治疗,新的BAS包括考来替泊和考来维仑有较少的副作用,奥贝胆酸(OCA)作为一种新药物,未来可能有很好的发展前景。文章就目前BAD的病因、发病机制及诊治进展进行综述。

Bile-acid diarrhoea（BAD） is a common cause of chronic diarrhoea,resulting from the excess amounts of bile acids enter the colon.The understanding of people about the cause of this diarrhea is still relatively limited for a variety of reasons.Clinically,^（75）SeHCAT is the first-line diagnostic test,Other diagnostic tests including the measurement of serum 7α-hydroxy-4-cholesten-3-one（C4） 、serum fibroblast growth factor 19（FGF19） 、fecal bile acids and the empirical treatment of bile acid sequestrants（BAS）.First-line treatment is with BAS for BAD,primarily cholestyramine,Newer BAS such as colestipol and colesevelam have fewer side effects.Obeticholic acid（OCA）,as a new drug,maybe have a significant future.This article gives an overview on the etiology,pathogenesis、diagnosis and treatment progress of BAD.