Primary biliary cirrhosis(PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies(AMA), and characteristic liver...Primary biliary cirrhosis(PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies(AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis(AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis. PBC is hypothesized to be related to environmental exposure in genetically vulnerable individuals. It typically occurs in middle-aged females. Prominent clinical features include fatigue, pruritis, jaundice, xanthomas, osteoporosis, and dyslipidemia. The Mayo Risk score is the most widely used and best prognostic system. Ursodeoxycholic acid is the primary therapy. It works partly by reducing the concentration and injury from relatively toxic bile acids. PBC-AIH overlap syndrome is treated with ursodeoxycholic acid and corticosteroids, especially budesonide. Obeticholic acid and fibrate are promising new, but incompletely tested, therapies. Liver transplantation is the definitive therapy for advanced disease, with about 70% 10-year survival after transplantation. Management of pruritis includes local skin care, dermatologist referral, avoiding potential pruritogens, cholestyramine, and possibly opioid antagonists, sertraline, or rifaximin. Management of osteoporosis includes life-style modifications, administration of calcium and vitamin D, and alendronate. Statins are relatively safe to treat the osteopenia associated with PBC. Associated Sjogren's syndrome is treated by artificial tears, cyclosporine ophthalmic emulsion to stimulate tear production; and saliva substitutes, cholinergic agents, and scrupulous oral and dental care. Complications of cirrhosis from advanced PBC include esophageal varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatoma formation.展开更多
Objective: To investigate the effect of clinical ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy in the treatment of intrahepatic and intrahepatic bile duct stones. Methods: Patients w...Objective: To investigate the effect of clinical ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy in the treatment of intrahepatic and intrahepatic bile duct stones. Methods: Patients with intrahepatic and intrahepatic bile duct stones treated by surgery in our hospital from October 2017 to December 2018 were randomly divided into control group and observation group.Patients in the control group were treated with laparoscopic choledochoscopy combined with holmium laser lithotripsy, and patients of the observation group were treated with ursodeoxycholic acid on the basis of the control group. The clinical efficacy, total bile acid (TBA), phospholipid (PLIP), cholesterol (CHO) levels and the incidence of complications of liver function and bile related indicators were compared between the two groups after 3 and 6 months treatment. Results: After 3 months treatment, there were 22 cases of cured patients, 11 cases of markedly effective and 5 cases of effective patients in the observation group of, which he clinical curative effect was significantly better than that of control group (P<0.05). After 3 months and 6 months treatment, AST, ALT, TBil, CHO levels in two groups were decreased compared with that before treatment, and TBA, PLIP levels were increased. The liver function of patientsin the observation group was obviously better than that in the control group with the statistical significance difference (P<0.05). However, the symptoms such as the right upper quadrant pain, jaundice, chills, fever in the observation group was significantly improvedthan that of the control group. The incidence of complications including nausea and vomiting, fatiguewas 4.76%, significantly lower than that 19.05% in the control group (P<0.05). After 1 year follow-up, it was found that recurrence reoperation rate of observation group was significantly lower than that the control group. The difference was statistically significant (P<0.05). Conclusion: Theclinical curative effect of the ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy was distinct, whichcould effectively improve the undesirable complications, reduce the postoperative recurrence and reoperation rate. The main reason may be the combination therapy could improve the patients' associates, PLIP level, lower levels of AST, ALT, TB il and CHO, which helped to improve liver function, reduce the cholestasis, prevent the recurrence of liver and gallbladder stones, and promote good prognosis.展开更多
目的系统评价熊去氧胆酸(UDCA)联合蓝光对新生儿高胆红素血症的治疗效果。方法检索PubMed、EMbase、Web of Science、Cochrane图书馆、中国期刊全文数据库(CNKI)、万方数据库(Wanfang)和中国国生物医学文献数据库(SinoMed)有关熊去氧胆...目的系统评价熊去氧胆酸(UDCA)联合蓝光对新生儿高胆红素血症的治疗效果。方法检索PubMed、EMbase、Web of Science、Cochrane图书馆、中国期刊全文数据库(CNKI)、万方数据库(Wanfang)和中国国生物医学文献数据库(SinoMed)有关熊去氧胆酸联合蓝光治疗新生儿高胆红素血症的临床随机对照研究,检索时间自建库至2021年2月。对符合标准的研究进行质量评价,并应用RevMan5.4软件进行Meta分析。结果共纳入随机对照研究4篇,共400例新生儿,其中熊去氧胆酸组198例,对照组202例。Meta分析结果显示,熊去氧胆酸组治疗12 h(MD=-2.37,95%CI:-3.10~-1.64)、24 h(MD=-2.95,95%CI:-3.88~-2.02)总胆红素值低于对照组,差异有统计学意义(P<0.00001);熊去氧胆酸组治疗48 h总胆红素低于对照组(MD=-2.46,95%CI:-4.98~0.06),但差异无统计学意义(P>0.05);熊去氧胆酸组总光疗时长短于对照组(SMD=-2.70,95%CI:-3.01~-2.40),差异有统计学意义(P<0.00001)。结论熊去氧胆酸联合蓝光治疗对于新生儿高胆红素血症患儿具有较好的疗效,但该结论仍需大量多中心的随机对照研究进一步证实。展开更多
文摘Primary biliary cirrhosis(PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies(AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis(AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis. PBC is hypothesized to be related to environmental exposure in genetically vulnerable individuals. It typically occurs in middle-aged females. Prominent clinical features include fatigue, pruritis, jaundice, xanthomas, osteoporosis, and dyslipidemia. The Mayo Risk score is the most widely used and best prognostic system. Ursodeoxycholic acid is the primary therapy. It works partly by reducing the concentration and injury from relatively toxic bile acids. PBC-AIH overlap syndrome is treated with ursodeoxycholic acid and corticosteroids, especially budesonide. Obeticholic acid and fibrate are promising new, but incompletely tested, therapies. Liver transplantation is the definitive therapy for advanced disease, with about 70% 10-year survival after transplantation. Management of pruritis includes local skin care, dermatologist referral, avoiding potential pruritogens, cholestyramine, and possibly opioid antagonists, sertraline, or rifaximin. Management of osteoporosis includes life-style modifications, administration of calcium and vitamin D, and alendronate. Statins are relatively safe to treat the osteopenia associated with PBC. Associated Sjogren's syndrome is treated by artificial tears, cyclosporine ophthalmic emulsion to stimulate tear production; and saliva substitutes, cholinergic agents, and scrupulous oral and dental care. Complications of cirrhosis from advanced PBC include esophageal varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatoma formation.
基金Hainan health and family planning industry research project (19A200054)
文摘Objective: To investigate the effect of clinical ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy in the treatment of intrahepatic and intrahepatic bile duct stones. Methods: Patients with intrahepatic and intrahepatic bile duct stones treated by surgery in our hospital from October 2017 to December 2018 were randomly divided into control group and observation group.Patients in the control group were treated with laparoscopic choledochoscopy combined with holmium laser lithotripsy, and patients of the observation group were treated with ursodeoxycholic acid on the basis of the control group. The clinical efficacy, total bile acid (TBA), phospholipid (PLIP), cholesterol (CHO) levels and the incidence of complications of liver function and bile related indicators were compared between the two groups after 3 and 6 months treatment. Results: After 3 months treatment, there were 22 cases of cured patients, 11 cases of markedly effective and 5 cases of effective patients in the observation group of, which he clinical curative effect was significantly better than that of control group (P<0.05). After 3 months and 6 months treatment, AST, ALT, TBil, CHO levels in two groups were decreased compared with that before treatment, and TBA, PLIP levels were increased. The liver function of patientsin the observation group was obviously better than that in the control group with the statistical significance difference (P<0.05). However, the symptoms such as the right upper quadrant pain, jaundice, chills, fever in the observation group was significantly improvedthan that of the control group. The incidence of complications including nausea and vomiting, fatiguewas 4.76%, significantly lower than that 19.05% in the control group (P<0.05). After 1 year follow-up, it was found that recurrence reoperation rate of observation group was significantly lower than that the control group. The difference was statistically significant (P<0.05). Conclusion: Theclinical curative effect of the ursodeoxycholic acid combined with holmium laser by laparoscopic choledochoscopy was distinct, whichcould effectively improve the undesirable complications, reduce the postoperative recurrence and reoperation rate. The main reason may be the combination therapy could improve the patients' associates, PLIP level, lower levels of AST, ALT, TB il and CHO, which helped to improve liver function, reduce the cholestasis, prevent the recurrence of liver and gallbladder stones, and promote good prognosis.
