应用奥贝胆酸和贝特类药物治疗对熊去氧胆酸治疗不完全应答的原发性胆汁性胆管炎患者临床研究*

doi:10.3969/j.issn.1672-5069.2023.02.019

Abstract

Abstract: Objective The aim of this study was to explore the clinical efficacy of obeticholic acid (OCA) and fibrates rescue therapy in patients with primary biliary cholangitis (PBC) who didn’t response to ursodeoxycholic acid (UDCA) treatment. Methods 41 PBC patients without complete response to UDCA therapy were encountered in our hospital between January 2019 and December 2020, and were randomly divided into control (n=20) and observation group (n=21), receiving OCA or OCA and fenofibrate combination at base of UDCA maintaining treatment in both group for 24 weeks. Serum type IV collagen (IV-C), hyaluronic acid (HA), type III procollagen (PIIIP) and laminin (LN) were detected by radioimmunoassay, serum immunoglobulins (IgG, IgA and IgM) were detected by immunoturbidimetry, and serum interleukin-2 (IL-2), IL-6, IL-10 and tumor necrosis factor-α (TNF-α) were detected by ELISA. Results At the end of 24 week treatment, serum ALT, bilirubin, GGT and ALP levels in the observation group were (29.1±5.3)U/L, (24.8±4.1)μmol/L, (86.4±15.7)U/L and (100.6±26.3)U/L, all significantly lower than [(42.8±7.6)U/L, (30.2±6.5)μmol/L, (121.7±18.6)U/L and (131.8±33.7)U/L, respectively, P＜0.05] in the control; serum IV-C, HA and P Ⅲ P levels were (125.1±19.5)μg/L, (118.5±28.9)μg/L and (136.8±31.5)μg/L, all significantly lower than [(149.3±30.1)μg/L, (165.3±40.2)μg/L and (167.9±42.8)μg/L, respectively, P＜0.05] in the control; serum IgG, IgA and IgM levels were (11.7±1.6)g/L, (2.9±0.5)g/L and (2.2±0.3)g/L, all significantly lower than [(15.9±2.2)g/L, (3.6±0.7)g/L and (3.0±0.8)g/L, respectively, P＜0.05] in the control group; serum IL-2 level was (84.6±18.4)pg/ml, significantly higher than [(63.2±12.9)pg/ml, P＜0.05], while serum IL-6 and TNF-α levels were (3.3±1.4)pg/ml and (5.1±1.9)pg/ml, both significantly lower than [(6.6±1.8)pg/ml and (7.4±2.3)pg/ml, P＜0.05] in the control. Conclusion The rescue treatment of OCA and fibrate combination in dealing with PBC patients without complete response to UDCA therapy could improve liver function tests and alleviate liver fibrosis, which might be related to inhibition of immunoglobulins secretion and regulation of serum cytokine metabolism.

Key words: Primary biliary cholangitis, Obeticholic acid, Fenofibrate, Ursodeoxycholic acid, Therapy

Li Yanfen, Zhang Xiaowen, Wang Yanru, et al.. Rescuing therapy of obeticholic acid and fibrates in patients with primary biliary cholangitis without complete response to ursodeoxycholic acid treatment[J]. Journal of Practical Hepatology, 2023, 26(2): 226-229.

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Rescuing therapy of obeticholic acid and fibrates in patients with primary biliary cholangitis without complete response to ursodeoxycholic acid treatment

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