摘要
目的探讨原发性胆汁性肝硬化（PBC）临床分期的意义。方法观察不同时段（1995—1998年13例、1999-2002年11例、2003--2007年66例）确诊的90例PBC患者的临床表现，检测其生化指标，并行肝穿刺活组织检查，对比治疗效果。结果近年来PBC的早期诊断率明显提高，2003年以后共发现症状发生前期患者2例和无症状期患者19例。无症状期患者中4例有门静脉高压、7例有肝脾肿大的辅助检查证据。临床期和失代偿期患者瘙痒、黄瘤、骨病和夜盲症发生率差异无统计学意义（P值均〉0．05），但乏力、黄疸、门静脉高压、腹水和并发其他免疫性疾病的发生率差异有统计学意义（P值均〈0．05）。各时段患者的碱性磷酸酶和IgM水平差异有统计学意义（P〈0．05）。γ-谷氨酰转肽酶水平在症状发生前期[（36．75±1．77）μmol／L]、无症状期[（303．71±82．15）μmol／L]和症状期[（513．68±289．85）μmol／L]间差异有统计学意义（P〈0．01）。无症状期和症状期的组织学改变可表现为病理学分期中的任何一期。熊去氧胆酸无症状期治疗可使生化指标获明显改善，症状期治疗所获生化指标和症状改善程度优于失代偿期。结论强调PBC临床分期可促进临床PBC的早期诊断，随之的早期治疗可获较好疗效和预后。
Objective To investigate the clinical staging for primary biliary cirrhosis（PBC）. Methods Ninety six patients diagnosed of PBC in three periods（1995 1998, 13 cases; 1999--2002, 11 cases; 2003--2007, 66 cases）were enrolled and their clinical manifestation and biochemical indictors were observed. The liver biopsy and therapeutic effects were evaluated. Results The early diagnostic rate had increased in recent years. Since 2003, 19 asymptomatic（4 with portal hypertention and 7 with splenohepatomegalia） and 2 early presymptomatic cases were diagnosed. There was no statistical difference in pruritus, lipoid granuloma, osteopathis, and night-blindness between symptomatic and decompensated patients （P 〉 0.05）, while there was significant difference in lethargy, jaundice, portal hypertension, ascites, splenohepatomegalia and the incidence of other immune diseases between two groups （P〈0.05）. There was significant difference in levels of alkaline phosphatase and IgM among patients in three periods. The levels of GGT were 36.75±1.77, 303. 71±82.15, 513. 68± 289.85 of μmol/L in presymptomatic, asymptomatic and symptomatic stage, respectively （P 〈 0.01）. The patients in asymptomatic and symptomatic stage had histological changes of any pathologic stage. Ursodeoxycholic acid treatment could improve biochemical indicator of asymptomatic patients. The outcome of patients received treatment in asymptomatic stage was better than those in symptomatic stage. Conclusions The clinical staging may result of early diagnosis of PBC and the early treatment will be more effective.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2008年第1期7-10,共4页
Chinese Journal of Digestion
关键词
肝硬化
胆汁性
肝脏/病理学
熊去氧胆酸
Liver cirrhosis, biliary
Liver/Pathology
Ursodeoxycholic acid
