牛磺熊去氧胆酸与熊去氧胆酸对肝移植术后肝功能恢复的疗效比较

王玥; 朱志军; 孙丽莹; 魏林; 曲伟; 刘颖; 曾志贵

doi:10.3969/j.issn.1674-7445.2016.03.013

牛磺熊去氧胆酸与熊去氧胆酸对肝移植术后肝功能恢复的疗效比较

doi: 10.3969/j.issn.1674-7445.2016.03.013

300070 天津医科大学(王玥)；首都医科大学附属北京友谊医院国家消化系统疾病临床医学研究中心移植耐受与器官保护北京市重点实验室(朱志军、孙丽莹、魏林、曲伟、刘颖、曾志贵)

基金项目:

北京市卫生系统高层次卫生技术人才项目 2014-2-002

详细信息

通讯作者:
朱志军，Email：zhu-zhijun@outlook.com

中图分类号: R617
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出版历程
- 收稿日期: 2016-01-20
- 网络出版日期: 2021-01-19
- 刊出日期: 2016-05-15

Comparison of clinical efficacy between tauroursodeoxycholic acid and ursodesoxycholic acid on liver function recovery after liver transplantation

Tianjin Medical University, Tianjin 300070, China

More Information

Corresponding author: Zhu Zhijun, Email: zhu-zhijun@outlook.com

摘要

摘要: 目的比较牛磺熊去氧胆酸与熊去氧胆酸用于改善肝移植术后肝功能的临床效果。方法选择2006年至2012年在首都医科大学附属北京友谊医院接受原位肝移植手术的受者28例，术后即开始口服熊去氧胆酸，治疗3个月转换为口服牛磺熊去氧胆酸6个月。比较入组前，入组后1、2、3、4、5、6、9个月的总胆汁酸(TBA)、总胆红素(TB)、直接胆红素(DB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)的变化情况。其中5例分别于入组3个月和9个月行胆汁酸成分测定，比较疏水性胆汁酸与亲水性胆汁酸的变化情况。结果应用熊去氧胆酸后，肝功能各项指标在入组3个月内均有所上升。应用牛磺熊去氧胆酸后，与入组3个月比较，TBA在入组5、9个月明显降低；ALT在入组5、6个月时下降；AST在入组4、5个月下降；ALP在入组9个月明显下降；GGT在入组6、9个月下降(均为P < 0.05)。应用牛磺熊去氧胆酸后，患者胆汁酸中亲水性胆汁酸富集，以牛磺熊去氧胆酸为主。结论肝移植术后应用牛磺熊去氧胆酸的利胆及保护肝功能作用比熊去氧胆酸更强。
- 肝移植 /
- 胆汁淤积 /
- 牛磺熊去氧胆酸 /
- 熊去氧胆酸
Abstract: Objective To compare the clinical efficacy between tauroursodeoxycholic acid and ursodesoxycholic acid on liver function recovery following liver transplantation. Methods Twenty eight recipients undergoing orthotopic liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from 2006 to 2012 were recruited in this investigation. All patients were orally administered with ursodesoxycholic acid for 3 months and subsequently received oral administration of tauroursodeoxycholic acid for 6 months. The changes in the levels of total bile acid (TBA), total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT) were statistically compared before and 1, 2, 3, 4, 5, 6 and 9 months after enrollment. At 3 and 9 months following enrollment, the components of bile acid were determined in 5 cases to compare the changes between the hydrophobic and hydrophilic bile acid. Results Within 3 months after oral administration of ursodesoxycholic acid, all parameters related to liver function were elevated. Compared with the level at 3 months after enrollment, the level of TBA was significantly decreased at 5 and 9 months after enrollment. The level of ALT declined at 5 and 6 months. The concentration of AST was decreased at 4 and 5 months. The largest decrease in the level of ALP was noted at 9 months. The content of GGT was found to decline at 6 and 9 months (all P < 0.05). After oral administration of tauroursodeoxycholic acid, a higher level of hydrophilic bile acid was detected in the patients' bile acid, dominated by tauroursodeoxycholic acid. Conclusions Tauroursodeoxycholic acid exerts higher clinical efficacy on promoting the secretion of bile and protecting liver function compared with ursodesoxycholic acid after liver transplantation.
- Liver transplantation /
- Cholestasis /
- Tauroursodeoxycholic acid /
- Ursodesoxycholic acid

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图 1 实验组与对照组间总胆汁酸、总胆红素和直接胆红素的变化

Figure 1. Changes of total bile acid, total bilirubin, and direct bilirubin in experimental group and control group

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图 2 实验组与对照组间丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转肽酶和碱性磷酸酶的变化

Figure 2. Changes of alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase and alkaline phosphatase in experimental group and control group

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表 1 胆汁淤积患者胆汁酸成分比较(μmol/ml，x±s)

Table 1. Comparison of bile acid composition of patients with cholestasis

胆汁酸成分	n	对照组	实验组	P值
胆酸	5	0.25±0.04	0.53±0.11	0.25
鹅去氧胆酸	5	－	－	－
去氧胆酸	5	0.28±0.17	0.48±0.40	0.26
甘氨胆酸	5	865±163	1 257±348	0.07
甘氨鹅去氧胆酸	5	584±163	809±315	0.11
甘氨去氧胆酸	5	－	－	－
甘氨熊去氧胆酸	5	750±468	14±8	0.02
石胆酸	5	0.16±0.03	0.25±0.14	0.42
牛磺胆酸	5	749±462	775±510	0.76
牛磺鹅去氧胆酸	5	364±218	402±108	0.73
牛磺去氧胆酸	5	－	－	－
牛磺石胆酸	5	0.43±0.31	0.79±0.43	0.15
牛磺熊去氧胆酸	5	197±130	1 811±1 059	0.03
熊去氧胆酸	5	0.37±0.14	－	－
注：－为未检出

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