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頁籤選單縮合
題名 | 原發性硬化膽道炎之治療爭議=The Clinical Controversies in Management of Primary Sclerosing Cholangitis |
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作者 | 楊士磐; 郭正睿; 童玟津; 簡素玉; Yang, Shih-pan; Kuo, Cheng-jui; Tung, Wen-jin; Chien, Su-yu; |
期刊 | 藥學雜誌 |
出版日期 | 20130600 |
卷期 | 29:2=115 2013.06[民102.06] |
頁次 | 頁35-39 |
分類號 | 415.456 |
語文 | chi |
關鍵詞 | 原發性硬化膽道炎; 高劑量; Primary sclerosing cholangitis; Ursodeoxycholic acid; |
中文摘要 | 原發性硬化膽道炎 (primary sclerosing cholangitis, PSC) 是一種慢性進行性不明原因之膽道發炎、纖維化、縮小而引起的疾病,大多數案例有潛在潰瘍性結腸炎。 PSC 有許多併發症包括膽汁淤積、膽道狹窄、膽結石與膽管炎、膽管癌、大腸癌 (患有潰瘍性結腸炎者),可能進展為肝門靜脈高壓或肝臟衰竭。 對於 PSC 治療,期望能延遲與逆轉疾病進展,治療其併發症,但至目前為止,研究顯示並未證明治療可以減緩疾病進展,且部分藥品療效具爭議性,雖然目前有許多免疫抑制劑與抗發炎藥品被用於治療 PSC,但皆未見長期的臨床益處,少數藥品僅有短期益處。其中 ursodeoxycholic acid (UDCA) 對於 PSC 前期未發生肝臟纖維化患者之肝臟組織有明顯益處,可降低組織惡化與膽管異常,及緩解患者膽汁淤積及其併發症;但高劑量 UDCA 於治療原發性硬化膽道炎,肝功能指數雖降低,但反而增加臨床事件之風險。若病人所有治療包括藥物與其他外科方式皆無法阻止疾病進程時,唯有進行肝臟移植才能維持病人生命。 |
英文摘要 | Primary sclerosing cholangitis (PSC) is a chronic progressive disorder of unknown etiology. It is characterized by inflammation, fibrosis, and stricturing of biliary ducts in the liver. Most of cases have underlying ulcerative colitis. PSC is associated with many complications including cholestasis, dominant stricture formation, cholelithiasis and cholangitis, cholangiocarcinoma, and colon cancer (in patients with concurrent ulcerative colitis). In addition, PSC may follow a progressive course resulting in portal hypertension and liver failure. There are two major goals of treatment in PSC, including retardation and reversal of the disease process, management of progressive disease and its complications. A variety of immunosuppressive and antiinflammatory agents have been studied in patients with PSC. Unfortunately, none has shown conclusively a long term effect to this disorder. The standard dose of ursodeoxycholic acid (UDCA) in early stage PSC without fibrosis may be helpful. It has a benefit in liver histology and a trend toward a reduction in histologic deterioration and improvement of cholangiographic abnormalities. High dose UDCA therapy is associated with improvement in serum liver tests in PSC, but it does not improve survival and was associated with higher rates of serious adverse events. Liver transplantation is the treatment of choice for patients with advanced liver disease due to PSC when medication and other surgical methods are invalid. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。