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

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

    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。

     

    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.

     

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