原发性胆汁性胆管炎合并转氨酶升高的思考

胡明礼; 王绮夏; 马雄

doi:10.3969/j.issn.1001-5256.2021.10.005

原发性胆汁性胆管炎合并转氨酶升高的思考

DOI: 10.3969/j.issn.1001-5256.2021.10.005

上海交通大学医学院附属仁济医院消化内科，上海市消化疾病研究所，上海 200001

基金项目:

国家自然科学基金 (82070581);

国家自然科学基金 (81790634)

详细信息

通信作者:
马雄，maxiongmd@163.com

中图分类号: R575.22
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出版历程
- 收稿日期: 2021-09-12
- 录用日期: 2021-09-12
- 出版日期: 2021-10-20

Considerations on the elevation of aminotransferases in primary biliary cholangitis

Shanghai Institute of Digestive Disease, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China

Research funding:

National Natural Science Foundation of China (82070581);

National Natural Science Foundation of China (81790634)

摘要

摘要: 原发性胆汁性胆管炎是一种自身免疫介导的慢性胆汁淤积性肝病，典型生化表现为ALP及GGT显著升高，伴或不伴转氨酶轻至中度升高。ALP和GGT在原发性胆汁性胆管炎的诊断、监测过程中具有重要意义。随着对疾病认知的深入，转氨酶升高的诊治意义也得到更多关注。现就原发性胆汁性胆管炎患者出现转氨酶升高的意义予以简要分析和总结。
- 肝硬化, 胆汁性 /
- 转氨酶类 /
- 自身免疫疾病
Abstract: Primary biliary cholangitis (PBC) is an autoimmune-mediated chronic cholestatic liver disease, with the typical biochemical manifestation of significantly elevated alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT), with or without mild-to-moderate elevation of aminotransferases. ALP and GGT play an important role in the diagnosis and monitoring of PBC. With a deeper understanding of PBC, the significance of elevated aminotransferases in diagnosis and treatment has attracted more and more attention. This article briefly summarizes the significance of elevation of aminotransferases in PBC patients.
- Liver Cirrhosis, Biliary /
- Transaminases /
- Autoimmune Diseases

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参考文献(21)

[1]	LINDOR KD, BOWLUS CL, BOYER J, et al. Primary biliary cholangitis: 2018 practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology, 2019, 69(1): 394-419. DOI: 10.1002/hep.30145.
[2]	European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis[J]. J Hepatol, 2017, 67(1): 145-172. DOI: 10.1016/j.jhep.2017.03.022.
[3]	ZHANG FC, WANG L, SHUAI ZW, et al. Recommendations for diagnosis and treatment of primary biliary cholangitis in China (2021)[J]. Chin J Intern Med, 2021, 60(8): 709-715. DOI: 10.3760/cma.j.cn112138-20210520-00360. 张奉春, 王立, 帅宗文, 等. 原发性胆汁性胆管炎诊疗规范(2021)[J]. 中华内科杂志, 2021, 60(8): 709-715. DOI: 10.3760/cma.j.cn112138-20210520-00360.
[4]	GULAMHUSEIN AF, HIRSCHFIELD GM. Primary biliary cholangitis: Pathogenesis and therapeutic opportunities[J]. Nat Rev Gastroenterol Hepatol, 2020, 17(2): 93-110. DOI: 10.1038/s41575-019-0226-7.
[5]	The Study of Drug Induced Liver Disease of Chinese. Diagnosis and treatment guideline on drug-induced liver injury[J]. J Prac Hepatol, 2017, 20(2): After insert 1-After insert 18. DOI: 10.3969/j.issn.1672-5069.2017.02.039. 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 实用肝脏病杂志, 2017, 20(2): 后插1-后插18. DOI: 10.3969/j.issn.1672-5069.2017.02.039.
[6]	Chinese Society of Health Management, Chinese Society of Hepatology, Chinese Society of Laboratory Medicine. Expert consensus on viral hepatitis health management (2021)[J]. Chin J Health Manage, 2021, 15(4): 323-331. DOI: 10.3760/cma.j.cn115624-20210531-00305. 中华医学会健康管理学分会, 中华医学会肝病学分会, 中华医学会检验医学分会. 病毒性肝炎健康管理专家共识(2021年)[J]. 中华健康管理学杂志, 2021, 15(4): 323-331. DOI: 10.3760/cma.j.cn115624-20210531-00305.
[7]	POUPON R, CHAZOUILLÈRES O, BALKAU B, et al. Clinical and biochemical expression of the histopathological lesions of primary biliary cirrhosis. UDCA-PBC Group[J]. J Hepatol, 1999, 30(3): 408-412. DOI: 10.1016/s0168-8278(99)80098-1.
[8]	JIANG X, LIAN M, LI Y, et al. The immunobiology of mucosal-associated invariant T cell (MAIT) function in primary biliary cholangitis: Regulation by cholic acid-induced Interleukin-7[J]. J Autoimmun, 2018, 90: 64-75. DOI: 10.1016/j.jaut.2018.01.007.
[9]	FÄRKKILÄ M, RAUTIAINEN H, KÄRKKÄINEN P, et al. Serological markers for monitoring disease progression in noncirrhotic primary biliary cirrhosis on ursodeoxycholic acid therapy[J]. Liver Int, 2008, 28(6): 787-797. DOI: 10.1111/j.1478-3231.2008.01722.x.
[10]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Consensus on the diagnosis and management of primary biliary cirrhosis (cholangitis)(2015)[J]. J Clin Hepatol, 2015, 31(12): 1980-1988. DOI: 10.3969/j.issn.1001-5256.2015.12.004. 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J]. 临床肝胆病杂志, 2015, 31(12): 1980-1988. DOI: 10.3969/j.issn.1001-5256.2015.12.004.
[11]	LAMMERS WJ, van BUUREN HR, HIRSCHFIELD GM, et al. Levels of alkaline phosphatase and bilirubin are surrogate end points of outcomes of patients with primary biliary cirrhosis: An international follow-up study[J]. Gastroenterology, 2014, 147(6): 1338-1349. e5; quiz e15. DOI: 10.1053/j.gastro.2014.08.029.
[12]	CARBONE M, SHARP SJ, FLACK S, et al. The UK-PBC risk scores: Derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis[J]. Hepatology, 2016, 63(3): 930-950. DOI: 10.1002/hep.28017.
[13]	FAN X, MEN R, NI P, et al. Concomitant systemic lupus erythematosus might have a negative impact on the biochemical responses to treatment in patients with primary biliary cholangitis[J]. Clin Rheumatol, 2020, 39(3): 795-803. DOI: 10.1007/s10067-019-04853-2.
[14]	CORPECHOT C, CHAZOUILLÈRES O, ROUSSEAU A, et al. A placebo-controlled trial of bezafibrate in primary biliary cholangitis[J]. N Engl J Med, 2018, 378(23): 2171-2181. DOI: 10.1056/NEJMoa1714519.
[15]	TANAKA A, HIROHARA J, NAKANO T, et al. Association of bezafibrate with transplant-free survival in patients with primary biliary cholangitis[J]. J Hepatol, 2021, 75(3): 565-571. DOI: 10.1016/j.jhep.2021.04.010.
[16]	CARRION AF, LINDOR KD, LEVY C. Safety of fibrates in cholestatic liver diseases[J]. Liver Int, 2021, 41(6): 1335-1343. DOI: 10.1111/liv.14871.
[17]	PRINCE MI, BURT AD, JONES DE. Hepatitis and liver dysfunction with rifampicin therapy for pruritus in primary biliary cirrhosis[J]. Gut, 2002, 50(3): 436-439. DOI: 10.1136/gut.50.3.436.
[18]	POUPON R, CHAZOUILLERES O, CORPECHOT C, et al. Development of autoimmune hepatitis in patients with typical primary biliary cirrhosis[J]. Hepatology, 2006, 44(1): 85-90. DOI: 10.1002/hep.21229.
[19]	CHAZOUILLÈRES O, WENDUM D, SERFATY L, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: Clinical features and response to therapy[J]. Hepatology, 1998, 28(2): 296-301. DOI: 10.1002/hep.510280203.
[20]	WANG Q, SELMI C, ZHOU X, et al. Epigenetic considerations and the clinical reevaluation of the overlap syndrome between primary biliary cirrhosis and autoimmune hepatitis[J]. J Autoimmun, 2013, 41: 140-145. DOI: 10.1016/j.jaut.2012.10.004.
[21]	OZASLAN E, EFE C, HEURGUÉ-BERLOT A, et al. Factors associated with response to therapy and outcome of patients with primary biliary cirrhosis with features of autoimmune hepatitis[J]. Clin Gastroenterol Hepatol, 2014, 12(5): 863-869. DOI: 10.1016/j.cgh.2013.09.021.