PDF下载 ( 1758 KB)
欧洲与我国最新原发性硬化性胆管炎临床实践指南的比较
DOI: 10.3969/j.issn.1001-5256.2023.01.007
利益冲突声明：所有作者均声明不存在利益冲突。
作者贡献声明：李小科、叶永安对确定论文设计有关键性的贡献；孙鑫起草了论文；张婷玉、姚俞昊、郭紫薇、张嘉鑫参与了论文撰写；李小科对论文的主要内容进行了修订。
Highlights of the EASL clinical practice guidelines on sclerosing cholangitis versus the latest Chinese guideline
-
摘要: 2022年欧洲肝病学会(EASL)发布了《欧洲肝病学会硬化性胆管炎临床实践指南》。本文结合《2017年欧洲胃肠道内窥镜学会和欧洲肝病学会临床指南：内窥镜检查在原发性硬化性胆管炎中的作用》提炼更新要点，并着重与2021年中华医学会肝病学分会《原发性硬化性胆管炎诊断及治疗指南(2021)》中的相应内容进行比较，归纳了新版指南在诊断、治疗、监测和特殊人群管理等方面的更新意见，分析了更新推荐意见的依据及其对原发性硬化性胆管炎(PSC)临床实践优化的指导意义。对比分析表明，新版指南在诊治和随访的总体观点与我国指南相仿，在包括熊去氧胆酸推荐剂量及长期随访方案等技术细节上值得借鉴。但该病作为慢性难治性疾病，现有指南推荐药物仍难以阻断、逆转疾病进展，而免疫疗法、终末期并发症筛查方案缺乏共识，是值得关注的研究方向。Abstract: In 2022, the European Association for the Study of the Liver issued Clinical practice guidelines on sclerosing cholangitis. With reference to the 2017 edition of Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline (2017) and in comparison to the corresponding contents in Guidelines on the diagnosis and management of primary sclerosing cholangitis (2021) issued by Chinese Society of Hepatology, Chinese Medical Association, in 2021, this article summarizes the updates in diagnosis, treatment, monitoring, and management of special populations and analyzes the basis for updated recommendations and their guiding significance in optimizing the clinical management of primary sclerosing cholangitis (PSC). The comparative analysis shows that the new version of the guidelines is similar to the Chinese guidelines in terms of diagnosis, treatment, and follow-up, and it is worth learning from the technical details such as the recommended dose of ursodeoxycholic acid and long-term follow-up plan. Since PSC is a chronic refractory disease, the drugs recommended by current guidelines cannot delay or reverse disease progression, and there is still a lack of consensus statements on immunotherapy and screening protocols for end-stage complications, which might be the directions for further research.
-
Key words:
- Primary Sclerosing Cholangitis /
- Diagnosis /
- Therapeutics /
- Surveillance /
- Practice Guidelines as Topic
-
[1] DEAN G, HANAUER S, LEVITSKY J. The role of the intestine in the pathogenesis of primary sclerosing cholangitis: evidence and therapeutic implications[J]. Hepatology, 2020, 72(3): 1127-1138. DOI: 10.1002/hep.31311. [2] GUICCIARDI ME, TRUSSONI CE, LARUSSO NF, et al. The spectrum of reactive cholangiocytes in primary sclerosing cholangitis[J]. Hepatology, 2020, 71(2): 741-748. DOI: 10.1002/hep.31067. [3] de KRIJGER M, WILDENBERG ME, de JONGE WJ, et al. Return to sender: Lymphocyte trafficking mechanisms as contributors to primary sclerosing cholangitis[J]. J Hepatol, 2019, 71(3): 603-615. DOI: 10.1016/j.jhep.2019.05.006. [4] LEMOINNE S, KEMGANG A, BEN BELKACEM K, et al. Fungi participate in the dysbiosis of gut microbiota in patients with primary sclerosing cholangitis[J]. Gut, 2020, 69(1): 92-102. DOI: 10.1136/gutjnl-2018-317791. [5] LIWINSKI T, ZENOUZI R, JOHN C, et al. Alterations of the bile microbiome in primary sclerosing cholangitis[J]. Gut, 2020, 69(4): 665-672. DOI: 10.1136/gutjnl-2019-318416. [6] NAKAZAWA T, NOTOHARA K, TAZUMA S, et al. The 2016 diagnostic criteria for primary sclerosing cholangitis[J]. J Gastroenterol, 2017, 52(7): 838-844. DOI: 10.1007/s00535-016-1286-x. [7] PONSIOEN CY, ASSIS DN, BOBERG KM, et al. Defining primary sclerosing cholangitis: results from an international primary sclerosing cholangitis study group consensus process[J]. Gastroenterology, 2021, 161(6): 1764-1775. e5. DOI: 10.1053/j.gastro.2021.07.046. [8] BERGQUIST A, EKBOM A, OLSSON R, et al. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis[J]. J Hepatol, 2002, 36(3): 321-327. DOI: 10.1016/s0168-8278(01)00288-4. [9] BOONSTRA K, WEERSMA RK, van ERPECUM KJ, et al. Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis[J]. Hepatology, 2013, 58(6): 2045-2055. DOI: 10.1002/hep.26565. [10] European Association for the Study of the Liver. EASL Clinical Practice Guidelines on sclerosing cholangitis[J]. J Hepatol, 2022, 77(3): 761-806. DOI: 10.1016/j.jhep.2022.05.011. [11] European Society of Gastrointestinal Endoscopy, European Association for the Study of the Liver. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline[J]. J Hepatol, 2017, 66(6): 1265-1281. DOI: 10.1016/j.jhep.2017.02.013. [12] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of primary sclerosing cholangitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 50-61. DOI: 10.3760/cma.j.cn112138-20211109-00786.中华医学会肝病学分会. 原发性硬化性胆管炎诊断及治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 50-61. DOI: 10.3760/cma.j.cn112138-20211109-00786. [13] BROOLING J, LEAL R. Secondary sclerosing cholangitis: a review of recent literature[J]. Curr Gastroenterol Rep, 2017, 19(9): 44. DOI: 10.1007/s11894-017-0583-8. [14] ANG TL, FOCK KM, NG TM, et al. Clinical profile of primary sclerosing cholangitis in Singapore[J]. J Gastroenterol Hepatol, 2002, 17(8): 908-913. DOI: 10.1046/j.1440-1746.2002.02835.x. [15] LIU HH, LUO SQ. New progress in diagnosis and treatment of primary sclerosing cholangitis[J]. J Prac Hepatol, 2013, 16(1): 91-93. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSY201301035.htm刘红虹, 罗生强. 原发性硬化性胆管炎诊断及治疗新进展[J]. 实用肝脏病杂志, 2013, 16(1): 91-93. https://www.cnki.com.cn/Article/CJFDTOTAL-GBSY201301035.htm [16] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of cholestatic liver diseases[J]. J Hepatol, 2009, 51(2): 237-267. DOI: 10.1016/j.jhep.2009.04.009. [17] 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. [18] DENEAU M, JENSEN MK, HOLMEN J, et al. Primary sclerosing cholangitis, autoimmune hepatitis, and overlap in Utah children: epidemiology and natural history[J]. Hepatology, 2013, 58(4): 1392-1400. DOI: 10.1002/hep.26454. [19] DENEAU MR, EL-MATARY W, VALENTINO PL, et al. The natural history of primary sclerosing cholangitis in 781 children: A multicenter, international collaboration[J]. Hepatology, 2017, 66(2): 518-527. DOI: 10.1002/hep.29204. [20] WEISMVLLER TJ, TRIVEDI PJ, BERGQUIST A, et al. Patient age, sex, and inflammatory bowel disease phenotype associate with course of primary sclerosing cholangitis[J]. Gastroenterology, 2017, 152(8): 1975-1984. e8. DOI: 10.1053/j.gastro.2017.02.038. [21] DAVE M, ELMUNZER BJ, DWAMENA BA, et al. Primary sclerosing cholangitis: meta-analysis of diagnostic performance of MR cholangiopancreatography[J]. Radiology, 2010, 256(2): 387-396. DOI: 10.1148/radiol.10091953. [22] MOFF SL, KAMEL IR, EUSTACE J, et al. Diagnosis of primary sclerosing cholangitis: a blinded comparative study using magnetic resonance cholangiography and endoscopic retrograde cholangiography[J]. Gastrointest Endosc, 2006, 64(2): 219-223. DOI: 10.1016/j.gie.2005.12.034. [23] CZAJA AJ, CARPENTER HA. Autoimmune hepatitis with incidental histologic features of bile duct injury[J]. Hepatology, 2001, 34(4 Pt 1): 659-665. DOI: 10.1053/jhep.2001.27562. [24] SARCOGNATO S, SACCHI D, GRILLO F, et al. Autoimmune biliary diseases: primary biliary cholangitis and primary sclerosing cholangitis[J]. Pathologica, 2021, 113(3): 170-184. DOI: 10.32074/1591-951X-245. [25] MEHTA TI, WEISSMAN S, FUNG BM, et al. Global incidence, prevalence and features of primary sclerosing cholangitis: A systematic review and meta-analysis[J]. Liver Int, 2021, 41(10): 2418-2426. DOI: 10.1111/liv.15007. [26] EATON JE, SILVEIRA MG, PARDI DS, et al. High-dose ursodeoxycholic acid is associated with the development of colorectal neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis[J]. Am J Gastroenterol, 2011, 106(9): 1638-1645. DOI: 10.1038/ajg.2011.156. [27] LINDOR KD, KOWDLEY KV, LUKETIC VA, et al. High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis[J]. Hepatology, 2009, 50(3): 808-814. DOI: 10.1002/hep.23082. [28] LINDOR KD, KOWDLEY KV, HARRISON ME, et al. ACG clinical guideline: primary sclerosing cholangitis[J]. Am J Gastroenterol, 2015, 110(5): 646-659; quiz 660. DOI: 10.1038/ajg.2015.112. [29] de VRIES E, BOLIER R, GOET J, et al. Fibrates for itch (FITCH) in fibrosing cholangiopathies: a double-blind, randomized, placebo-controlled trial[J]. Gastroenterology, 2021, 160(3): 734-743. e6. DOI: 10.1053/j.gastro.2020.10.001. [30] van ERP LW, CUNNINGHAM M, NARASIMMAN M, et al. Risk of gallbladder cancer in patients with primary sclerosing cholangitis and radiographically detected gallbladder polyps[J]. Liver Int, 2020, 40(2): 382-392. DOI: 10.1111/liv.14326. [31] BARNES EL, HOLUBAR SD, HERFARTH HH. Systematic review and meta-analysis of outcomes after ileal pouch-anal anastomosis in primary sclerosing cholangitis and ulcerative colitis[J]. J Crohns Colitis, 2021, 15(8): 1272-1278. DOI: 10.1093/ecco-jcc/jjab025. [32] SHAPIRO JM, SMITH H, SCHAFFNER F. Serum bilirubin: a prognostic factor in primary biliary cirrhosis[J]. Gut, 1979, 20(2): 137-140. DOI: 10.1136/gut.20.2.137. [33] European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis-2021 update[J]. J Hepatol, 2021, 75(3): 659-689. DOI: 10.1016/j.jhep.2021.05.025. [34] AVCIOǦLU U, ERUZUN H, USTAOǦLU M. The gamma-glutamyl transferase to platelet ratio for noninvasive evaluation of liver fibrosis in patients with primary biliary cholangitis[J]. Medicine (Baltimore), 2022, 101(40): e30626. DOI: 10.1097/MD.0000000000030626. [35] INNES H, MORLING JR, BUCH S, et al. Performance of routine risk scores for predicting cirrhosis-related morbidity in the community[J]. J Hepatol, 2022, 77(2): 365-376. DOI: 10.1016/j.jhep.2022.02.022. [36] LOOSEN SH, KOSTEV K, KEITEL V, et al. An elevated FIB-4 score predicts liver cancer development: A longitudinal analysis from 29, 999 patients with NAFLD[J]. J Hepatol, 2022, 76(1): 247-248. DOI: 10.1016/j.jhep.2021.08.030. [37] EKIN N, UCMAK F. GPR, King's Score and S-Index are superior to other non-invasive fibrosis markers in predicting the liver fibrosis in chronic hepatitis B patients[J]. Acta Gastroenterol Belg, 2022, 85(1): 62-68. DOI: 10.51821/85.1.9156. [38] LIU DP, LU W, ZHANG ZQ, et al. Comparative evaluation of GPR versus APRI and FIB-4 in predicting different levels of liver fibrosis of chronic hepatitis B[J]. J Viral Hepat, 2018, 25(5): 581-589. DOI: 10.1111/jvh.12842. [39] EYISOY ÖG, TAŞDEMIR V, ERIÇ ÖZDEMIR M, et al. Aspartate aminotransferase to platelet ratio index (APRI) score: is it useful in patients with intrahepatic cholestasis of pregnancy?[J]. J Matern Fetal Neonatal Med, 2022, 35(25): 10137-10142. DOI: 10.1080/14767058.2022.2122036. [40] CORPECHOT C, GAOUAR F, EL NAGGAR A, et al. Baseline values and changes in liver stiffness measured by transient elastography are associated with severity of fibrosis and outcomes of patients with primary sclerosing cholangitis[J]. Gastroenterology, 2014, 146(4): 970-979; quiz e15-16. DOI: 10.1053/j.gastro.2013.12.030. [41] EATON JE, SEN A, HOODESHENAS S, et al. Changes in liver stiffness, measured by magnetic resonance elastography, associated with hepatic decompensation in patients with primary sclerosing cholangitis[J]. Clin Gastroenterol Hepatol, 2020, 18(7): 1576-1583. e1. DOI: 10.1016/j.cgh.2019.10.041. [42] VESTERHUS M, HOV JR, HOLM A, et al. Enhanced liver fibrosis score predicts transplant-free survival in primary sclerosing cholangitis[J]. Hepatology, 2015, 62(1): 188-197. DOI: 10.1002/hep.27825. [43] CHARATCHAROENWITTHAYA P, ENDERS FB, HALLING KC, et al. Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis[J]. Hepatology, 2008, 48(4): 1106-1117. DOI: 10.1002/hep.22441. [44] LIU JZ, HOV JR, FOLSERAAS T, et al. Dense genotyping of immune-related disease regions identifies nine new risk loci for primary sclerosing cholangitis[J]. Nat Genet, 2013, 45(6): 670-675. DOI: 10.1038/ng.2616. [45] CHRISTENSEN B, MICIC D, GIBSON PR, et al. Vedolizumab in patients with concurrent primary sclerosing cholangitis and inflammatory bowel disease does not improve liver biochemistry but is safe and effective for the bowel disease[J]. Aliment Pharmacol Ther, 2018, 47(6): 753-762. DOI: 10.1111/apt.14525. [46] EJIM L, FARHA MA, FALCONER SB, et al. Combinations of antibiotics and nonantibiotic drugs enhance antimicrobial efficacy[J]. Nat Chem Biol, 2011, 7(6): 348-350. DOI: 10.1038/nchembio.559. [47] HIRSCHFIELD GM, CHAZOUILLÈRES O, DRENTH JP, et al. Effect of NGM282, an FGF19 analogue, in primary sclerosing cholangitis: A multicenter, randomized, double-blind, placebo-controlled phase Ⅱ trial[J]. J Hepatol, 2019, 70(3): 483-493. DOI: 10.1016/j.jhep.2018.10.035. [48] TRAUNER M, GULAMHUSEIN A, HAMEED B, et al. The nonsteroidal farnesoid X receptor agonist cilofexor (GS-9674) improves markers of cholestasis and liver injury in patients with primary sclerosing cholangitis[J]. Hepatology, 2019, 70(3): 788-801. DOI: 10.1002/hep.30509. [49] MUIR AJ, LEVY C, JANSSEN H, et al. Simtuzumab for primary sclerosing cholangitis: phase 2 study results with insights on the natural history of the disease[J]. Hepatology, 2019, 69(2): 684-698. DOI: 10.1002/hep.30237. -
本文二维码
计量
- 文章访问数: 2354
- HTML全文浏览量: 1258
- PDF下载量: 215
- 被引次数: 0
下载:
