胆汁淤积性肝病的发生机制及治疗进展ppt课件.pptVIP

Pruritus was scored by a semiquantitative scale of 1–4, with grade 1 ?occasional pruritus, grade 2 ?daily intermittent pruritus with preponderance of asymptomatic periods, grade 3 ?daily intermittent pruritus with preponderance of symptomatic periods and grade 4 ?persistent pruritus, day and night. * * * * study was to evaluate the efficacy and safety of ursodeoxycholic acid in comparison with cholestyramine. Eighty-four symptomatic patients with intrahepatic cholestasis of pregnancy were randomized to receive either ursodeoxycholic acid, 8-10 mg/kg body weight daily (n = 42), or cholestyramine, 8 g daily (n = 42), for 14 days. The primary end point was a reduction of pruritus by more than 50% after 14 days of treatment as evaluated by a pruritus score. Secondary end points were outcome of pregnancy, reduction of serum aminotransferase activities and serum bile acid levels, and drug safety. Intention-to-treat analysis was applied. Pruritus was more effectively reduced by ursodeoxycholic acid than cholestyramine (66.6% vs 19.0%, respectively; P .005). Babies were delivered significantly closer to term by patients treated with ursodeoxycholic acid than those treated with cholestyramine (38.7 +/- 1.7 vs 37.4 +/- 1.5 weeks, respectively, P .05). Serum alanine and aspartate aminotransferase activities were markedly reduced by 78.5% and 73.8%, respectively, after ursodeoxycholic acid, but by only 21.4%, each, after cholestyramine therapy (P .01 vs ursodeoxycholic acid). Endogenous serum bile acid levels decreased by 59.5% and 19.0%, respectively (P .02). Ursodeoxycholic acid, but not cholestyramine was free of adverse effects. CONCLUSIONS: Ursodeoxycholic acid is safe and more effective than cholestyramine in intrahepatic cholestasis of pregnancy. * * NULLIPARITY:未经产的 * * Comparison of pruritus score before and after treatment in the two groups * * 值得注意的是，治疗瘙痒剂量范围内的利福平可有肝脏毒性，所以用药期间必须随访肝功能。另外，利福平可通过干扰维生素D 的吸收而加重骨质软化；通过超敏反应引发胆汁淤积性肝炎，甚至发生胆汁淤积性瘙痒等并发症。事实上，由于利福平潜在的副作用，