原发性硬化性胆管炎的许多面孔:争议越来越多
Brian J Wentworth1, Rachita Khot2, Stephen H Caldwell3
1Division of Gastroenterology and Hepatology, School of Medicine, University of Virginia, PO Box 800708, Charlottesville, VA, 22908, USA. bw8xz@uvahealth.org.
Digestive diseases and sciences
|June 26, 2023
概括
原发性硬化性胆道炎 (PSC) 由于其复杂性和缺乏疾病修饰性治疗方法,因此存在管理方面的挑战. 本综述解决了临床困境,包括PSC患者的ursodeoxycolic acid使用和gadolinium对比问题.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 自免疫性疾病 自免疫性疾病
背景情况:
- 初级硬化性胆道炎 (PSC) 是一种罕见的慢性肝病,其特征是胆道炎症和纤维化.
- 由于疾病的异质性,缺乏治愈疗法,以及向肝硬化和肝衰竭的变异性进展,管理是复杂的.
- 目前的指导方针对医疗保健提供者面临的日常临床挑战提供了有限的深度.
研究的目的:
- 深入研究一级硬化胆管炎管理中的有争议和未解决的临床困境.
- 提供关于ursodeoxycolic acid (UDCA) 的实用性和性酸酶正常化的重要性的见解.
- 讨论查PSC变种,模仿者和肝胆恶性瘤的含义,包括加多对比剂暴露风险.
主要方法:
- 审查当前的文献和临床实践指南.
- 在PSC管理中讨论有争议的话题.
- 分析有关诊断成像对比剂的新兴问题.
主要成果:
- 对于PSC中ursodeoxycolic酸的有用性仍在争论中,没有普遍接受的治疗方法可以改变疾病的进展.
- 性酸酶正常化是一种潜在的替代标记物,但其临床意义需要进一步阐明.
- 在接受频繁MRI扫描的PSC患者中,重复暴露于基于加多的对比剂的长期影响尚不清楚,需要进行调查.
结论:
- 初级硬化性胆管炎的管理需要细微的方法来解决诊断和治疗的不确定性.
- 需要进一步的研究来澄清UDCA的作用,生物化学标记物的预后价值,以及加多对比剂在PSC中的安全性.
- 解决这些临床困境对于改善患者的治疗结果和指导未来治疗策略至关重要.
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