Cholestatic liver diseases: new targets, new therapies.

Cholestatic liver diseases: new targets, new therapies.
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DOI:
10.1177/1756284818787400
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发表时间:
2018
影响因子:
4.2
通讯作者:
Levy C
Levy C
中科院分区:
医学3区
文献类型:
--
作者:
Santiago P;Scheinberg AR;Levy C

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胆汁淤积性肝病是由胆管的逐渐破坏、胆汁酸的积累和导致胆管细胞和肝细胞损伤的炎症过程的自我延续引起的。如果不及时治疗,胆汁淤积将导致纤维化,胆汁性肝硬化,最终导致终末期肝病。原发性胆汁性胆管炎(PBC)和原发性硬化性胆管炎(PSC)是影响成人的两种最常见的慢性胆汁淤积性肝病,其病因仍然令人费解。虽然熊去氧胆酸(UDCA)治疗显著改善了PBC患者的结局并延长了无移植生存期,但UDCA无应答者的治疗选择仍然有限。此外,没有可用的药物治疗PSC。随着近年来与胆汁酸调节相关的分子生物学的进展和对免疫途径的理解,出现了新的药物治疗方法。在这篇综述中,我们讨论了治疗标准,并强调了PBC和PSC的各种新兴治疗方法。
Cholestatic liver diseases result from gradual destruction of bile ducts, accumulation of bile acids and self-perpetuation of the inflammatory process leading to damage to cholangiocytes and hepatocytes. If left untreated, cholestasis will lead to fibrosis, biliary cirrhosis, and ultimately end-stage liver disease. Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are the two most common chronic cholestatic liver diseases affecting adults, and their etiologies remain puzzling. While treatment with ursodeoxycholic acid (UDCA) has significantly improved outcomes and prolonged transplant-free survival for patients with PBC, treatment options for UDCA nonresponders remain limited. Furthermore, there is no available medical therapy for PSC. With recent advances in molecular biochemistry specifically related to bile acid regulation and understanding of immunologic pathways, novel pharmacologic treatments have emerged. In this review, we discuss the standard of care and emphasize the various emerging treatments for PBC and PSC.
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