OUTCOME OF CHENODEOXYCHOLIC ACID (CDCA) TREATMENT IN 125 PATIENTS WITH RADIOLUCENT GALLSTONES - FACTORS INFLUENCING EFFICACY, WITHDRAWAL, SYMPTOMS AND SIDE-EFFECTS AND POST-DISSOLUTION RECURRENCE
OUTCOME OF CHENODEOXYCHOLIC ACID (CDCA) TREATMENT IN 125 PATIENTS WITH RADIOLUCENT GALLSTONES - FACTORS INFLUENCING EFFICACY, WITHDRAWAL, SYMPTOMS AND SIDE-EFFECTS AND POST-DISSOLUTION RECURRENCE
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DOI：
10.1097/00005792-198203000-00003
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发表时间：
1982-01-01
期刊：
影响因子：
1.6
通讯作者：
DOWLING, RH
中科院分区：
文献类型：
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作者：
MATON, PN;ISER, JH;DOWLING, RH
1971 年至 1977 年间，125 名胆囊功能可透的胆结石患者接受鹅去氧胆酸 (CDCA) 治疗，其中 47 名患者胆结石完全溶解，总体疗效为 38%。然而，1976 年对影响疗效的因素进行的回顾性分析表明，对于直径 < 15 mm 的结石患者，使用 > 13 mg CDCA kg-1 day-1 治疗不少于 1 年且出现不饱和胆汁 (n = 27)，疗效上升至 78% 完全溶解和 93% 部分加完全胆结石溶解。自 1977 年以来，这种选择/管理方法的有效性在 42 名选择接受治疗的可比较患者中得到了前瞻性证实；疗效（胆结石完全溶解）达到76%。胆结石完全溶解的中位治疗时间为 7.5 个月。适用于直径 < 5 毫米的宝石； 12.0 适用于 5-10 毫米的宝石； 22.0 适用于 10-15 毫米的宝石； 26 名患有大结石（> 15 毫米）的仅有 2 名患者最终显示胆结石完全溶解，为 28.5。 78 名患者退出治疗，其中 21 人在 6 个月内退出。开始CDCA的时间（在第一次随访胆囊造影之前）：其余57人因胆结石并发症（11名患者）、治疗不足（剂量和/或持续时间，20名患者）、选择不当或不合适的结石（19名患者）以及对CDCA耐药（7名患者）而退出。腹泻虽然常见，但通常是轻微或短暂的。胆绞痛和非特异性消化不良在治疗期间趋于改善。迄今为止，14 名患者 (30%) 在停止 CDCA 治疗后 3 个月至 5 年内检测到胆结石复发。
Of 125 patients with radiolucent gallstones in functioning gallbladders treated with chenodeoxycholic acid (CDCA) between 1971-1977, 47 showed complete gallstone dissolution, an overall efficacy of 38%. However, a retrospective analysis of factors governing efficacy carried out in 1976 showed that in patients with stones < 15 mm in diameter, treated with > 13 mg CDCA kg-1 day-1 for not less than 1 yr who developed unsaturated bile (n = 27), efficacy rose to 78% complete and 93% partial plus complete gallstone dissolution. The usefulness of this selection/management approach was then confirmed prospectively in 42 comparable patients selected for treatment since 1977; efficacy (complete gallstone dissolution) reached 76%. The median duration of treatment for complete gallstone dissolution was 7.5 mo. for stones < 5 mm in diameter; 12.0 for 5-10 mm stones; 22.0 for 10-15 mm stones; and 28.5 for the only 2 patients (of 26) with large (> 15 mm) stones who ultimately showed complete gallstone dissolution. Seventy-eight patients withdrew from therapy, 21 within 6 mo. of starting CDCA (before their 1st follow-up cholecystogram): the remaining 57 withdrew because of complications of gallstones (11 patients), inadequate treatment (dose and/or duration, 20 patients), inappropriate selection or unsuitable stones (19 patients) and resistance to CDCA (7 patients). Diarrhea, although common, was usually mild or transient. Biliary colic and nonspecific dyspepsia tended to improve during therapy. To date, gallstone recurrence was detected in 14 patients (30%), 3 mo.-5 yr after discontinuing treatment with CDCA.