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ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of common bile duct stones

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World Journal of Gastroenterology 2018年第39期24卷 4489-4498页

作者： Hai-Yang Chang Chang-Jun Wang Bin Liu Yong-Zheng Wang Wu-Jie Wang Wei Wang Dong Li Yu-Liang Department of Intervention Medicine the Second Hospital of Shandong UniversityJinan 250033Shandong ProvinceChina Interventional Oncology Institute Shandong UniversityJinan 250033Shandong ProvinceChina Department of Radiology Jiyang People’s HospitalJinan 251400Shandong ProvinceChina

AIM To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct(CBD) *** From April 2014 to May 2016, 15 consecutive patients(6 men and 9 women) aged 45-86(mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder. RESULTS All patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain(n = 1), abdominal distension(n = 1), and fever(n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred. CONCLUSION For patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones.

关键词： Common bile duct stones Gallstones Percutaneous transhepatic removal ursodeoxycholic acid

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ursodeoxycholic acid ameliorates hepatic lipid metabolism in LO2 cells by regulating the AKT/mTOR/SREBP-1 signaling pathway

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World Journal of Gastroenterology 2019年第12期25卷 1492-1501页

作者： Jie Hu Wei Hong Kan-Nan Yao Xiao-Hong Zhu Zhi-Yun Chen Lei Ye Department of Infectious Diseases The First Affiliated Hospital of Zhejiang Chinese Medical University the Second Central Laboratory The First Affiliated Hospital of Zhejiang Chinese Medical University

BACKGROUND Nonalcoholic fatty liver disease(NAFLD), the most common chronic liver disease, can progress into nonalcoholic steatohepatitis(NASH), cirrhosis, and even hepatocellular carcinoma. Bile acids such as ursodeoxycholic acid(UDCA)play an essential role in the pathogenesis of NAFLD by regulating the level of sterol regulatory element-binding protein(SREBP) 1 c, but the underlying regulatory mechanism remains elusive. Increased evidence indicates that the AKT/mTOR/SREBP-1 signaling pathway is a key pathway to regulate hepatic cellular lipid metabolism. UDCA may regulate the AKT/mTOR/SREBP-1 signaling pathway to ameliorate hepatic lipid *** To investigate the functional mechanism of UDCA in an oleic acid(OA)-induced cellular model of *** The cellular model of NAFLD was established using OA and treated with ***, the best concentration of UDCA was selected. For the best time-dependent assay, cells were stimulated with OA only or co-treated with OA and 2 mmol/L UDCA for 24 h, 48 h, and 72 h. Oil red O staining was used to observe the accumulation of intracellular lipids, while the intracellular contents of triglyceride, alanine aminotransferase(ALT), gamma-glutamyl transpeptidase(GGT), and aspartate aminotransferase(AST) were detected by enzymatic methods. Meanwhile, the expression levels of AKT/mTOR/SREBP-1 signaling pathway-related proteins were detected by real-time PCR and Western *** In the NAFLD cell model established with LO2 cells induced using OA, lipid accumulation was obvious. UDCA significantly inhibited lipid accumulation at different concentrations(especially 2 mmol/L) and decreased cell growth ability at different time points. The biochemical parameters like ALT, AST, and GGT were significant improved by UDCA. UDCA treatment vividly repressed the activation of AKT, mTOR, and CRTC2 and the expression of nSREBP-1 in LO2 cells induced with *** Our findings demonstrate the effect of UDCA in improving NAFLD. U

关键词： ursodeoxycholic acid Hepatic lipid metabolism AKT/mTOR/SREBP-1 Hepatic steatosis

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ursodeoxycholic acid therapy in gallbladder disease,a story not yet completed

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World Journal of Gastroenterology 2013年第31期19卷 5029-5034页

作者： Michele Pier Luca Guarino Silvia Cocca Annamaria Altomare Sara Emerenziani Michele Cicala Department of Digestive Disease Campus Bio Medico University 00128 RomeItaly

Gallstone disease represents an important issue in the healthcare *** principal non-invasive nonsurgical medical treatment for cholesterol gallstones is still represented by oral litholysis with bile *** first successful and documented dissolution of cholesterol gallstones was achieved in *** then a large number of investigators all over the world,have been dedicated in biochemical and clinical studies on ursodeoxycholic acid(UDCA),demonstrating its extreme *** editorial is aimed to provide a brief review of recent developments in UDCA use,current indications for its use and,the more recent advances in understanding its effects in terms of an antiinflammatory drug.

关键词： Gallbladder Cholesterol gallstones ursodeoxycholic acid

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Thermal Decomposition Kinetics of ursodeoxycholic Acid Drug Crystal

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Journal of Crystallization Process and Technology 2017年第4期7卷 85-90页

作者： S. Ramukutty R. Jeyasudha E. Ramachandran Department of Physics Thiruvalluvar College Papanasam India

The crystallization of ursodeoxycholic acid drug crystals in gel by reduction of solubility method is the first of its kind to be reported in literature. Monoclinic crystalline form of the structure was confirmed using single crystal X-ray diffraction analysis. This report deals with the kinetic analysis made from the thermogravimetric analysis/differential thermal analysis (TGA/DTA) data using Coats-Redfern (CR) relation. Thermodynamic parameters were also determined. Arrhenius equation for ursodeoxycholic acid was derived as k = 3.10 × 1010 e−172581/RT mol−1•s−1.

关键词： Thermal Analysis Thermal Decomposition Kinetics ursodeoxycholic Acid

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Effect of ursodeoxycholic acid combined with bifidobacterium quadruple preparations on myocardial enzyme, immune function and inflammatory response of hyperbilirubinemia neonatal

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Journal of Hainan Medical University 2018年第7期24卷 39-42页

作者： Song-Mei Yang Yu-Mei Liang Yan-Ni Feng Mei Lin Yan Huang Neonatal Pediatrics Department Affiliated Hospital of Youjiang Medical College for NationalitiesBaise 533000GuangxiChina

Objective: To investigate the effects of myocardial enzyme, immune function and inflammatory response by ursodeoxycholic acid combined with bifidobacterium quadruple preparations on hyperbilirubinemia neonatal. Methods: A total of 100 cases of neonatal hyperbilirubinemia in our hospital from June 2016 to May-2017 were selected and divided into control group and observation group by random number table, 50 cases in each group. Two groups of neonatal were given routine symptomatic treatment. The control group was treated with ursodeoxycholic acid and the observation group was treated with Bifidobacterium tetralogy of live bacteria on the basis of the control group. The two groups of neonatal were both treated for 7 d. The serum levels of CK-MB, CK, LDH, AST, CD3+, CD4+, CD4+/CD8+, CD8+, CRP and TNF-α were measured before and after the treatment of the two groups. Results: Before treatment, there was no significant difference in serum CK-MB, CK, LDH, AST, CD3+, CD4+, CD4+/CD8+, CD8+, CRP and TNF-α levels between the 2 groups. After treatment: 2 groups of serum CK-MB, CK, LDH, AST, CD8+, CRP, TNF-α levels significantly decreased compared with the group before treatment, CD3+, CD4+ and CD4+/CD8+ levels were significantly increased after treatment, and the observation group with serum CK-MB, CK, LDH, AST, CD8 +, CRP, TNF-α levels were significantly lower than the control group, CD3+, CD4+ and CD4+/CD8+ levels were significantly higher than the control group, the differences were statistically significant. Conclusion: ursodeoxycholic acid combined with Bifidobacterium quadruple viable tablets can can reduce the activity of myocardial enzyme, improve the state of spectrum index of neonatal hyperbilirubinemia.

关键词： ursodeoxycholic acid Bifidobacterium quadruple preparations Hyperbilirubinemia neonatal Myocardial enzyme Immune function Inflammatory response

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Risk factors for hepatic decompensation in patients with primary biliary cirrhosis

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World Journal of Gastroenterology 2013年第7期19卷 1111-1118页

作者： Tian-Yan Shi Li-Na Zhang Hua Chen Li Wang Min Shen Xuan Zhang Feng-Chun Zhang Department of Rheumatology Key Laboratory of Rheumatology and Clinical ImmunologyPeking Union Medical College HospitalChinese Academy of Medical Science

AIM:To examine the clinical features and analyze prognostic factors in a prospective study of primary biliary cirrhosis(PBC) ***:From 1995 to 2010,PBC patients without hepatic decompensation seen at the Peking Union Medical College Hospital were *** signs and manifestations(pruritus,persistent fatigue,jaundice and pain in the right hypochondrium),laboratory parameters(auto-antibodies for autoimmune hepatic disease,biliary and hepatic enzymes,immunoglobulin,bilirubin,and albumin) and imaging findings were recorded at entry and at specific time points during *** regression and Kaplan-Meier analyses,respectively,assessed the risk factors for hepatic decompensation and ***:Two hundred and sixty-two PBC patients were enrolled with a median follow-up of 75.2 mo(range,21-201 mo).The 240 patients were aged 51.5 ± 10.2 years at diagnosis and 91.6% were *** hundred and forty-five(93.5%) were seropositive for anti-mitochondrial *** presentation,170 patients(64.9%) were symptomatic,while 96 patients(36.6%) had extra-hepatic autoimmune *** the follow-up period,62(23.7%) patients developed hepatic decompensation of whom four underwent liver transplantation and 17 *** cumulative survival rate and median survival time were 83.9% and 181.7 mo,*** regression analysis revealed that an incomplete ursodeoxycholic acid(UDCA) response or inconsistent treatment [P < 0.001;hazard risk(HR) 95%CI = 2.423-7.541],anti-centromere antibodies(ACA) positivity(P < 0.001;HR 95%CI = 2.516-7.137),alanine aminotransferase ratio(AAR) elevations(P < 0.001;HR 95%CI = 1.357-2.678),and histological advanced liver disease(P = 0.006;HR 95%CI = 1.481-10.847) were predictors of hepatic *** clinical features and survival of PBC in China are consistent with those described in Western ***:Incomplete UDCA response or inconsistent treatment,ACA positivity,AAR elevations,and advanced histolog

关键词： Primary biliary cirrhosis Risk factor Hepatic decompensation Survival ursodeoxycholic acid response Anti-centromere antibodies Histological stage

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Δ4-3-oxosteroid-5β-reductase deficiency: Responses to oral bile acid therapy and long-term outcomes

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World Journal of Gastroenterology 2019年第7期25卷 859-869页

作者： Mei-Hong Zhang Kenneth DR Setchell Jing Zhao Jing-Yu Gong Yi Lu Jian-She Wang Department of Pediatrics Jinshan Hospital Fudan University Department of Pathology and Laboratory Medicine Cincinnati Children's Hospital Medical Center The Center for Pediatric Liver Diseases Children's Hospital of Fudan University Department of Pediatrics Shanghai Medical College of Fudan University

BACKGROUND Disorders of primary bile acid synthesis may be life-threatening if undiagnosed,or not treated with primary bile acid replacement therapy. To date, there are few reports on the management and follow-up of patients with Δ4-3-oxosteroid 5β-reductase(AKR1 D1) deficiency. We hypothesized that a retrospective analysis of the responses to oral bile acid replacement therapy with chenodeoxycholic acid(CDCA) in patients with this bile acid synthesis disorder will increase our understanding of the disease progression and permit evaluation of this treatment regimen as an alternative to the Food and Drug Administration(FDA) approved drug cholic acid, which is currently unavailable in *** To evaluate the therapeutic responses of patients with AKR1 D1 deficiency to oral bile acid therapy, specifically *** Twelve patients with AKR1 D1 deficiency, confirmed by fast atom bombardment ionization-mass spectrometry analysis of urine and by gene sequencing for mutations in AKR1 D1, were treated with differing doses of CDCA or ursodeoxycholic acid(UDCA). The clinical and biochemical responses to therapy were monitored over a period ranging 0.5-6.4 years. Dose adjustment, to optimize the therapeutic dose, was based on changes in serum biochemistry parameters,notably liver function tests, and suppression of the urinary levels of atypical hepatotoxic 3-oxo-Δ4-bile acids measured by mass *** Physical examination, serum biochemistry parameters, and sonographic findings improved in all 12 patients during bile acid therapy, except one who underwent liver transplantation. Urine bile acid analysis confirmed a significant reduction in atypical hepatotoxic 3-oxo-Δ4 bile acids concomitant with clinical and biochemical improvements in those patients treated with CDCA. UDCA was ineffective in down-regulating endogenous bile acid synthesis as evidenced from the inability to suppress the urinary excretion of atypical 3-oxo-Δ4-bile acids. The dose of CDCA require

关键词： Δ4-3-oxosteroid-5β-reductase deficiency Mass spectrometry Bile acid synthesis disorder Chenodeoxycholic acid ursodeoxycholic acid

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Effect of biliary drainage on inducible nitric oxide synthase, CD14 and TGR5 expression in obstructive jaundice rats

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World Journal of Gastroenterology 2013年第15期19卷 2319-2330页

作者： Zi-Kai Wang Jian-Guo Xiao Xue-Fei Huang Yi-Chun Gong Wen Li Department of Gastroenterology and Hepatology the General Hospital of the Chinese People's Liberation Army Critical Care Medicine the General Hospital of the Chinese People's Liberation Army Department of Cadre Health Care the Navy General Hospital of the Chinese People's Liberation Army Intensive Care Unit the 309th Hospital of the Chinese People's Liberation Army

AIM: To investigate the effect of biliary drainage on inducible nitric oxide synthase (iNOS), CD14 and TGR5 expression in rats with obstructive jaundice (OJ). METHODS: Male adult Sprague-Dawley rats were randomly assigned to four groups: OJ, sham operation (SH), internal biliary drainage (ID) and external biliary drainage (ED). Rat models were successfully established by two operations and succumbed for extraction of Kupffer cells (KCs) and liver tissue collection on the 8 th and 15 th day. KCs were isolated by in situ hepatic perfusion and digested with collagen Ⅳ, density gradient centrifuged by percoll reagent and purified by cell culture attachment. The isolated KCs were cultured with the endotoxin lipopolysaccharide (LPS) with and without the addition of ursodeoxycholic acid (UDCA). The expression of iNOS, CD14 and bile acid receptor-TGR5 protein in rat liver tissues was determined by immunohistochemistry. The expression of iNOS and CD14 messenger RNA (mRNA) on the isolated KCs was detected by reverse transcription polymerase chain reaction (PCR) and the TGR5 mRNA level in KCs was measured by real-time quantitative PCR. RESULTS: The iNOS protein was markedly expressed in the liver of OJ rats, but rare expressed in SH rats. After relief of OJ, the iNOS expression was decidedly suppressed in the ID group (ID vs OJ, P < 0.01), but obviously increased in rats of ED (ED vs OJ, P=0.004). When interfered only with LPS, the expression of iNOS mRNA by KCs was increased in the OJ group compared with the SH group (P=0.004). After relief of biliary obstruction, the iNOS mRNA expression showed slight changes in the ED group (ED vs OJ, P=0.71), but dropped in the ID group (ID vs OJ, P=0.001). Compared with the simple intervention with LPS, the expressions of iNOS mRNA were significantly inhibited in all four groups after interfered with both LPS and UDCA (P < 0.01, respectively). After bile duct ligation, the CD14 protein expression in rat liver was significantly strengthene

关键词： Obstructive jaundice Biliary drainage Kupffer cells CD14 TGR5 ursodeoxycholic acid

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Treatment of primary sclerosing cholangitis in children

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World Journal of Hepatology 2019年第1期11卷 19-35页

作者： Trevor J Laborda M Kyle Jensen Marianne Kavan Mark Deneau Department of Pediatrics University of Utah

Primary sclerosing cholangitis(PSC) is a rare disease of stricturing and destruction of the biliary tree with a complex genetic and environmental *** patients have co-occurring inflammatory bowel disease. Children generally present with uncomplicated disease, but undergo a variable progression to endstage liver disease. Within ten years of diagnosis, 50% of children will develop clinical complications including 30% requiring liver *** is a rare but serious complication affecting 1% of *** acid and oral vancomycin therapy used widely in children as medical therapy, and may be effective in a subset of patients. Gamma glutamyltransferase is a potential surrogate endpoint for disease activity, with improved survival in patients who achieve a normal value. Endoscopic retrograde cholangiopancreatography is a necessary adjunct to medical therapy to evaluate mass lesions or dominant strictures for malignancy, and also to relieve biliary obstruction. Liver transplantation remains the only option for patients who progress to end-stage liver disease. We review special considerations for patients before and after transplant, and in patients with inflammatory bowel disease. There is presently no published treatment algorithm or guideline for the management of children with PSC. We review the evidence for drug efficacy, dosing, duration of therapy, and treatment targets in PSC, and provide a framework for endoscopic and medical management of this complex problem.

关键词： Liver transplant Pediatric ursodeoxycholic acid Oral vancomycin Oral vancomycin therapy Endoscopic retrograde cholangiopancreatography

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World Journal of Hepatology 2011年第6期3卷 170-174页

作者： Nourr-Eddine Farouj Jean-Franois D Cadranel Ali Mofredj Vincent Jouannaud Maria Lahmiri Pierre LeLann Alain Cazier Intensive Care Department Centre Hospitalier Laёnnec BP 72 60100 CreilFrance Liver Gastroenteroly and Nutrition DepartmentCentre Hospitalier Laёnnec BP 72 60100 CreilFrance Chest and Lung Department Centre Hospitalier Laёnnec BP 72 60100 CreilFrance Pathological Centre Hospitalier Laёnnec BP 72 60100 CreilFrance

Sarcoidosis is a systemic granulomatous disease which may involve many *** approximately 95% of patients there is liver involvement,with noncaseating hepatic granulomas occurring in 21 to 99% of patients with *** involvement is usually asymptomatic and limited to mild to moderate abnormalities in liver *** occurrence of jaundice in sarcoidosis is rare;extensive imaging procedures and the examination of liver biopsies permit a precise *** associated with sarcoidosis has been reported in less than 20 cases and can lead to biliary cirrhosis and liver-related *** report here on a case of ductopenia-related sarcoidosis in which primary biliary cirrhosis and extrahepatic cholestasis have been carefully *** patient follow up was 8 *** ursodesoxycholic acid appears to improve liver biochemistry it does not preclude the rapid occurrence of extensive fibrosis.A review of the literature of reported cases of ductopenia related to sarcoidosis is provided.

关键词： Sarcoidosis Cholestasis ductopenia ursodeoxycholic acid

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