原发性胆汁性胆管炎个性化诊疗策略

郑林华; 韩英

doi:10.12449/JCH250707

原发性胆汁性胆管炎个性化诊疗策略

DOI: 10.12449/JCH250707

郑林华,
韩英^, ,

空军军医大学西京医院消化内科，西安 710032

基金项目:

国家自然科学基金 (82270551);

陕西省创新能力支撑计划 (2024RS-CXTD-79)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：韩英负责拟定写作思路，指导撰写文章、论文修改并最后定稿；郑林华负责设计论文框架，起草论文。

详细信息

通信作者:
韩英， hanying@fmmu.edu.cn （ORCID： 0000-0003-3046-9507）

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出版历程
- 收稿日期: 2025-04-18
- 录用日期: 2025-05-20
- 出版日期: 2025-07-25

Personalized diagnosis and treatment strategies of primary biliary cholangitis

Linhua ZHENG,
Ying HAN^{,
,}

Department of Gastroenterology，Xijing Hospital，Air Force Medical University，Xi’an 710032，China

Research funding:

National Natural Science Foundation of China (82270551);

Science and Technology Innovation Team of Shaanxi Province (2024RS-CXTD-79)

More Information

Corresponding author: HAN Ying， hanying@fmmu.edu.cn （ORCID： 0000-0003-3046-9507）

摘要

摘要: 目前原发性胆汁性胆管炎（PBC）存在早期诊断率不足、治疗药物选择局限等问题。对于ALP水平正常的不典型PBC患者，IgM水平、年龄和性别可作为诊断PBC的重要指标。“西安标准”通过缩短评估周期，在1个月时即可判断是否对熊去氧胆酸应答，使难治患者能够更早接受二线治疗，对临床预后评估具有突破性意义。在优化现有预后评价模型基础上，应基于血清指标、肝硬度等建立新的动态预后评估模型，对精准判断疾病预后、积极开展新药研发具有重要意义。
- 原发性胆汁性胆管炎 /
- 预测 /
- 治疗学
Abstract: At present， there are still certain problems in the diagnosis and treatment of primary biliary cholangitis （PBC）， such as a low rate of early diagnosis， limitations in the selection of therapeutic drugs. For patients with atypical PBC and a normal level of alkaline phosphatase， IgM， age， and sex can be used as important indicators for the diagnosis of PBC. By shortening the cycle for evaluation， “Xi’an criteria” can facilitate early identification of patients who have a suboptimal response to ursodesoxycholic acid after 1-month treatment and allows clinicians to initiate second-line therapeutic agent. It provides significant platform in the clinical evaluation of prognostic information. Based on the optimization of existing models for prognostic evaluation， new dynamic models should be established based on serum indicators and liver stiffness to facilitate accurate prognostic assessment and active new drug research and development.
- Primary Biliary Cholangitis /
- Forecasting /
- Therapeutics

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表 1 PBC的生化应答标准

Table 1. Biochemical response criteria for PBC

应答标准	时间	定义
西安标准	1个月	ALP≤2.5×ULN、AST≤2×ULN和TBil≤1×ULN
巴塞罗那标准	12个月	ALP水平下降40%或恢复正常
梅奥标准	6个月	ALP≤2×ULN
巴黎Ⅰ标准	12个月	ALP≤3×ULN、AST≤2×ULN和TBil≤1 mg/dL
巴黎Ⅱ标准	12个月	ALP≤1.5×ULN、AST≤1.5×ULN和TBil≤1 mg/dL
多伦多标准	24个月	ALP≤1.67×ULN
鹿特丹标准	12个月	胆红素、白蛋白水平正常
UK-PBC评分	12个月	基线白蛋白、血小板；UDCA治疗1年后的胆红素、ALP、ALT或AST；预测5年、10年、15年生存率及对 UDCA的应答
PBC GLOBE评分	12个月	基线年龄，UDCA治疗1年后的胆红素、ALP、白蛋白、血小板；预测3年、5年、10年生存率及与UDCA 的应答

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