切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (04) : 313 -319. doi: 10.3877/cma.j.issn.1674-1358.2017.04.001

所属专题: 指南共识

指南

多烯磷脂酰胆碱在肝病临床应用的专家共识
多烯磷脂酰胆碱在肝病临床应用专家委员会   
  • 收稿日期:2017-08-01 出版日期:2017-08-15
  • 基金资助:
    北京市医院管理局扬帆计划项目(肝炎专业)(No. ZYLX201402); 登峰计划项目(肝炎专业)(No. DFL20151701)

Experts consensus on the treatment with polyenphosphatidylcholine in patients with liver diseases

Committee of the treatment with polyenphosphatidylcholine in patients with liver diseases   

  • Received:2017-08-01 Published:2017-08-15
引用本文:

多烯磷脂酰胆碱在肝病临床应用专家委员会. 多烯磷脂酰胆碱在肝病临床应用的专家共识[J]. 中华实验和临床感染病杂志(电子版), 2017, 11(04): 313-319.

Committee of the treatment with polyenphosphatidylcholine in patients with liver diseases. Experts consensus on the treatment with polyenphosphatidylcholine in patients with liver diseases[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(04): 313-319.

随着临床研究证据的积累,多烯磷脂酰胆碱已被我国多部肝病诊疗指南列为抗炎保肝治疗药物。但限于篇幅,上述指南均未就多烯磷脂酰胆碱的具体临床应用展开论述,也未能给出详尽的循证医学证据。为此,本文以多烯磷脂酰胆碱在各种肝病临床应用的结果作为证据,参照肝病诊疗相关的各项指南和共识,结合肝病治疗的发展趋势,讨论并撰写本专家共识,以期为临床医生进一步提供用药依据。

Polyenphosphatidylcholine are recommended to improve liver function in several national guidelines based on the clinical evidence which showed that polyenphosphatidylcholine were effective in patients with multiple liver diseases. Due to the limited description of data on polyenphosphatidylcholine in previous guidelines, the comprehensive review of polyenphosphatidylcholine in patients with liver diseases is needed. The committee of the treatment with polyenphosphatidylcholine in patients with liver diseases published the present consensus to standardize the clinical use of polyenphosphatidylcholine in patients with liver diseases.

表1 循证医学证据与推荐等级(参照GRADE系统[4,5]
[1]
中华医学会感染病学分会, 肝脏炎症及其防治专家共识专家委员会. 肝脏炎症及其防治专家共识[J]. 中华肝脏病杂志,2014,22(2):94-103.
[2]
中华医学会肝病学分会脂肪肝和酒精性肝病学组. 酒精性肝病诊疗指南(2010年修订版)[J/CD]. 中国肝脏病杂志(电子版),2010,2(4):49-53.
[3]
中华医学会肝病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南(2010年修订版)[J/CD]. 中国肝脏病杂志(电子版),2010,2(4):43-48.
[4]
Shiffman RN, Shekelle P, Overhage JM, et al. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization[J]. Ann Intern Med,2003,139(6):493-498.
[5]
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ,2008,336(7650):924-926.
[6]
Kuntz E. The "essential" phospholipids in hepatology -- 50 years of experimental and clinical experiences[J]. Z Gastroenterol,1991,29(Suppl 2):7-13.
[7]
Navder KP, Lieber CS. Dilinoleoylphosphatidylcholine is responsible for the beneficial effects of polyenylphosphatidylcholine on ethanol-induced mitochondrial injury in rats[J]. Biochem Biophys Res Commun,2002,291(4):1109-1112.
[8]
Gundermann KJ, Kuenker A, Kuntz E, et al. Activity of essential phospholipids (EPL) from soybean in liver diseases[J]. Pharmacol Rep,2011,63(3):643-659
[9]
王涛, 陈东风. 多烯磷脂酰胆碱通过过氧化物酶体增殖物激活受体α/肉碱棕榈酰基转移酶1A通路影响肝细胞脂肪变性[J]. 中华肝脏病杂志,2016,24(4):291-296.
[10]
Ling J, Chaba T, Zhu LF, et al. Hepatic ratio of phosphatidylcholine to phosphatidylethanolamine predicts survival after partial hepatectomy in mice[J]. Hepatology,2012,55(4):1094-1102.
[11]
Cao M, Li X, Zhang B, et al. The effect of polyene phosphatidyl choline intervention on nonalcoholic steatohepatitis and related mechanism[J]. Am J Transl Res,2016,8(5):2325-2330.
[12]
van der Veen JN, Kennelly JP, Wan S, et al. The critical role of phosphatidylcholine and phosphatidylethanolamine metabolism in health and disease[J]. Biochim Biophys Acta, 2017,1859:1558-1572.
[13]
Cantafora A, Masella R, Angelico M, et al. Effect of intravenous polyunsaturated phosphatidylcholine infusion on insulin receptor processing and lipid composition of erythrocytes in patients with liver cirrhosis[J]. Eur J Clin Invest,1992,22(12):777-782.
[14]
Navder KP, Baraona E, Lieber CS. Polyenylphosphatidylcholine attenuates alcohol-induced fatty liver and hyperlipemia in rats[J]. J Nutr,1997,127(9):1800-1806.
[15]
Saba P, Galeone F, Salvadorini F, et al. Effects of soybean polyunsaturated phosphatidylcholine (Lipoetabil R) on hyperlipoproteinemia[J]. Cuur Therap Res,1978,24:299-306.
[16]
Horsch AK, Majolk I, Heuck CC, et al. Influence of polyenphosphatidylcholine (PPC) on serum lipids of patients with hyperlipoproteinemis[J]. VASA,1986,15(3):251-256.
[17]
陈兰. 多烯磷脂酰胆碱对兔动脉粥样硬化防治的实验研究[D]. 新疆医科大学,2012.
[18]
Gonciarz Z, Besser P, Lelek E, et al. Randomised placebo-controlled double blind trial on essential phospholipids in the treatment of fatty liver associated with diabetes[J]. Médecine et Chirurgie Digestives,1988,17:61-65.
[19]
Sas E, Grinevich V, Efimov O, et al. Beneficial influence of polyunsaturated phosphatidylcholine enhances functional liver condition and liver structure in patients with nonalcoholic steatohepatitis. Results of prolonged randomized blinded prospective clinical study[J]. J Hepatol,2013,58(6):S549.
[20]
郭秀丽, 梁丕霞, 徐有青. 甘草酸二铵与多烯磷脂酰胆碱治疗非酒精性脂肪性肝炎的疗效比较[J]. 中国新药杂志,2012,21(3):289-292.
[21]
吴莘, 袁方, 黄欣, 等. 多烯磷脂酰胆碱联合甘草酸二铵治疗非酒精性脂肪性肝病疗效观察[J]. 中华消化杂志,2015,35(6):411-412.
[22]
Fan XF, Deng YQ, Ye L, et al. Effect of Xuezhikang Capsule on serum tumor necrosis factor-alpha and interleukin-6 in patients with nonalcoholic fatty liver disease and hyperlipidemia[J]. Chin J Integr Med,2010,16(2):119-123.
[23]
苏红领, 朱玉侠, 高正军, 等. 双环醇与多烯磷脂酰胆碱治疗非酒精性脂肪肝的疗效比较[J]. 中华肝脏病杂志,2011,19(7):552-553.
[24]
Dajani AI, Abu Hammour AM, Zakaria MA, et al. Essential phospholipids as a supportive adjunct in the management of patients with NAFLD[J]. Arab J Gastroenterol,2015,16(3-4):99-104.
[25]
郑盛, 刘海, 尹静, 等. 水飞蓟素胶囊联合多烯磷脂酰胆碱治疗非酒精性脂肪性肝炎的疗效观察[J]. 实用肝脏病杂志,2010,13(6):431-432.
[26]
吴伟奋, 潘业. 易善复结合有氧运动治疗非酒精性脂肪肝293例[J]. 齐齐哈尔医学院学报,2008,29(18):2202-2204.
[27]
乔永刚, 赵立平, 张妮. 易善复联合二甲双胍治疗肥胖相关非酒精性脂肪肝临床观察[J]. 内蒙古中医药,2014,33(6):13.
[28]
施伎蝉, 蒋贤高, 何贵清, 等. 熊去氧胆酸联合多烯磷脂酰胆碱治疗非酒精性脂肪性肝病的疗效观察[J]. 中国医师进修杂志,2013,36(24):58-60.
[29]
吴春晓, 陈燕鸿, 周晓蕾, 等. 多烯磷脂酰胆碱联合调脂治疗非酒精性脂肪性肝病的临床观察[J/CD]. 中国肝脏病杂志(电子版),2012,4(2):17-20.
[30]
李康, 刘旭明. 多烯磷脂酰胆碱联合托尼奈酸治疗非酒精性脂肪性肝炎疗效观察[J]. 肝脏,2013,22(12):825-826.
[31]
纪奕锋, 洪万东, 朱启槐. 左卡尼汀联合多烯磷脂酰胆碱治疗非酒精性脂肪肝的效果[J]. 实用医学杂志,2008,24(24):4286-4287.
[32]
Lieber CS, Weiss DG, Groszmann R, et al. Veterans affairs cooperative study of polyenylphosphatidylcholine in alcoholic liver disease[J]. Alcohol Clin Exp Res,2003,27(11):1765-1772.
[33]
Sas E, Grinevich V, Kravchuk U, et al. Polyunsaturated phosphati-dylcholine reduces insulin resistance and hepatic fibrosis in patients with alcoholic liver disease: results of randomized blinded prospective clinical study[J]. J Hepatol,2011,54(11):S207.
[34]
Schuller Perez A, Gonzales San Martin F. Placebo-controlled study with polyunsaturated phosphatidylcholine in alcoholic steatosis of the liver[J]. Med Welt,1985,36(17):517-521.
[35]
金玉坤, 罗雁, 陆伟. 易善复治疗酒精性脂肪肝的临床研究[J]. 实用肝脏病杂志,2008,11(2):104-105.
[36]
钱进. 易善复治疗酒精性肝硬化52例临床分析[J]. 右江医学,2007,35(6):642-643.
[37]
Ilic V, Begic-Janev A. Therapy of HBsAg-positive chronic active hepatitis[J]. Med Welt,1991,42(6):523-525.
[38]
张孝秩, 贡德曼, 巫善明, 等. 复方多烯磷脂酰胆碱治疗慢性乙型活动性肝炎的随机对照双盲临床试验[J]. 药物流行病学杂志,1995,4(1):4-6.
[39]
刘丽珍, 蔡水泽. 阿德福韦酯联合多烯磷脂酰胆碱胶囊治疗慢性乙型肝炎肝纤维化[J]. 河南大学学报(医学版),2015,34(3):192-194.
[40]
Niederau C, Strohmeyer G, Heintges T, et al. Polyunsaturated phosphatidyl-choline and interferon alpha for treatment of chronic hepatitis B and C: a multi-center, randomized, double-blind, placebo-controlled trial. Leich Study Group[J]. Hepatogastroenterology,1998,45(21):797-804.
[41]
Fassati P, Horejsi J, Fassati M, et al. The effect of essential choline phospholipids on HBsAg and on certain biochemical tests in cirrhosis of the liver[J]. Cas Lek ces,1981,120:56-60.
[42]
Djuric-Milosavijevic O. Polyunsaturated phosphatidylcholine (EPL) used to prevent hepatic lesions during the treatment of tuberculosis[J]. Epat,1982:28:3-9.
[43]
Hirose S, Morodoni I, Tanaka M, et al. The prophylactic effects of polyene phosphatidylcholines (EPL) on liver disorders induced by antitubercular drugs (rifampicin, isoniazid)[J]. Kiso to Rinsho,1982,16:4801-4803.
[44]
贺冬林, 吴孝雄, 罗明. 多烯磷脂酰胆碱治疗原发性肝癌经导管肝动脉化疗栓塞相关性肝损伤的临床研究[J]. 传染病信息,2014,27(2):102-104.
[45]
王宝利, 崔建东. 多烯磷脂酰胆碱在妇科恶性肿瘤术后辅助化疗时护肝作用研究[J]. 西南国防医药,2012,22(8):859-860.
[46]
Otegbayo JA, Kuti MA, Ogunbode O, et al. Livolin ameliorates elevations in alanine transaminase in HIV infected patients commencing highly active antiretroviral therapy[J]. Afr J Med Med Sci,2012,41(4):417-422.
[47]
陈永刚, 朱兴婕. 还原型谷胱甘肽联合多烯磷脂酰胆碱治疗急性药物性肝损伤的临床疗效[J]. 中国药物经济学,2015,10(1):55-56.
[48]
关荣, 吴治龙. 多烯磷脂酰胆碱联合还原型谷胱甘肽治疗化疗药物性肝损害的疗效观察[J]. 中国肿瘤临床与康复,2014,21(10):1181-1183.
[49]
张东萍, 肖招英, 巫爱峰, 等. 多烯磷脂酰胆碱联合护肝片治疗药物性肝损伤疗效观察[J]. 中国药师,2014,17(9):1524-1525, 1528.
[50]
中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志,2015,31(11):1752-1769.
[51]
赵凤娥, 石振东. 多烯磷脂酰胆碱在自身免疫性肝炎治疗中的作用[J]. 中国实用医刊,2012,39(7):封3.
[52]
吕雪幼, 叶国良. 多烯磷脂酰胆碱治疗老年中重度脂肪肝的临床研究[J]. 中国临床药理学杂志,2016,32(15):1370-1373.
[53]
岳欣, 韩国荣, 白淑芬. 多烯磷脂酰胆碱注射液治疗妊娠合并肝功异常的疗效观察[J]. 南京医科大学学报(自然科学版),2009,29(8):1175-1177.
[54]
胡蓉, 曾义岚, 王丽, 等. 多烯磷脂酰胆碱治疗妊娠早期合并肝炎[J]. 寄生虫病与感染性疾病,2009,7(3):168-169.
[55]
李永红, 闫芳. 多烯磷脂酰胆碱注射液治疗妊娠期肝内胆汁淤积症的疗效观察[J]. 实用妇产科杂志,2014,30(6):469-471.
[56]
王迎. 多烯磷脂酰胆碱治疗妊娠期肝内胆汁淤积症的临床研究[J]. 生殖医学杂志,2016,25(2):144-147.
[1] 中华医学会烧伤外科学分会小儿烧伤学组. 儿童烧伤早期休克液体复苏专家共识(2023版)[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 371-376.
[2] 中国老年医学学会烧创伤分会, 中国生物材料学会烧创伤创面修复材料分会. 中国糖尿病足截肢(趾)治疗专家共识(2022年版)[J]. 中华损伤与修复杂志(电子版), 2023, 18(01): 1-9.
[3] 中国肾移植供体来源游离DNA应用与研究专家组, 中国医药生物技术协会移植技术分会. 供体来源游离DNA检测在肾移植中临床应用的专家共识(2022版)[J]. 中华移植杂志(电子版), 2022, 16(05): 257-265.
[4] 广东省医疗行业协会泌尿外科管理分会. 老年尿失禁护理专家共识[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(05): 389-393.
[5] 李咏生, 孙建国, 李梦侠, 重庆肺癌精准治疗协作组(CPLOG). 第三代EGFR-TKI耐药后诊疗策略专家共识[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 145-155.
[6] 中国呼吸医师协会介入委员会胸膜疾病专业组. 内科胸腔镜下光动力治疗胸膜肿瘤的专家共识[J]. 中华肺部疾病杂志(电子版), 2022, 15(05): 615-620.
[7] 中国医师协会结直肠肿瘤专业委员会腹膜肿瘤专委会. 结直肠癌腹膜转移诊治中国专家共识(2022版)[J]. 中华结直肠疾病电子杂志, 2022, 11(04): 265-271.
[8] 刘玲, 李绪言, 徐永昊, 赵慧颖, 罗巧侠, 欧晓峰, 宋雷, 程渊, 周娟, 曾以萍, 刘爱华, 边巴穷达, 张烁, 吕杰, 王玺, 鲁燕云, 陈佰绪, 达珍, 俞云, 邵佳, 中华医学会重症医学分会重症呼吸学组, 西藏医学会高原医学暨心血管专业委员会, 中国医师协会重症医学医师分会. 高原地区新型冠状病毒肺炎重症患者(重型/危重型)诊疗专家共识[J]. 中华重症医学电子杂志, 2022, 08(04): 340-346.
[9] 静脉淋巴功能不全临床专家共识编写组. 静脉淋巴功能不全临床专家共识[J]. 中华临床医师杂志(电子版), 2023, 17(06): 630-638.
[10] 中国老年医学学会麻醉学分会. 老年患者术后肺部并发症防治专家共识[J]. 中华临床医师杂志(电子版), 2023, 17(01): 7-22.
[11] 杨旭希, 郑吉洋, 陈秀梅, 陈淑玲, 杨峻青, 苏芝琪, 左咏臻, 广东省医师协会心力衰竭专业医师分会, 广东省护士协会介入护士分会. 慢性心力衰竭患者容量管理护理专家共识[J]. 中华介入放射学电子杂志, 2023, 11(03): 201-207.
[12] 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 普通心脏起搏器和植入型心律转复除颤器手术操作规范中国专家共识(2023)[J]. 中华心脏与心律电子杂志, 2023, 11(02): 65-102.
[13] 中华医学会消化内镜学分会护理协作组. 消化内镜中心的环境与布局专家共识建议(2023年,北京)[J]. 中华胃肠内镜电子杂志, 2023, 10(04): 240-247.
[14] 中华医学会消化内镜学分会. 中国结直肠息肉冷切专家共识(2023年,杭州)[J]. 中华胃肠内镜电子杂志, 2023, 10(02): 73-82.
[15] 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组. 肥胖代谢外科个案管理术前临床路径中国专家共识(2023版)[J]. 中华肥胖与代谢病电子杂志, 2023, 09(02): 73-82.
阅读次数
全文


摘要