Клинический разбор в общей медицине

Первичный билиарный холангит (ПБХ) – хроническое аутоиммунное холестатическое заболевание печени, характеризующееся опосредованным Т-лимфоцитами повреждением внутрипеченочных билиарных эпителиальных клеток и наличием специфического серологического маркера – антимитохондриальных антител, при отсутствии лечения приводящее к терминальной стадии билиарного цирроза печени. ПБХ остается серьезной проблемой общественного здравоохранения. До недавнего времени ПБХ обозначали как «первичный билиарный цирроз», однако заболевание часто диагностируется в доцирротическую фазу, когда еще нет сформированного цирроза, а есть лишь угроза его развития. Смена дефиниции болезни гармонично укладывается в рамки концепции превентивной медицины, поскольку своевременной постановкой диагноза и адекватной терапией эту фазу заболевания можно продлить на годы и десятилетия, однако все эти годы пациента «травмирует» заранее поставленный диагноз цирроза печени. В конце предшествующего десятилетия было опубликовано большое число международных клинических рекомендаций и гайдлайнов, посвященных ПБХ. В рамках представленного обзора о современном состоянии проблемы ПБХ использованы публикации из различных международных баз данных с акцентом на публикации текущего десятилетия, в которых отмечается важность ранней диагностики заболевания с акцентом на биохимические маркеры холестаза (прежде всего щелочную фосфатазу) и иммунологические маркеры (в первую очередь антимитохондриальные антитела) и раннего начала лечения с применением препарата 1-й линии – урсодезоксихолевой кислоты.

Ключевые слова: первичный билиарный холангит, дефиниция болезни, эпидемиология, диагностика, щелочная фосфатаза, антимитохондриальные антитела, клиника, лечение, урсодезоксихолевая кислота, обетихолевая кислота, мониторинг, прогноз.

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