成人常见胆汁淤积性肝病糖皮质激素治疗新进展
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摘要
胆汁淤积性肝病在临床中较常见,且病因较多。糖皮质激素因具有强大的抗炎、免疫抑制及调节胆汁酸代谢等作用而广泛用于治疗伴有炎症状态的胆汁淤积性肝病,糖皮质激素在发挥治疗作用的同时,也可引起感染、肥胖、骨质疏松、升高血压及血糖等并发症,故合理运用糖皮质激素很重要。本文就使用糖皮质激素治疗成人常见病因引起的胆汁淤积性肝病的新进展作一概述。
Cholestatic liver disease is more common in clinic, and its causes are varied. It is widely used to treatment of cholestasis due to its anti-inflammatory, immunosuppressive and regulation of bile acid metabolism that glucocorticoids. But it may couse infection, obesity, osteoporosis, elevated blood pressure and blood sugar, etc. So it is important to use glucocorticoids properly. This article reviewed the recent progress of glucocorticoids in the treatment of cholestasis induced by common etiology in adults.
Cholestatic liver disease is more common in clinic, and its causes are varied. It is widely used to treatment of cholestasis due to its anti-inflammatory, immunosuppressive and regulation of bile acid metabolism that glucocorticoids. But it may couse infection, obesity, osteoporosis, elevated blood pressure and blood sugar, etc. So it is important to use glucocorticoids properly. This article reviewed the recent progress of glucocorticoids in the treatment of cholestasis induced by common etiology in adults.
引文
[1] DEVRIES E,BEUERS U.Management of cholestatic disease in 2017 [J].Liver Int,2017,37 Suppl 1:123-129.DOI:10.1111/liv.13306.
[2] CHINESS S H ,CHINESS S G ,CHINESS S I D,et al.Consensus on the diagnosis and treatment of cholestatic liver diseases (2015,China) [J].J Dig Dis,2016,17(3):137-154.DOI:10.1111/1751-2980.12333.
[3] BEUERS U,BOBERG K M,CHAPMAN R W,et al.EASL Clinical Practice Guidelines:management of cholestatic liver diseases [J].Hepatol,2009,51(2):237-267.DOI:10.1016/j.jhep.2009.04.009.
[4] SONG K H,CHIANG J Y.Glucagon and cAMP inhibit cholesterol 7alpha-hydroxylase (CYP7A1) gene expression in human hepatocytes:discordant regulation of bile acid synthesis and gluconeogenesis [J].Hepatology,2006,43(1):117-125.DOI:10.1002/hep.20919.
[5] CAI S Y ,BOYER J L.Studies on the mechanisms of bile acid initiated hepatic inflammation in cholestatic liver injury [J].Inflamm Cell Signal,2017.4(2):pii:e1561.
[6] RAO N A,MCCALMAN M T,MOULOS P,et al.Coactivation of GR and NFKB alters the repertoire of their binding sites and target genes [J].Genome Res,2011,21(9):1404-1416.DOI:10.1101/gr.118042.110.
[7] BUTTGEREIT F,SPIES C M,BIJLSMA J W.Novel glucocorticoids:where are we now and where do we want to go [J].Clin Exp Rheumatol,2015,33(4 Suppl 92):S29-S33.
[8] ERICE O,MUNOZ G P,VAQUERO J,et al.MicroRNA-506 promotes primary biliary cholangitis-like features in cholangiocytes and immune activation [J].Hepatology,2017,DOI:10.1002/hep.29533.
[9] WEBB C F,BRYANT J,POPOWSKI M,et al.The ARID family transcription factor bright is required for both hematopoietic stem cell and B lineage development [J].Mol Cell Biol,2011,31(5):1041-1053.DOI:10.1128/MCB.01448-10.
[10] CHINESS S H,CHINESS S G,CHINESS S I D,et al.Consensus on the diagnosis and treatment of cholestatic liver diseases (2015,China)[J].J Dig Dis,2016,17(3):137-154.DOI:10.1111/1751-2980.12333.
[11] WHITTIER X,SAAQ K G.Glucocorticoid-induced osteoporosis [J].Rheum Dis Clin North Am,2016.42(1):177-189,x.DOI:10.1016/j.rdc.2015.08.005.
[12] 于乐成,茅益民,陈成伟,等.药物性肝损伤诊治指南[J].肝脏,2015,20(10):750-767.DOI:10.14000/j.cnki.issn.1008-1704.2015.10.002.YU L C,MAO Y M,CHEN C W,et al.Guidelines for the diagnosis and treatment of drug-induced liver injury [J].Chinese Hepatology,2015,20(10):750-767.DOI:10.14000/j.cnki.issn.1008-1704.2015.10.002.
[13] TEKIN R,YOLBAS I,DAL T,et al.Evaluation of adults with acute viral hepatitis a and review of the literature [J].Clin Ter,2013,164(6):537-541.DOI:10.7417/CT.2013.1634.
[14] 王秀娟.糖皮质激素在胆汁淤积性病毒性肝炎中的应用[J].中外医疗,2015,34(32):123-124.DOI:10.16662/j.cnki.1674-0742.2015.32.123.WANG X J.Application of glucocorticoid in the treatment of intrahepatic biliary stasis viral hepatitis [J].China & Foreign Medical Treatment,2015,34(32):123-124.DOI:10.16662/j.cnki.1674-0742.2015.32.123.
[15] SARGES P,STEINBERG J M,LEWIS J H.Drug-induced liver injury:highlights from a review of the 2015 literature [J].Drug Saf,2016,39(9):801-821.DOI:10.1007/s40264-016-0427-8.
[16] HAMILTON L A,COLLINS Y A,COLLINS R E.Drug-induced liver injury [J].AACN Adv Crit Care,2016,27(4):430-440.DOI:10.4037/aacnacc2016953.
[17] BENICHOU C.Criteria of drug-induced liver disorders.Report of an international consensus meeting [J].J Hepatol,1990,11(2):272-276.
[18] CHIN M,LEVY R D,YOSHIDA E M,et al.Sitaxsentan-induced acute severe hepatitis treated with glucocorticoid therapy [J].Can Respir J,2012,19(1):e1-e2.DOI:10.1155/2012/567024.
[19] 周超,罗生强,宫嫚,等.糖皮质激素在常见肝病治疗中的应用[J].胃肠病学和肝病学杂志,2015,24(1):15-17.DOI:10.3969 /j.issn.1006-5709.2015.01.005.ZHOU C,LUO S Q,GONG M,et al.Application of glucocorticoid in the treatment of common liver disease [J].Chin J Gastroenterol Hepatol,2015,24(1):15-17.DOI:10.3969/j.issn.1006-5709.2015.01.005.
[20] 张玉果,赵素贤,李文聪,等.糖皮质激素治疗重症药物性肝损伤的临床研究[J].肝脏,2017,22(3):214-218.DOI:10.14000/j.cnki.issn.1008-1704.2017.03.008.ZHANG Y G,ZHAO S X,LI W C,et al.Treatment response of glucocorticoid in severe drug-induced liver injury [J].Chinese Hepatology,2017,22(3):214-218.DOI:10.14000/j.cnki.issn.1008-1704.2017.03.008.
[21] EUROPEAN A S L.EASL clinical practical guidelines:management of alcoholic liver disease [J].Hepatol,2012,57(2):399-420.DOI:10.1016/j.jhep.2012.04.004.
[22] 王菲,王炳元.糖皮质激素在重症酒精性肝炎治疗中的运用[J].中华肝脏病杂志,2011,19(8):630-633.DOI:10.3760/cma.j.issn.1007-3418.2011.08.020.WANG F,WANG B Y.Application of glucocorticosteroids in severe alcoholic hepatitis [J].Chin J Hepatol,2011,19(8):630-633.DOI:10.3760/cma.j.issn.1007-3418.2011.08.020.
[23] OSHEA R S,DASARATHY S,MCCULLOUGH A J.Alcoholic liver disease [J].Hepatology,2010.51(1):307-328.DOI:10.1002/hep.23258.
[24] WANG F,WANG B Y.Corticosteroids or non-corticosteroids:a fresh perspective on alcoholic hepatitis treatment [J].Hepatobiliary Pancreat Dis Int,2011,10(5):458-464.
[25] MITCHELL M C,FRIEDNAN L S,NCCLAIN C J.Medical management of severe alcoholic hepatitis:expert review from the Clinical Practice Updates Committee of the AGA Institute [J].Clin Gastroenterol Hepatol,2017,15(1):5-12.DOI:10.1016/j.cgh.2016.08.047.
[26] 龙振昼,聂青和.糖皮质激素:肝病治疗中的双刃剑[J].胃肠病学和肝病学杂志,2016,25(5):485-489.DOI:10.3969 /j.issn.1006-5709.2016.05.002.LONG Z Z ,NIE Q H.Glucocorticoid:a double-edged sword in the treatment of liver diseases [J].Chin J Gastroenterol Hepatol,2016,25(5):485-489.DOI:10.3969/j.issn.1006-5709.2016.05.002.
[27] BEUERS U,TRAUNER M,JANSEN P,et al.New paradigms in the treatment of hepatic cholestasis:from UDCA to FXR,PXR and beyond [J].J Hepatol,2015,62(1 Suppl):S25-S37.DOI:10.1016/j.jhep.2015.02.023.
[28] TRIVEDI P J,HIRSCHFIELD G M,GERSHWIN M E.Obeticholic acid for the treatment of primary biliary cirrhosis [J].Expert Rev Clin Pharmacol,2016,9(1):13-26.DOI:10.1586/17512433.2015.1092381.
[29] DYSON J K,HIRSCHFIELD G M,ADAMS D H,et al.Novel therapeutic targets in primary biliary cirrhosis [J].Nat Rev Gastroenterol Hepatol,2015,12(3):147-58.DOI:10.1038/nrgastro.2015.12.
[30] DEVRIES E ,BEUERS U.Management of cholestatic disease in 2017 [J].Liver Int,2017,37 Suppl 1:123-129.DOI:10.1111/liv.13306.
[31] CZUL F,LEVY C.Novel therapies on primary biliary cirrhosis [J].Clin Liver Dis,2016,20(1):113-130.DOI:10.1016/j.cld.2015.08.006.
[32] LINDOR K D,KOWDLEY K V,HARRISON M E,et al.ACG clinical guideline:primary sclerosing cholangitis [J].Am J Gastroenterol,2015,110(5):646-59,quiz 660.DOI:10.1038/ajg.2015.112.
[33] SAFFIOTI F,GURUSAMY K S,HAWKINS N,et al.Pharmacological interventions for primary sclerosing cholangitis:an attempted network meta-analysis [J].Cochrane Database Syst Rev,2017,3:CD011343.DOI:10.1002/14651858.CD011343.
[34] MURATORI P,LALANNE C,BARBATO E,et al.Features and progression of asymptomatic autoimmune hepatitis in italy [J].Clin Gastroenterol Hepatol,2016,14(1):139-146.DOI:10.1016/j.cgh.2015.07.017.
[35] LIWIASKI T,SCHRAMM C.Autoimmune hepatitis-update on clinical management in 2017 [J].Clin Res Hepatol Gastroenterol,2017,41(6):617-625.DOI:10.1016/j.clinre.2017.07.002.
[36] 黄颖秋.自身免疫性肝病重叠综合征的现状[J].世界华人消化杂志,2014,22(3):301-309.DOI:10.11569/wcjd.v22.i3.301.HUANG Y Q.Current progress in research of overlap syndrome of autoimmune liver diseases [J].World Chinese Journal of Digestology,2014,22(3):301-309.DOI:10.11569/wcjd.v22.i3.301.
[37] POUPON R.Evidence-based treatment of primary biliary cirrhosis [J].Dig Dis,2014,32(5):626-30.DOI:10.1159/000360516.
[38] OZASLAN E,EFE C,AKBULUT S,et al.Therapy response and outcome of overlap syndromes:autoimmune hepatitis and primary biliary cirrhosis compared to autoimmune hepatitis and autoimmune cholangitis [J].Hepatogastroenterology,2010,57(99-100):441-446.
[39] TRIVEDI P J,HIRSCHFIELD G M.Review article:overlap syndromes and autoimmune liver disease [J].Aliment Pharmacol Ther,2012,36(6):517-33.DOI:10.1111/j.1365-2036.2012.05223.x.
[40] MALIK N,VENKATESH S K.Imaging of autoimmune hepatitis and overlap syndromes [J].Abdom Radiol (NY),2017,42(1):19-27.DOI:10.1007/s00261-016-1019-x.
[41] 连敏,马雄.胆汁淤积性肝病的诊断与治疗[J].中华肝脏病杂志,2015,23(8):564-568.DOI:10.3760/cma.j.issn.1007-3418.2015.08.002LIAN M,MA X.Diagnosis and treatment of cholestatic liver disease [J].Chin J Hepatol,2015,23(8):564-568.DOI:10.3760/cma.j.issn.1007-3418.2015.08.002.
[42] HART P A,TOPAZIAN M D,WITZIG T E,et al.Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab:the Mayo Clinic experience [J].Gut,2013,62(11):1607-1615.DOI:10.1136/gutjnl-2012-302886.
[43] FERRY J A,KLEPEIS V,SOHANI A R,et al.IgG4-related orbital disease and its mimics in a Western population [J].Am J Surg Pathol,2015,39(12):1688-700.DOI:10.1097/PAS.0000000000000497.
[44] 周贺,马静婷,李翠翠,等.IgG4相关性硬化性胆管炎的研究进展[J].临床误诊误治,2017,30(4):108-112.DOI:10.3969 /j.issn.1002-3429.2017.04.037.
[2] CHINESS S H ,CHINESS S G ,CHINESS S I D,et al.Consensus on the diagnosis and treatment of cholestatic liver diseases (2015,China) [J].J Dig Dis,2016,17(3):137-154.DOI:10.1111/1751-2980.12333.
[3] BEUERS U,BOBERG K M,CHAPMAN R W,et al.EASL Clinical Practice Guidelines:management of cholestatic liver diseases [J].Hepatol,2009,51(2):237-267.DOI:10.1016/j.jhep.2009.04.009.
[4] SONG K H,CHIANG J Y.Glucagon and cAMP inhibit cholesterol 7alpha-hydroxylase (CYP7A1) gene expression in human hepatocytes:discordant regulation of bile acid synthesis and gluconeogenesis [J].Hepatology,2006,43(1):117-125.DOI:10.1002/hep.20919.
[5] CAI S Y ,BOYER J L.Studies on the mechanisms of bile acid initiated hepatic inflammation in cholestatic liver injury [J].Inflamm Cell Signal,2017.4(2):pii:e1561.
[6] RAO N A,MCCALMAN M T,MOULOS P,et al.Coactivation of GR and NFKB alters the repertoire of their binding sites and target genes [J].Genome Res,2011,21(9):1404-1416.DOI:10.1101/gr.118042.110.
[7] BUTTGEREIT F,SPIES C M,BIJLSMA J W.Novel glucocorticoids:where are we now and where do we want to go [J].Clin Exp Rheumatol,2015,33(4 Suppl 92):S29-S33.
[8] ERICE O,MUNOZ G P,VAQUERO J,et al.MicroRNA-506 promotes primary biliary cholangitis-like features in cholangiocytes and immune activation [J].Hepatology,2017,DOI:10.1002/hep.29533.
[9] WEBB C F,BRYANT J,POPOWSKI M,et al.The ARID family transcription factor bright is required for both hematopoietic stem cell and B lineage development [J].Mol Cell Biol,2011,31(5):1041-1053.DOI:10.1128/MCB.01448-10.
[10] CHINESS S H,CHINESS S G,CHINESS S I D,et al.Consensus on the diagnosis and treatment of cholestatic liver diseases (2015,China)[J].J Dig Dis,2016,17(3):137-154.DOI:10.1111/1751-2980.12333.
[11] WHITTIER X,SAAQ K G.Glucocorticoid-induced osteoporosis [J].Rheum Dis Clin North Am,2016.42(1):177-189,x.DOI:10.1016/j.rdc.2015.08.005.
[12] 于乐成,茅益民,陈成伟,等.药物性肝损伤诊治指南[J].肝脏,2015,20(10):750-767.DOI:10.14000/j.cnki.issn.1008-1704.2015.10.002.YU L C,MAO Y M,CHEN C W,et al.Guidelines for the diagnosis and treatment of drug-induced liver injury [J].Chinese Hepatology,2015,20(10):750-767.DOI:10.14000/j.cnki.issn.1008-1704.2015.10.002.
[13] TEKIN R,YOLBAS I,DAL T,et al.Evaluation of adults with acute viral hepatitis a and review of the literature [J].Clin Ter,2013,164(6):537-541.DOI:10.7417/CT.2013.1634.
[14] 王秀娟.糖皮质激素在胆汁淤积性病毒性肝炎中的应用[J].中外医疗,2015,34(32):123-124.DOI:10.16662/j.cnki.1674-0742.2015.32.123.WANG X J.Application of glucocorticoid in the treatment of intrahepatic biliary stasis viral hepatitis [J].China & Foreign Medical Treatment,2015,34(32):123-124.DOI:10.16662/j.cnki.1674-0742.2015.32.123.
[15] SARGES P,STEINBERG J M,LEWIS J H.Drug-induced liver injury:highlights from a review of the 2015 literature [J].Drug Saf,2016,39(9):801-821.DOI:10.1007/s40264-016-0427-8.
[16] HAMILTON L A,COLLINS Y A,COLLINS R E.Drug-induced liver injury [J].AACN Adv Crit Care,2016,27(4):430-440.DOI:10.4037/aacnacc2016953.
[17] BENICHOU C.Criteria of drug-induced liver disorders.Report of an international consensus meeting [J].J Hepatol,1990,11(2):272-276.
[18] CHIN M,LEVY R D,YOSHIDA E M,et al.Sitaxsentan-induced acute severe hepatitis treated with glucocorticoid therapy [J].Can Respir J,2012,19(1):e1-e2.DOI:10.1155/2012/567024.
[19] 周超,罗生强,宫嫚,等.糖皮质激素在常见肝病治疗中的应用[J].胃肠病学和肝病学杂志,2015,24(1):15-17.DOI:10.3969 /j.issn.1006-5709.2015.01.005.ZHOU C,LUO S Q,GONG M,et al.Application of glucocorticoid in the treatment of common liver disease [J].Chin J Gastroenterol Hepatol,2015,24(1):15-17.DOI:10.3969/j.issn.1006-5709.2015.01.005.
[20] 张玉果,赵素贤,李文聪,等.糖皮质激素治疗重症药物性肝损伤的临床研究[J].肝脏,2017,22(3):214-218.DOI:10.14000/j.cnki.issn.1008-1704.2017.03.008.ZHANG Y G,ZHAO S X,LI W C,et al.Treatment response of glucocorticoid in severe drug-induced liver injury [J].Chinese Hepatology,2017,22(3):214-218.DOI:10.14000/j.cnki.issn.1008-1704.2017.03.008.
[21] EUROPEAN A S L.EASL clinical practical guidelines:management of alcoholic liver disease [J].Hepatol,2012,57(2):399-420.DOI:10.1016/j.jhep.2012.04.004.
[22] 王菲,王炳元.糖皮质激素在重症酒精性肝炎治疗中的运用[J].中华肝脏病杂志,2011,19(8):630-633.DOI:10.3760/cma.j.issn.1007-3418.2011.08.020.WANG F,WANG B Y.Application of glucocorticosteroids in severe alcoholic hepatitis [J].Chin J Hepatol,2011,19(8):630-633.DOI:10.3760/cma.j.issn.1007-3418.2011.08.020.
[23] OSHEA R S,DASARATHY S,MCCULLOUGH A J.Alcoholic liver disease [J].Hepatology,2010.51(1):307-328.DOI:10.1002/hep.23258.
[24] WANG F,WANG B Y.Corticosteroids or non-corticosteroids:a fresh perspective on alcoholic hepatitis treatment [J].Hepatobiliary Pancreat Dis Int,2011,10(5):458-464.
[25] MITCHELL M C,FRIEDNAN L S,NCCLAIN C J.Medical management of severe alcoholic hepatitis:expert review from the Clinical Practice Updates Committee of the AGA Institute [J].Clin Gastroenterol Hepatol,2017,15(1):5-12.DOI:10.1016/j.cgh.2016.08.047.
[26] 龙振昼,聂青和.糖皮质激素:肝病治疗中的双刃剑[J].胃肠病学和肝病学杂志,2016,25(5):485-489.DOI:10.3969 /j.issn.1006-5709.2016.05.002.LONG Z Z ,NIE Q H.Glucocorticoid:a double-edged sword in the treatment of liver diseases [J].Chin J Gastroenterol Hepatol,2016,25(5):485-489.DOI:10.3969/j.issn.1006-5709.2016.05.002.
[27] BEUERS U,TRAUNER M,JANSEN P,et al.New paradigms in the treatment of hepatic cholestasis:from UDCA to FXR,PXR and beyond [J].J Hepatol,2015,62(1 Suppl):S25-S37.DOI:10.1016/j.jhep.2015.02.023.
[28] TRIVEDI P J,HIRSCHFIELD G M,GERSHWIN M E.Obeticholic acid for the treatment of primary biliary cirrhosis [J].Expert Rev Clin Pharmacol,2016,9(1):13-26.DOI:10.1586/17512433.2015.1092381.
[29] DYSON J K,HIRSCHFIELD G M,ADAMS D H,et al.Novel therapeutic targets in primary biliary cirrhosis [J].Nat Rev Gastroenterol Hepatol,2015,12(3):147-58.DOI:10.1038/nrgastro.2015.12.
[30] DEVRIES E ,BEUERS U.Management of cholestatic disease in 2017 [J].Liver Int,2017,37 Suppl 1:123-129.DOI:10.1111/liv.13306.
[31] CZUL F,LEVY C.Novel therapies on primary biliary cirrhosis [J].Clin Liver Dis,2016,20(1):113-130.DOI:10.1016/j.cld.2015.08.006.
[32] LINDOR K D,KOWDLEY K V,HARRISON M E,et al.ACG clinical guideline:primary sclerosing cholangitis [J].Am J Gastroenterol,2015,110(5):646-59,quiz 660.DOI:10.1038/ajg.2015.112.
[33] SAFFIOTI F,GURUSAMY K S,HAWKINS N,et al.Pharmacological interventions for primary sclerosing cholangitis:an attempted network meta-analysis [J].Cochrane Database Syst Rev,2017,3:CD011343.DOI:10.1002/14651858.CD011343.
[34] MURATORI P,LALANNE C,BARBATO E,et al.Features and progression of asymptomatic autoimmune hepatitis in italy [J].Clin Gastroenterol Hepatol,2016,14(1):139-146.DOI:10.1016/j.cgh.2015.07.017.
[35] LIWIASKI T,SCHRAMM C.Autoimmune hepatitis-update on clinical management in 2017 [J].Clin Res Hepatol Gastroenterol,2017,41(6):617-625.DOI:10.1016/j.clinre.2017.07.002.
[36] 黄颖秋.自身免疫性肝病重叠综合征的现状[J].世界华人消化杂志,2014,22(3):301-309.DOI:10.11569/wcjd.v22.i3.301.HUANG Y Q.Current progress in research of overlap syndrome of autoimmune liver diseases [J].World Chinese Journal of Digestology,2014,22(3):301-309.DOI:10.11569/wcjd.v22.i3.301.
[37] POUPON R.Evidence-based treatment of primary biliary cirrhosis [J].Dig Dis,2014,32(5):626-30.DOI:10.1159/000360516.
[38] OZASLAN E,EFE C,AKBULUT S,et al.Therapy response and outcome of overlap syndromes:autoimmune hepatitis and primary biliary cirrhosis compared to autoimmune hepatitis and autoimmune cholangitis [J].Hepatogastroenterology,2010,57(99-100):441-446.
[39] TRIVEDI P J,HIRSCHFIELD G M.Review article:overlap syndromes and autoimmune liver disease [J].Aliment Pharmacol Ther,2012,36(6):517-33.DOI:10.1111/j.1365-2036.2012.05223.x.
[40] MALIK N,VENKATESH S K.Imaging of autoimmune hepatitis and overlap syndromes [J].Abdom Radiol (NY),2017,42(1):19-27.DOI:10.1007/s00261-016-1019-x.
[41] 连敏,马雄.胆汁淤积性肝病的诊断与治疗[J].中华肝脏病杂志,2015,23(8):564-568.DOI:10.3760/cma.j.issn.1007-3418.2015.08.002LIAN M,MA X.Diagnosis and treatment of cholestatic liver disease [J].Chin J Hepatol,2015,23(8):564-568.DOI:10.3760/cma.j.issn.1007-3418.2015.08.002.
[42] HART P A,TOPAZIAN M D,WITZIG T E,et al.Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab:the Mayo Clinic experience [J].Gut,2013,62(11):1607-1615.DOI:10.1136/gutjnl-2012-302886.
[43] FERRY J A,KLEPEIS V,SOHANI A R,et al.IgG4-related orbital disease and its mimics in a Western population [J].Am J Surg Pathol,2015,39(12):1688-700.DOI:10.1097/PAS.0000000000000497.
[44] 周贺,马静婷,李翠翠,等.IgG4相关性硬化性胆管炎的研究进展[J].临床误诊误治,2017,30(4):108-112.DOI:10.3969 /j.issn.1002-3429.2017.04.037.