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摘要：
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摘要：原发性胆汁性胆管炎（primary biliary cholangitis，PBC）是一种发病机制复杂的自身免疫性肝
病，常伴血脂异常。本文对PBC患者血脂异常的特点、机制、心血管事件风险及降脂药物在PBC中的
应用等进行综述。PBC患者血脂异常多表现为胆固醇水平升高，在组织学病变早期以极低密度脂蛋白
和低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）水平升高为主；中期以LDL-C及
脂蛋白X显著升高为主；疾病进展到晚期，血脂水平降低。其机制可能与胆汁淤积导致胆固醇代谢紊
乱及脂蛋白X的产生有关。对于PBC患者，单纯血脂异常不会增加心血管疾病的发生风险，而合并代
谢综合征时，心血管疾病发生风险增加，可给予降脂药物干预。联用降脂药物也可改善熊去氧胆酸
（ursodeoxycholic acid capsules，UDCA）应答不佳患者的生物化学指标，提示应关注PBC患者的血脂
异常，尤其是合并代谢综合征时应给予个体化治疗。
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Abstract: Primary biliary cholangitis (PBC) is a complex autoimmune liver disease often accompanied by
dyslipidemia. In this paper, the characteristics and mechanism of dyslipidemia in patients with PBC, the risk
of cardiovascular events and the application of lipid-lowering drugs in PBC were reviewed. Dyslipidemia in
patients with PBC is mostly manifested as elevated cholesterol. In the early histological stage, the levels of
very low density lipoprotein and low density lipoprotein cholesterol (LDL-C) were mainly increased; in the
middle stage, the levels of LDL-C and lipoprotein X were significantly increased; and in the advanced stage
of the disease, the levels of blood lipids were all decreased. The mechanism may be related to the disturbance
of cholesterol metabolism caused by cholestasis and the production of lipoprotein X. For patients with
PBC, dyslipidemia alone does not increase the risk of cardiovascular events, however, lipid-lowering drug
intervention is recommended for PBC patients complicated with metabolic syndrome. Combined use of lipid-
lowering agents can also improve the biochemistry of patients with poor ursodeoxycholic acid response. It
is recommended to pay attention to dyslipidemia in patients with PBC, especially in patients with metabolic
syndrome.
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