文献阅读感悟：先前并不知道骨质疏松是PSC的并发症，这篇文章从PSC的并发症作为切入点，进行实验研究，发了一篇影响因子20的文章。在《原发性硬化性胆管炎诊断及治疗指南(2021)》中确实是提到这一点的。我没仔细看作者是如何证明Th17细胞数量与低骨量有关的了。不过我在看讨论部分的时候发现，其实大家研究的东西都是有基础的，这个前期研究基础有可能是自己先前做的，有可能是别人已经做过的，甚至别人其实已经做过很相似的内容了，而你只是从某一个小角度重新去验证一遍别人已经验证过的观点。来自不同研究者采用不同试验方法从不同层面探讨同一个问题并且得到相同/相似的答案，积累的研究多了，大家验证过都没有问题了，那么研究结果/结论就能够终于成为临床疾病的诊断治疗指南了。
PSC合并症和并发症——脂溶性维生素缺乏、代谢性骨病：PSC所致的胆汁淤积可导致脂溶性维生素的吸收不良，以维生素 A、D、E 的缺乏最为常见。应对 PSC 患者进行脂溶性维生素水平的检测，如缺乏可予以相应补充。代谢性骨病是慢性胆汁淤积时常见的并发症。PSC患者体内成骨活动降低，骨吸收增加，出现骨质疏松的风险是正常人群的24倍。年龄较大、BMI较低及长期合并IBD时，骨质疏松症的危险性增加。PSC疾病的严重程度可能与骨质疏松的程度无明显相关性，双能X线在诊断微小骨密度变化时，比MRI等技术更具优势。合并骨质疏松的PSC患者可按照骨质疏松相关指南进行治疗。
Lay summary: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease characterized by progressive bile duct destruction. One serious complication of PSC is reduced bone mass resulting in increased fracture risk. Herein, we demonstrate that Th17 cells mediate bone loss in PSC by inducing bone resorption, which suggests that antibody-based IL-17 blockade might be beneficial for the treatment of bone loss in affected patients.
We show that low bone mass in patients with PSC is not associated with disturbed calcium homeostasis but with increased bone resorption and an increased Th17 cell frequency. Moreover, the deletion of IL-17 in a mouse model of PSC resulted in a correction of the observed osteopenia by reducing osteoclastogenesis.
结果
★Low bone mass in patients with PSC is not associated with age, disease duration or liver fibrosis.
★Low bone mass in patients with PSC is associated with high bone resorption.
★Bone loss in patients with PSC is associated with an increased Th17 cell frequency.
★IL-17 deficiency corrects osteopenia in Abcb4-deficient mice.
