原发性胆汁性胆管炎与肝硬化患者临床指标差异分析*

doi:10.3969/j.issn.1672-5069.2022.03.025

摘要/Abstract

摘要： 目的探讨原发性胆汁性胆管炎(PBC)与原发性胆汁性肝硬化患者临床指标的差异。方法 2015年5月～2021年9月我院诊治的PBC患者164例,其中胆管炎组70例,肝硬化组94例。收集临床指标,应用Logistic回归分析影响PBC患者疾病进展的相关危险因素。结果本组肝硬化患者年龄为(58.6±13.0)岁,显著大于胆管炎组【(53.4±11.1)岁,P＜0.05】;血清谷丙转氨酶、谷草转氨酶、碱性磷酸酶、总胆红素分别为49.7(27.5,80.2) U/L、62.6(44.9,114.7) U/L、156.8(126.5,230.5) U/L和31.5(17.6,88.4) μmol/L,显著高于胆管炎组【分别为39.3(23.9,66.0) U/L、36.4(26.8,63.4) U/L、126.5(94.8,187.3) U/L和14.6(10.0,24.3)μmol/L,P＜0.05】;肝硬化组血清抗核抗体和抗gp210抗体阳性率分别为91.5%和43.6%,显著高于胆管炎组的80.0%和25.7%(P＜0.05);肝硬化组血清IgG、IgA和IgM水平分别为17.0(13.2,20.9) g/L、3.5(2.5,4.8) g/L和2.9(2.0,4.8) g/L,显著高于胆管炎组【分别为14.2(12.7,15.8) g/L、2.6(2.0,3.4) g/L和1.8(1.2,3.3) g/L,P＜0.05】,而补体C3和C4水平分别为0.7(0.5,0.9) g/L和0.1(0.1,0.2) g/L,显著低于胆管炎组【分别为1.2(1.1,1.4) g/L和0.2(0.2,0.3) g/L,P＜0.05】;多因素Logistic回归分析发现IgM增高和补体C4降低是PBC进展至肝硬化的独立危险因素(P＜0.05)。结论原发性胆汁性胆管炎患者进展至肝硬化阶段有一些显著的临床指标变化,血清IgM水平升高和补体C4水平降低有一定的提示作用。

关键词: 原发性胆汁性胆管炎, 免疫球蛋白M, 补体C4

Abstract: Objective The aim of this study was to compare the clinical feature of patients with primary biliary cholangitis and primary biliary cirrhosis. Methods 164 patients, including 70 with primary biliary cholangitis and 94 with primary biliary cirrhosis were encountered in the First Affiliated Hospital, Nanjing Medical University between May 2015 and September 2021, and their clinical materials were reviewed. The Logistic regression analysis was applied to investigate the risk factors for disease progression in this kind of patients. Result The age of the patients with cirrhosis was ( 58.6±13.0) year-old, significantly greater than [( 53.4± 11.1) year-old, P<0.05] in patients without cirrhosis; serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and total bilirubin levels in patients with cirrhosis were 49.7(27.5, 80.2) U/L, 62.6(44.9, 114.7) U/L, 156.8(126.5, 230.5) U/L and 31.5 (17.6, 88.4) μmol/L, significantly higher than [39.3(23.9, 66.0) U/L, 36.4(26.8, 63.4) U/L, 126.5(94.8, 187.3) U/L and 14.6(10.0, 24.3) μmol/L, respectively, P＜0.05] in patients with primary biliary cholangitis; the positive rates of serum anti-nuclear antibody and anti gp210 antibody in patients with primary biliary cirrhosis were 91.5% and 43.6%, significantly higher than 80.0% and 25.7%(P＜0.05) in patients with primary biliary cholangitis; serum IgG, IgA and IgM levels in patients with primary biliary cirrhosis were 17.0(13.2, 20.9) g/L, 3.5(2.5, 4.8) g/L and 2.9(2.0, 4.8) g/L, significantly higher than [14.2(12.7, 15.8) g/L、2.6(2.0, 3.4) g/L and 1.8(1.2, 3.3) g/L, respectively, P＜0.05], while serum C3 and C4 levels were 0.7(0.5, 0.9) g/L and 0.1(0.1, 0.2) g/L, significantly lower than [1.2(1.1, 1.4) g/L and 0.2(0.2, 0.3) g/L, respectively, P＜0.05] in patients with primary biliary cholangitis; the multivariate Logistic analysis showed that increased serum IgM and decreased C4 levels were the independent risk factors for the occurrence of liver cirrhosis (P＜0.05). Conclusion Some feature could hint the liver cirrhosis in patients with primary biliary cholangitis, out of them, higher serum IgM and low serum complement C4 levels might be the easy parameters.

Key words: Primary biliary cholangitis, Immunoglobulin, Complement C4

袁慧, 李毓雯, 李军, 朱传龙. 原发性胆汁性胆管炎与肝硬化患者临床指标差异分析^*[J]. 实用肝脏病杂志, 2022, 25(3): 403-406.

Yuan Hui, Li Yuwen, Li Jun, et al. Clinical feature of patients with primary biliary cholangitis and primary biliary cirrhosis[J]. Journal of Practical Hepatology, 2022, 25(3): 403-406.

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原发性胆汁性胆管炎与肝硬化患者临床指标差异分析^*

Clinical feature of patients with primary biliary cholangitis and primary biliary cirrhosis

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