61例原发性胆汁性肝硬化主要症状、实验室检查指标及病理分析

Main symptoms,laboratory indicators and pathological staging in 61 patients with primary biliary cirrhosis

目的探讨原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)患者的主要症状、实验室检查指标、病理分期及其之间的关系,以指导临床诊断、治疗及预后判断。方法回顾性总结61例完成肝脏病理学检查的PBC患者的临床表现和实验室检查指标,分析该病临床表现、实验室检查指标特点及其在不同病理分期中的变化。结果 61例中,女49例(80.3%),发病年龄平均为41.11岁。主要症状依次为乏力、尿黄、肝功能异常、纳差、皮肤瘙痒和肝区不适。98.4%的患者GGT升高,86.9%的患者AST升高,80.3%的患者ALT升高,80.0%的患者ALP升高,76.8%的患者TBA升高,60.7%的患者TBIL升高,57.4%的患者ALT/AST>1;仅有11.5%的患者LDH轻度异常,26.2%的患者CHE轻度异常;77.5%的患者血清总胆固醇升高,62.8%的患者甘油三酯升高。73.8%的患者抗线粒体抗体(anti-mitochondrialantibody,AMA)和(或)AMA-M2亚型阳性,而57.4%的患者抗核抗体阳性。Ⅰ、Ⅱ期与Ⅲ、Ⅳ期患者之间只有TBIL差异有统计学意义,病理改变严重者TBIL升高明显。结论诊断PBC患者及判断病情的轻重应综合分析其临床症状、生化指标改变、自身抗体检测及组织学检查等,TBIL对病理分期有重要意义。

Objective To investigate main symptoms, laboratory indicators and pathological staging in patients with primary biliary cirrhosis （PBC）, and the relationship between them so as to provide evidence for clinical diagnosis, treatment and the determination of the prognosis. Methods A retrospective study was conducted to summarize the clinical manifestations and laboratory indicators of 61 PBC patients who had undergone liver biopsy, and to analyze the features of clinical manifestations and laboratory indicators and their changes in different pathological stages. Results Of the 61 patients, 49 （80.3%） were females. The mean onset age was 41.11 years. The main clinical manifestations included fatigue, dark urine, liver dysfunction, anorexia, skin itching and liver discomfort. The levels of GGT, AST, ALT, ALP, TBA and TBIL elevated in 98.4%, 86.9%, 80.3%, 80.0%, 76.8%, and 60.7% of the patients, respectively, and ALT/AST ratio was greater than 1 in 57.4% of the patients. LDH level was slightly abnormal in 11.5% of the patients and CHE in 26.2%. TC increased in 77.5% of the patients, and TG in 62.8%. Anti-mitochondrialantihody （AMA） and/or AMA-M2 was found to he positive in 73.8% of the patients while antinuclear antibodies in 57.4%. Only TBIL was found to be significantly different between the patients with pathological stage 1 and 2 and those with pathological stage 3 and 4 and the level increased more obviously in the patients with severe pathological change. Conclusions A comprehensive analysis of clinical symptoms, biochemical changes, autoantibody detection as well as histological examination is needed for the diagnosis of PBC patients and the determination of their disease state. TBIL level is important for distinguishing pathological stages.