70例原发性胆汁性肝硬化患者的临床特点分析

Clinical features of primary biliary cirrhosis: a clinical analysis of 70 cases

目的探讨原发性胆汁性肝硬化(PBC)患者的临床特点。方法回顾性分析2008年1月至2013年3月诊断为PBC的住院患者70例,记录患者的首诊症状、肝功能情况、AMA亚型抗体(M2、M4、M9)以及3例病理结果,并对ALT、AST、ALP、GGT增高的程度进行秩和检验,采用Wilcoxon法。结果 84.3%为女性患者,平均年龄(59.2±8.7)岁。主要的临床表现为乏力25.7%,皮肤瘙痒24.3%,右胁不适18.6%,腹胀18.6%。生化学异常以GGT[(324.5±250.4)U/L]、ALP[(381.1±259.0)U/L]增高最明显。GGT增高5倍以上的患者较多,与ALT、AST、ALP相比差异有统计学意义(u值分别为-5.861、-4.036、-4.445,P均为0.000),AST、ALP增高2倍以上的患者亦较ALT多(u值分别为-4.405、-3.625,P均为0.000)。87.1%的患者AM2A阳性;AM4A阳性占31.4%,AM9A阳性占11.4%。结论 PBC是女性多见的以GGT、ALP增高为明显的慢性肝功能损害,AMA抗体亚型(M2、M4、M9)的阳性是诊断该病的重要依据。

Objective To investigate the clinical features of patients with primary biliary cirrhosis （PBC）. Methods A retrospective anal- ysis was performed on the clinical data of 70 inpatients diagnosed with PBC from January 2008 to March 2013. The initial symptoms, liver function, and antimitochondrial antibody （AMA） subtypes （ M2, M4, and M9） of patients, as well as the pathological resuhs of 3 cases, were recorded. The increases in alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, alanine phosphatase （ALP）, and gamma - glutamyl transpeptidase （GGT） were analyzed by Wilcoxon rank sum test. Results Of all patients, 84.3 % were females; the mean age was 59.2 ± 8.7 years. The main clinical manifestations included weakness （ 25.7% ） , itching （ 24.3% ）, discomfort in the upper right abdominal quadrant （ 18.6% ）, and abdominal distension （ 18.6% ）. Abnormal liver function was mainly characterized by significant increases in GGT （324.5 ± 250.4 U/L） and ALP（381.1 ± 259.0 U/L）. The number of patients with more than 5 -fold increase in GGT was significantly higher than the numbers of patients with more than 5 - fold increases in ALT, AST, and ALP （ u = - 5. 861, P = O. （300 ; u = - 4. 036, P = 0. 000 ; u = - 4. 445, P = 0. 000）. The numbers of patients with more than 2 - fold increases in AST and ALP were sig- nificantly higher than the number of patients with more than 2 - fold increase in ALT （ u = - 4. 405, P = 0. 000 ; u = - 3. 625, P = 0. 000）. Among all patients, 87.1% were positive for antimitochondrial M2 antibody （AM2A） , 31.4% were positive for AM4A, and 11.4% were positive for AM9A. Conclusion PBC, more common in females, is the chronic liver damage characterized by significant increases in GGT and ALP. Detection of AMA subtypes （M2, M4and M9） is valuable for confirming the diagnosis of PBC.