基线红细胞分布宽度预测原发性胆汁性胆管炎对熊去氧胆酸应答反应的研究

Baseline red blood cell distribution width predicts the response of primary biliary choleitis to ursodeoxycholic acid

目的探讨基线红细胞分布宽度(RDW)评估PBC患者对熊去氧胆酸(UDCA)应答的价值。方法回顾性研究经UDCA治疗1年以上资料完整的67例PBC患者,收集其基线时和治疗1年后的随访数据;UDCA应答情况采用巴黎-Ⅰ标准进行评价,根据基线时RDW值是否高于正常上限(15%),将患者分为RDW升高组和RDW非升高组,比较2组临床及实验室特征,分析RDW水平与PBC患者基线指标之间的相关性。统计学方法采用t检验、Mann-Whitney检验、χ^2检验及Pearson相关和Spearman秩相关分析。结果67例PBC患者中,RDW升高组28例,RDW非升高组39例,实验室检查结果显示,RDW非升高组与RDW升高组相比,基线总胆红素(TBIL)[(20±15)μmol/L和(29±13)μmol/L,t=-2.517,P=0.014],ALP[(303±55)U/L和(416±83)U/L,t=-6.704,P<0.01];谷氨酰转肽酶(GGT)[(328±72)U/L和(393±5)U/L,t=-4.087,P<0.01],ALT[(85±35)U/L和(104±16)U/L,t=-2.461,P=0.017];AST[(74±25)U/L和(115±22)U/L,t=-7.057,P=0.001],Mayo评分[(4.4±0.5)分和(5.2±0.6)分,t=-5.781,P<0.01]均较低,差异有统计学意义(P<0.05),而生化应答率[59%和36%]较高,差异有统计学意义(χ2=6.661,P=0.010)。RDW水平与PBC患者TBIL、ALP、GGT、ALT、AST呈正相关,r值分别为0.298、0.609、0.371和0.348、0.508(P<0.05)。结论基线时RDW升高的患者生化异常更明显,Mayo风险评分更差,对UDCA的生化应答率更低。

Objective To evaluate the value of baseline erythrocyte distribution width (RDW) in evaluating the response to Ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC). Methods A retrospective study of 67 patients with PBC who had been treated with UDCA for more than 1 year was conducted. Baseline data and follow-up data after one year treatment were collected. The UDCA response was evaluated by the Paris-Ⅰ standard. According to whether the RDW value was higher than the normal upper limit (15%), patients were divided into two groups: the RDW elevation group and normal RDW group. The clinical and laboratory characteristics were compared. All data were analyzed by t-test, χ^2 test,Mann-Whitney test, Pearson and Spearman rank correlation analysis. Results Among the 67 PBC patients, 28 cases had elevated RDW and 39 cases had normal RDW. Compared to the non elevated RDW group, the RDW elevation group had significantly higher baseline levels of total serum bilirubin, alkaline phosphatase, glutamic pyruvic transaminase, glutamic pyruvic aminotransferase, Mayo risk score but lower biochemical response rate. RDW levels were positively correlated with TBIL, ALP, GGT and ALT, AST levels, r values were 0.298, 0.609, 0.371 and 0.348, 0.508 (P<0.05) respectively. Conclusion At baseline, patients with higher RDW levels have more abnormal biochemical abnormalities, the Mayo risk score is worse, and the biochemical response rate is lower when compared with patients with normal RDW.