原发性胆汁性胆管炎-乙型病毒性肝炎重叠综合征患者临床特征分析

Analysis on clinical characteristics in patients with primary biliary cholangitis-viral hepatitis B overlap syndrome

目的 比较单纯原发性胆汁性胆管炎（PBC）患者、单纯乙型病毒性肝炎（乙肝）患者及PBC-乙肝重叠综合征患者的临床特点,分析并总结PBC-乙肝重叠综合征患者临床特征。方法 回顾性分析从江苏省PBC协作组临床资料库（作者系协作组成员）中采用简单随机抽样方法随机筛选2007-2015年诊治并已确诊的104例单纯PBC患者（A组）、93例单纯乙肝患者（B组）、29例PBC-乙肝重叠综合征患者（C组）的临床资料,对患者年龄、性别及血清检测结果进行统计分析。结果 A、C组患者中女性明显多于男性,且A组患者中女性明显多于C组,差异均有统计学意义（P〈0.01）;C组患者年龄明显高于B组,差异有统计学意义（P〈0.01）,但与A组比较,差异无统计学意义（P〉0.05）;C组患者丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总蛋白、清蛋白、免疫球蛋白（A、G、M）水平与A、B组比较,差异均无统计学意义（P〉0.05）,但γ-谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）水平明显低于A组,高于B组,差异均有统计学意义（P〈0.05）;C组患者总胆红素、直接胆红素水平与A组比较,差异均无统计学意义（P〉0.05）,但高于B组,差异均有统计学意义（P〈0.05）。结论 乙肝患者经药物治疗后若ALT、AST水平降低而GGT、ALP、胆红素水平无明显改善时需进行抗线粒体抗体亚型检测,以确诊是否伴PBC。

Objective To compare the clinical features in the patients with primary biliary biliary cholangitis （PBC）,pa-tients with simple hepatitis B and patients with PBC-hepatitis B overlap syndrome （PBC-HBV）and to analyze and summarize the clinical characteristics in the patients with PBC-HBV. Methods The clinical data in 104 cases of simple PBC（group A）,93 cases of simple hepatitis B（group B） and 29 cases of PBC-HBV（group C） randomly screened from the data bank of the Jiangsu provin-cial PBC cooperative group during 2007-2015 by adopting the simple random sampling method were retrospectively analyzed. The age,gender and serological detection results were performed the statistical analysis. Results Females in the group A and C were significantly more than males,moreover the female patients in the group A were significantly more than those in the group C,the difference was statistically significant（P〈0.01）;the age in the group C was significantly higher than that in the group B with statisti-cal difference（P〈0.01）,but showed no statistical difference compared with the group A（P〉0.05）;there were no statistical differ-ences between the group C with the group A and B in serum levels of ALT,AST,total protein,albumin and immunoglobulin（IgA, IgG,IgM）,but the levels of GGT and ALP in the group C was lower than those in the group A and higher than those in the group B,the differences were statistically significant（P〈0.05）;the levels of total bilirubin and direct bilirubin had no statistical difference between the group C and A,but the group C was higher than the group B with statistical difference（P〈0.05）. Conclusion After medication treatment in the patients with hepatitis B,if the levels of ALT and AST are dropped,whereas the levels of GGT,ALP and bilirubin have no obvious improvement,which needs to conduct the examination of antimitochondrial antibody subtype to definitely diagnose whether complicating PBC.