原发性胆汁性肝硬化发生失代偿的危险因素研究

Risk factors of decompensated liver cirrhosis in primary biliary cirrhosis

目的探讨原发性胆汁性肝硬化(PBC)患者肝硬化失代偿期的危险因素指标,为临床诊治提供循证医学依据。方法回顾性分析115例PBC患者,将患者分为代偿期组(72例)和失代偿期组(43例),分析生化指标[白蛋白(Alb)、球蛋白(Glb)、总胆红素(TB)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]、凝血指标[凝血酶原时间(PT)]、免疫指标(Ig M、Ig G、Ig A、γ-Glb)、自身抗体[抗核点型靶抗原蛋白100(sp100)抗体、抗核孔复合物糖蛋白210(gp210)抗体、抗着丝点抗体]、Mayo评分与肝硬化失代偿的相关性,并通过多因素Logistic回归分析筛选出可有效独立预测PBC患者出现失代偿的危险因素。结果失代偿期组TB、TBA、PT、γ-Glb、Ig A、Ig G水平及Mayo评分均高于代偿期组,而Alb、GGT水平低于代偿期组(P<0.05)。2个组之间Glb、Alp、ALT、AST、Ig M水平及抗sp100抗体、抗gp210抗体、抗着丝点抗体阳性率差异均无统计学意义(P>0.05)。多因素非条件Logistic回归分析显示,Alb<34.5 g/L[比值比(OR)=4.458,95%可信区间(CI)1.019~19.501]、Ig A>3.09 g/L(OR=15.41,95%CI 2.868~82.786)、Mayo评分>5.04(OR=15.7,95%CI 2.653~92.907)为PBC患者肝硬化失代偿期的独立预测指标。受试者工作特征(ROC)曲线分析显示Alb、Ig A、Mayo评分的曲线下面积分别为0.881、0.700、0.860,Alb+Ig A+Mayo联合检测模型的曲线下面积为0.912。结论 Alb<34.5 g/L、Ig A>3.09 g/L、Mayo评分>5.04及Alb+Ig A+Mayo联合检测预测概率>0.45,可预测PBC患者出现肝硬化失代偿。

Objective To investigate the risk factors of decompensated liver cirrhosis in patients withprimary biliary cirrhosis（PBC）,and to provide an evidence-based medicine reference for clinical diagnosisand treatment. Methods The clinical data of 115 PBC patients,including 72 compensated patients and 43decompensated patients,were collected retrospectively. The correlations of decompensated liver cirrhosis withbiochemical indices [albumin（Alb）,globulin（Glb）,total bilirubin （TB）,alkaline phosphatase （ALP）,gamma-glutamyltransferase（GGT）,total bile acid（TBA）,alanine aminotransferase（ALT） and aspartateaminotransferase（AST）],coagulation index [prothrombin time（PT）],immunological indices（IgM,IgG,IgA and γ-Glb）,autoantibodies [anti-soluble acidic nuclear protein 100（sp100） antibody,anti-nuclear poreglycoprotein 210（gp210） antibody and anti-centromere antibody] and Mayo risk score were analyzed. MultivariateLogistic regression analysis was used to identify independent risk factors for predicting decompensation in PBCpatients. Results Compared with compensated patients,the decompensated patients had higher levels of TB,TBA,PT,γ-Glb,IgA,IgG and Mayo risk score,but they had lower levels of Alb and GGT （P〈0.05）. Therewas no statistical significance for the levels of Glb,ALP,ALT,AST and IgM and the positive rates of anti-sp100antibody,anti-gp210 antibody and anti-centromere antibody between the 2 groups（P〉0.05）. Multivariate Logistic regression analysis showed that Alb〈34.5 g/L [odds ratio （OR）=4.458,95% confidence interval （CI） 1.019-19.501],IgA〉3.09 g/L（OR=15.41,95%CI 2.868-82.786）,Mayo risk score 〉5.04 （OR=15.7,95%CI 2.653-92.907）were independent risk factors for predicting decompensation. The areas under receiver operating characteristic（ROC）curves of Alb,IgA and Mayo risk score were 0.881,0.700 and 0.860,respectively. The area under ROCcurve of the combined determination of Alb,IgA and Mayo risk score was 0.912. Conclusions Alb〈34.5 g/L,IgA 〉3.09 g/L and Mayo risk score 〉5.04 and the probability of Alb,IgA and Mayo risk score combineddetermination 〉0.45 play roles for predicting decompensation in patients with PBC.