PBC患者血清学指标与肝组织活检病理分期的关系及进展期PBC危险因素的Logistic回归分析

Correlation between serum indexes and pathological stages in patients with PBC, and Logistic regression analysis on risk factors of patients with advanced PBC

目的探讨原发性胆汁性胆管炎(primary biliary cholangitis,PBC)患者血清学指标与肝组织活检病理分期的相关性,并分析进展期PBC的相关危险因素,指导临床诊治及监测疾病进展。方法收集2013年1月至2018年4月昆明医科大学第二附属医院消化内科确诊PBC并行肝穿活检分期的87例患者的临床资料,按病理分期分为Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期,同时收集所有患者同期的生化、血细胞分析、凝血功能、免疫球蛋白、抗核抗体(ANA)及抗线粒体抗体(AMA)等指标,回顾性分析血清学指标与肝组织活检病理分期的关系及进展期PBC危险因素。结果87例PBC患者以女性为主(81.61%),发病中位年龄为49.16岁,该研究中所统计的血清学指标在PBC病理Ⅰ期、Ⅱ期组间差异均无统计学意义( P >0.05),其中白蛋白(ALB)、球蛋白(GLO)、白球比(A/G)、前白蛋白(PAB)、血小板(PLT)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、胆汁酸(TBA)、总胆红素(TB)、胆碱酯酶(CHE)、IgG、IgA、IgM仅部分在不同病理分期组间差异有统计学意义( P <0.05),ANA、抗线粒体抗体M2(AMA-M2)在不同病理分期组间差异无统计学意义( P >0.05)。多因素Logistic回归分析结果显示,A/G、TB、IgM是PBC病理分期进展的独立危险因素。结论虽然血清学指标对PBC的诊断具有重要意义,对评估早期及进展期肝组织病变有一定指导价值,但血清学指标对PBC不同肝组织活检病理分期的鉴别仍缺乏特异性及敏感性,A/G、TB、IgM是PBC进展期的危险因素,肝组织活检目前仍是明确PBC病理分期的可靠方法。

Objective To investigate the correlation between serum indexes and pathological stages in patients with primary biliary cholangitis (PBC), and the risk factors for patients with advanced PBC for clinical diagnosis-treatment and monitoring disease progression. Methods From Jan. 2013 to Apr. 2018, clinical data of 87 patients diagnosed with PBC and liver biopsy staging in Department of Gastroenterology, the Second Affiliated Hospital of Kunming Medical University were collected. According to the pathological stages, they were divided into stage Ⅰ,Ⅱ,Ⅲ,Ⅳ period, biochemical , blood analysis and blood coagulation function, immune globulin, antinuclear antibody and antimitochondrial antibodies and other indicators of these patients were collected. The relationship between serum indexes and pathological stages of liver biopsy and the risk factors of PBC in advanced stage were analyzed retrospectively. Results 87 cases of PBC patients were mainly female, accounting for 81.61%. The median age of onset was 49.16 years old. Serum indexes in PBC pathological stages Ⅰ,Ⅱ had no statistical significance ( P >0.05). Among them, albumin (ALB), globulin (GLO), leucocyte ratio (A/G), prealbumin (PAB), PLT, ALP, GGT, TBA, TB, cholinesterase (CHE), IgG, IgA and IgM were only partially statistically significant in different pathological stages ( P <0.05). There was no statistically significant difference in ANA and AMA-M2 in different pathological stages ( P >0.05). Multivariate Logistic regression analysis showed that A/G, TB and IgM were independent risk factors for pathological progression of PBC. Conclusion Although the serum indicators are of great significance for the diagnosis of PBC and have certain guiding value for the assessment of early and advanced liver tissue lesions. However, there is still a lack of specificity and sensitivity of serum indicators in the identification of PBC in different liver biopsy pathological stages. A/G, TB and IgM are risk factors for PBC progression, and liver biopsy is still a reliable method to determine the pathological stage of PBC.