抗gp210抗体阳性原发性胆汁性胆管炎患者临床特点研究

Study of clinical characteristics in patients with gp210 antibody-positive primary biliary cholangitis

目的大样本分析抗糖蛋白210抗体(抗gp210抗体)阳性原发性胆汁性胆管炎(PBC)患者的临床特征及其对预后的影响。方法回顾性研究首都医科大学附属北京佑安医院2010-2019年PBC患者931例。根据抗gp210抗体检测情况分为:抗gp210抗体阳性组(阳性组)318例和抗gp210抗体阴性组(阴性组)613例,比较两组之间的人口学、病史、临床指标、B超及病理指标间的差异,以及引起差异的病理性基础。应用SPSS 16.0软件进行统计分析,计量资料采用t检验或秩和检验,计数资料采用χ^(2)检验,多因素分析采用logistics检验,预后采用生存分析。结果阳性组与阴性组比较:阳性组男/女性别比例明显高于阴性组(1∶5.35对比1∶9.73,P<0.05);阳性组既往诊治病史激素应用比例高于阴性组(12.9%对比3.47%,P<0.05),差异均有统计学意义。阳性组生化学检测指标:丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)均高于阴性组(51.1 U/L对比41.1 U/L,62.6 U/L对比49.6 U/L,24.1μmol/L对比17.9μmol/L,228.3 U/L对比169.6 U/L,203.9 U/L对比147.6 U/L),P值均<0.05,差异均有统计学意义。阳性组抗核抗体阳性率、高滴度比例和免疫球蛋G水平均高于阴性组(95.2%对比81.6%,69.7%对比48.8%,17.2 g/L对比16.2 g/L),P值均<0.05,差异均有统计学意义;阳性组肝衰竭发生率高于阴性组(P<0.05);阳性组肝脏病理CK7评分和炎症评分高于阴性组(0.83±0.53对比0.28±0.47;1.06±0.39对比0.54±0.65,P值均<0.05),差异均有统计学意义。结论抗gp210抗体阳性组PBC患者病情重于阴性组患者,并且肝衰竭发生率明显增多,肝细胞胆管化可能是抗gp210抗体阳性PBC患者临床特点病理基础。

Objective To analyze the clinical characteristics and prognostic value of liver function in a large samples of patients with anti-glycoprotein 210(gp210 antibody)positive primary biliary cholangitis(PBC).Methods A retrospective study was performed on 931 PBC cases in Beijing You'an Hospital affiliated to Capital Medical University from 2010 to 2019.According to the detection of gp210 antibody,318 cases were divided into gp210 antibody positive group(positive group)and 613 cases were divided into gp210 antibody negative group(negative group).The differences in demographic,medical history,clinical indicators,B-ultrasound and pathological indicators as well as the histopathological basis were compared between the two groups.SPSS 16.0 software was used for statistical analysis.Measurement data were analyzed by t-test or rank sum test,and enumeration data byχ^(2) test.Multivariate analysis was used for logistic test,and and survival analysis was used for prognosis.Results The positive and the negative groups were compared.The ratio of male to female was significantly higher in positive than negative group(1:5.35 vs.1:9.73,P<0.05),and the difference was statistically significant.The proportion of hormone use in history of past diagnosed and treated was higher in positive than negative group(12.9%vs.3.47%,P<0.05),and the difference was statistically significant.The detection of biochemical indexes such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),alkaline phosphatase(ALP),glutamyl transpeptidase(GGT)were higher in positive than the negative group(51.1 U/L vs.41.1 U/L,62.6 U/L vs.49.6 U/L,24.1μmol/L vs.17.9μmol/L,228.3 U/L vs.169.6 U/L,203.9 U/L vs.147.6 U/L),(P<0.05),and the differences were statistically significant.Antinuclear antibody(ANA)-positive rate,high titer ratio and immunoglobulin G(IgG)levels were higher in positive than negative group(95.2%vs.81.6%,69.7%vs.48.8%,17.2 g/L vs.16.2 g/L),(P<0.05),and the differences were statistically significant.The incidence of liver failure was higher in positive than negative group(P<0.05).CK7 and inflammation score were higher in positive group than negative group in liver histopathological observations(0.83±0.53 vs.0.28±0.47;1.06±0.39 vs.0.54±0.65),(P<0.05),and the differences were statistically significant.Conclusion The illness condition of patients with gp210 antibody positive PBC is more severe than patients with gp210 antibody negative PBC,and the incidence of liver failure is significantly increased.Cholangiocytes may be the histopathological basis of the clinical characteristics of gp210 antibody positive PBC patients.