原发性胆汁性胆管炎患者的临床特征和治疗情况分析

Clinical characteristics and treatment effects of patients with primary biliary cholangitis

目的分析胆汁性胆管炎(PBC)患者的临床特征及治疗情况。方法回顾性分析2012年11月至2019年2月在福建医科大学附属协和医院消化内科治疗的43例PBC患者,对其临床表现和治疗转归情况进行分析总结。结果PBC男女发病之比为1:9.75,其中45~60岁女性发病率最高。常见的临床症状有乏力、腹部不适、皮肤瘙痒。PBC可伴发多种疾病,其中高脂血症14例(32.6%),胆囊炎伴或不伴胆囊结石11例(25.6%),骨质疏松3例(7.0%)。经熊去氧胆酸治疗后谷氨酰转肽酶(GGT)和碱性磷酸酶(ALP)可明显下降,尤以肝硬化失代偿期最为明显,治疗前GGT为(372.23±285.13)U/L,治疗后为(148.20±141.91)U/L(t=3.686,P=0.002);治疗前ALP为(361.34±245.10)U/L,治疗后为(183.27±115.17)U/L(t=3.252,P=0.005)。总胆红素(TBil)、直接胆红素(DBil)在代偿期变化不大,而在肝硬化失代偿期即使规律治疗仍有明显升高治疗前TBil为(42.93±27.41)μmol/L,治疗后为(123.49±127.21)μmol/L(t=2.612,P=0.019);治疗前DBil为(25.51±19.88)μmol/L,治疗后为(70.21±78.52)μmol/L(t=2.547,P=0.023)。结论PBC发病隐匿,应根据PBC的症状开展针对性诊疗,提高患者的治疗效果。

Objective To evaluate the clinical and treatment characteristics of patients with Primary Biliary Cholangitis(PBC),which can provide important evidence for prevention and control of PBC.Methods We retrospective analysed 43 PBC patients treated in Union Hospital Affiliated to Fujian Medical University from November 2012 to February 2019,evaluated and summarized their clinical characteristics and treatment outcomes.Results Middle and elderly aged women were at high incidence of PBC,the incidence rate between men and women was 1:9.75.Common symptoms were fatigue,abdominal discomfort and skin itching.PBC could be combined with multiple diseases,such as hyperlipidemia(14 cases,32.6%),cholecystitis with or without gallstone(11 cases,25.6%)and osteoporosis(3 cases,7.0%).After treated with ursodeoxycholic acid,γ-glutamyl transpeptadase and alkaline phosphatase decreased significantly,especially in decompensated group(GGT:372.23±285.13,148.20±141.91,t=3.686,P=0.002;ALP:361.34±245.10,183.27±115.17,t=3.252,P=0.005).While total bilirubin and direct bilirubin increased significantly in decompensated group(TBIL:42.93±27.41,123.49±127.21,t=2.612,P=0.019;DBIL:25.51±19.88,70.21±78.52,t=2.547,P=0.023).Conclusion The early symptoms of PBC was not obvious.Therefore,more attention should be paid to the prevention and treatment of the PBC.