原发性胆汁性胆管炎患者临床特征及预后的性别差异

Influence of gender on clinical characteristics and prognosis of patients with primary biliary cholangitis

目的探讨原发性硬化性胆管炎患者的发病趋势、临床特征、预后有无性别差异。方法对2013年7月至2020年9月在昆明医科大学第二附属医院接受治疗的497例PBC患者进行回顾性研究,按照年龄1∶1进行倾向性评分匹配,对不同性别患者的临床特征、血清实验室指标、不良事件进行对比分析,使用UK-PBC及GLOBE预后评分计算患者预后参数,对比短期及长期预后。结果497例PBC患者中,男女比例为1∶5.9,在不同年龄组的性别分布中,男性发病高峰年龄延后女性10年(Z=28.12,P<0.05);按照倾向性评分匹配后,比较不同性别PBC患者临床特征及体征,女性乏力、体重减轻、双下肢水肿及合并其他的自身免疫性疾病情况高于男性(62.5%vs 37.5%、27.8%vs 8.3%、18.1%vs 6.9%、30.6%vs 13.9%,P<0.05);实验室指标基线水平比较,男性血清胆红素高于女性40.0(18.4,89.1)μmol/L VS 26.2(15.8,49.0)μmol/L,P<0.05,γ-谷氨酰转肽酶男性高于女性350.0(134.3,680.5)U/L vs 240.5(74.8,439.5)U/L,P<0.05,而白蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、免疫球蛋白、肝病相关抗体男女间无差异(P>0.05);UK-PBC风险评分显示5年不良事件发生风险男女间比较无差异(P>0.05),10年及15年不良事件发生风险比较,男性不良事件发生风险高于女性11.1(6.3,53.3)vs 10.0(2.8,19.9);17.5(12.4,54.6)vs 15.2(5.9,23.5),P<0.05,GLOBE评分结果显示3年、5年无肝移植存活率男女间比较无差异(P>0.05),10年及15年存活率比较,女性存活率高于男性67.2(52.5,92.3)vs 50.4(14.2,84.6);46.5(30.2,84.3)vs 28.9(3.2,73.3),P<0.05。结论男性PBC患者发病的年龄高峰晚于女性,临床症状、体征少且不典型,男女短期预后相似,但长期预后男性比女性差,应引起临床重视。

Objective To explore the incidence trend,clinical features and prognosis of primary biliary cholangitis(PBC)in different genders.Methods A retrospective study was conducted on 497 patients with PBC who were treated in the Second Affiliated Hospital of Kunming Medical University from July 2013 to September 2020.According to the age 1∶1 propensity score matching,the clinical characteristics,serum laboratory indexes and adverse events of patients of different genders were compared and analyzed.The prognosis parameters of patients were calculated by UK-PBC and GLOBE prognostic scores,and we compared the short-term and long-term prognosis of the patients.Results The ratio of male to female was 1:5.9.In the gender distribution of different age groups,the peak age of male was 10 years later than that of female(Z=28.12,P<0.05);according to the propensity score matching,compared with the clinical characteristics and signs of PBC patients,women were more likely to show fatigue,weight loss and edema of both lower limbs,and were more likely to merge with other autoimmune diseases(62.5%VS 37.5%,27.8%VS 8.3%,18.1%VS 6.9%,30.6%VS 13.9%,P<0.05);Compared with the baseline level of laboratory indicators,the levels of serum bilirubin and gamma glutamyl transpeptidase in men were higher than those in women[40.0(18.4,89.1)μmol/L VS 26.2(15.8,49.0)μmol/L,350.0(134.3,680.5)U/L VS 240.5(74.8,439.5)U/L,P<0.05].There was no significant difference in albumin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,immunoglobulin and hepatopathy associated antibody between male and female.The UK-PBC risk score showed that there was no difference in the risk of adverse events between men and women in 5 years(P>0.05).The risk of adverse events in men was higher than that in women in 10 years and 15 years[11.1(6.3,53.3)VS 10.0(2.8,19.9);17.5(12.4,54.6)VS 15.2(5.9,23.5),P<0.05].The GLOBE score showed that there was no difference in the 3 year-and 5 year-survival rates between men and women,compared with 10 year-and 15 year-survival rates,women had a higher survival rate than men[67.2(52.5,92.3)VS 50.4(14.2,84.6);46.5(30.2,84.3)VS 28.9(3.2,73.3),P<0.05].Conclusion The peak age of male patients with PBC is later than that of female patients,and the clinical symptoms and signs are few and atypical.The short-term prognosis of male and female patients is similar,but the long-term prognosis of male patients is worse than that of female patients,which should be paid attention.