原发性胆汁性胆管炎合并肝细胞脂肪变性的临床特征及预后分析

Clinical and prognostic characteristics of primary biliary cholangitis and hepatocellular steatosis

目的探讨原发性胆汁性胆管炎(PBC)合并肝细胞脂肪变性患者的临床及预后特征。方法对2015年5月至2020年12月于南通市第三人民医院住院的67例PBC患者进行回顾性研究,分为合并肝细胞脂肪变性组34例(观察组)和无肝细胞脂肪变性组33例(对照组),比较两组患者临床特征、实验室指标、自身抗体结果,随访分析预后特征。根据巴黎Ⅱ标准,将患者分为治疗应答有效组与应答无效组,分析与患者应答相关的因素。结果两组患者在年龄、乏力、皮肤瘙痒发生率差异具有统计学意义,结果显示PBC合并肝细胞脂肪变性组年龄大于单纯PBC患者组(P=0.025),但乏力、皮肤瘙痒发生率低于单纯PBC组(P=0.002,P=0.045);实验室检测,PBC合并肝细胞脂肪变性组患者与单纯PBC患者比较,其总胆固醇(TC)、高密度脂蛋白(HDL)、补体C4指标水平偏高(P=0.039,P=0.035,P=0.000),而总胆红素(TBIL)、谷氨酰胺转肽酶(GGT)、碱性磷酸酶(ALP)、血小板计数(PLT)、IgM值、抗丙酮酸抗体的阳性率较低(P=0.013,P=0.000,P=0.003,P=0.008,P=0.001,P=0.001);两组患者应用熊去氧胆酸(UDCA)的应答效果在巴黎Ⅰ、巴黎Ⅱ及巴塞罗那标准上有统计学差异,PBC合并肝细胞脂肪变性组应答效果较好。多因素回归分析发现,是否合并肝细胞脂肪变性、天冬氨酸转氨酶(AST)、TBIL是PBC患者根据巴黎Ⅱ标准对UDCA应答的独立相关因素。结论合并肝细胞脂肪变性的PBC患者具有与单纯PBC患者不同的特征,合并肝细胞脂肪变性改变PBC的临床症状及UDCA应答效果有影响。

Objective To investigate the clinical and prognostic characteristics of patients with primary biliary cholangitis(PBC)combined with hepatocellular steatosis.Methods The 67 patients with PBC who were hospitalized in Nantong Third People’s Hospital from May 2015 to December 2020 were followed up,and they were divided into 34 patients with hepatocellular steatosis(observation group)and 33 patients without hepatocellular steatosis(control group).The clinical characteristics,laboratory indicators,and autoantibody results of the two groups were compared,and the prognostic characteristics were analyzed by follow-up.According to whether the patients responded effectively according to the ParisⅡstandard,the patients were divided into response effective group and response ineffective group,and related indicators were analyzed.Results The two groups of patients had statistically significant differences in the incidence of age,fatigue,and PBC combined with hepatocellular steatosis group was older than that of the simple PBC group(P=0.025),but the incidence of fatigue and skin itching was lower(P=0.002,P=0.045);laboratory tests showed that patients in the PBC combined with hepatocellular steatosis group had higher TC and HDL and complement C4 index levels(P=0.039,P=0.035,P=0.000),while total TBIL,GGT,ALP,PLT,IgM value,and anti-pyruvate antibody positive rates are lower(P=0.013,P=0.000,P=0.003,P=0.008,P=0.001,P=0.001);The response effect of UDCA between the two groups of patients was statistically different on the ParisⅠ,ParisⅡand Rotterdam criteria,and the PBC combined with hepatocellular steatosis group had a better response.Multivariate regression analysis found that combined with hepatocyte steatosis,AST,TBIL are independent factors related to the response of PBC patients to UDCA according to ParisⅡcriteria.Conclusion PBC patients with hepatocellular steatosis have different characteristics from patients with pure PBC,and hepatocellular steatosis changes the clinical symptoms of PBC and the UDCA response effect.