原发性胆汁性胆管炎患者血清学指标与病理分期的关系及原发性胆汁性胆管炎预后危险因素分析

Correlation between serological indicators and pathological staging in patients with primary biliary cholangitis and prognostic factors of primary biliary cholangitis

目的探讨原发性胆汁性胆管炎(PBC)患者血清学指标与病理分期的关系及PBC预后危险因素分析。方法选取2015年4月至2020年10月南昌市第九医院收治的46例PBC患者作为PBC组,选取同期住院的50例非肝病普通患者作为对照组,比较两组患者血清总胆红素(TBil)、胆汁酸(TBA)、胆碱酯酶(CHE)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白(ALB)、球蛋白(GLB)以及免疫学指标抗核抗体(ANA)、抗线粒体抗体(AMA)、抗线粒体抗体M2(AMA-M2)、抗gp210抗体(gp210)、抗sp100抗体(sp100),并分析以上指标与病理分期的关系,并探讨影响PBC预后的危险因素。结果PBC组TBil、TBA、CHE、ALP、γ-GT、ALT、AST、ALB、GLB水平高于对照组,差异有统计学意义(P<0.05)。Ⅲ期TBil、γ-GT、GLB水平均高于Ⅰ期,差异有统计学意义(P<0.05);Ⅱ期、Ⅲ期ALP、AST水平均高于Ⅰ期,差异有统计学意义(P<0.05);Ⅱ期、Ⅲ期CHE、ALB水平均低于Ⅰ期,差异有统计学意义(P<0.05);Ⅲ期的ALP水平高于Ⅱ期,差异有统计学意义(P<0.05)。PBC患者不同病理分期AMA-M2阳性检出率比较,差异有统计学意义(P<0.05)。单因素分析显示,年龄、TBil、γ-GT、ALB与PBC患者预后有关(P<0.05),多因素分析显示,TBil(β=0.031,OR=1.031,95%CI=1.015~1.048)是影响PBC患者预后的独立危险因素,ALB(β=-0.182,OR=0.834,95%CI=0.756~0.919)是影响PBC患者预后的保护因素(P<0.05)。结论PBC患者不同病理分期TBil、TBA、CHE、ALP、γ-GT、ALT、AST、ALB、GLB指标水平及ANA、AMA、AMA-M2、sp100阳性检出情况不同,且TBil、ALB是PBC患者预后的影响因素,临床中可通过检测血清学相关指标辅助判断病理分期及预后发展,为治疗提供一定依据。

Objective To investigate the correlation between serological indicators and pathological staging in patients with primary biliary cholangitis(PBC)and prognostic factors of PBC.Methods Forty-six patients with PBC(PBC group)admitted to Nanchang Ninth Hospital,and 50 patients without liver disease(control group)were selected between April 2015 and October 2020.Serum total bilirubin(TBil),total bile acid(TBA),cholinesterase(CHE),alkaline phosphatase(ALP),γ-glutamyl transpeptidase(γ-GT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),globulin(GLB)and immunological indicators(anti-nuclear antibody[ANA],anti-mitochondrial antibody[AMA],anti-mitochondrial antibody M2[AMA-M2],anti-gp210 antibody[gp210],anti-sp100 antibody[sp100])in the two groups were detected,and the correlation between the above indexes and pathological stages were analyzed,and the risk factors affecting the prognosis of PBC were discussed.Results The levels of TBil,TBA,CHE,ALP,γ-GT,ALT,AST,ALB,and GLB in the PBC group were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of TBil,γ-GT and GLB in stageⅢwere higher than those in stageⅠ,and the differences were statistically significant(P<0.05).The levels of ALP and AST in stageⅡand stageⅢwere higher than those in stageⅠ,and the differences were statistically significant(P<0.05).The levels of CHE and ALB in stageⅡand stageⅢwere lower than those in stageⅠ,and the differences were statistically significant(P<0.05).The level of ALP in stageⅢwas higher than that in stageⅡ,and the difference was statistically significant(P<0.05).There were statistically significant differences in the positive detection rate of AMA-M2 among patients with PBC in different pathological stages(P<0.05).Univariate analysis showed that age,TBil,γ-GT,and ALB were related to the prognosis of patients with PBC(P<0.05).Multivariate analysis found that TBil(β=0.031,OR=1.031,95%CI=1.015-1.048)was an independent prognostic factor of patients with PBC,and ALB(β=0.182,OR=0.834,95%CI=0.756-0.919)was a protective factor of patients′prognosis with PBC(P<0.05).Conclusion The levels of TBil,TBA,CHE,ALP,γ-GT,ALT,AST,ALB and GLB,the positive detection rates of ANA,AMA,AMA-M2,and sp100 are different in patients with PBC in different pathological stages.TBil and ALB are factors influencing the prognosis of patients with PBC.Clinically,the detection of related serological indicators can assist in judging the pathological stage and prognosis,thereby providing a basis for treatment.