原发性胆汁性胆管炎发生肝硬化失代偿危险因素评估病例对照研究

A case-control study to assess risk factors for the development of cirrhotic decompensation in patients with primary biliary cholangitis

目的:探讨原发性胆汁性胆管炎(PBC)患者发生肝硬化失代偿的相关危险因素。方法:回顾性分析2008年8月至2019年12月首都医科大学附属北京地坛医院864例PBC患者病历资料,按纳入及排除标准收集到PBC肝硬化代偿期组(n=246)和肝硬化失代偿期组(n=183)两组患者。纳入两组患者入组时年龄、性别、ALT、AST、TBil、Glo、Alb、GGT及ALP水平、血脂水平、免疫球蛋白水平、INR、APRI、FIB-4、NLR等指标并进行分析。计量资料符合正态分布的组间比较采用独立样本t检验;非正态分布则采用Mann-Whitney U检验。计数资料组间比较采用卡方检验。用二元logistic回归模型进行单因素和多因素分析,计算相关因素危险比及95%置信区间。结果:与PBC肝硬化代偿期患者相比,PBC肝硬化失代偿期患者WBC、NE#、LY#、MO#、RBC、HGB、PLT、ALT、AST、Che、Alb、GGT、ALP、TC、TG、PTA水平均偏低(P<0.05);PBC肝硬化失代偿期患者NLR、TBil、DBil、TBA、PT、INR、TT、CREA、IgA、IgM、ARPI评分、FIB-4指数水平均高于PBC肝硬化代偿期患者(P<0.05);通过logistic回归分析,发现年龄、PLT、Alb、IgA是PBC患者发生肝硬化失代偿的独立危险因素,其比值比及95%CI分别为:3.332(1.556~7.094),2.702(1.391~5.247),3.895(1.607~9.445),2.431(1.075~5.496)。结论:年龄增长、PLT下降、Alb水平下降、IgA水平升高是PBC患者发生肝硬化失代偿的独立危险因素,也是疾病进展的体现。

Objective:To investigate the risk factors for the development of cirrhotic decompensation in patients with primary biliary cholangitis(PBC).Methods:A retrospective analysis was performed for the clinical data of 864 patients who were diagnosed with PBC in The Beijing Ditan Hospital Capital Medical University from August 2008 to December 2019.According to related diagnostic criteria,the patients were divided into PBC compensated group(n=246)and PBC decompensated group(n=183).The age,gender,ALT,AST,TBIL,GLO,ALB,GGT,and ALP levels,immunoglobulin levels,INR,APRI,FIB-4,and NLR levels at the time of enrollment were compared between the two groups.The independent samples t-test was used for the comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for the comparison of non-normally distributed continuous data between groups.The chi-square test was used for the comparison of categorical data between groups.Univariate and multivariate analyses were performed with binary logistic regression models,and hazard ratios and 95%confidence intervals were calculated for the factors of interest.Results:①Comprised with the PBC cirrhosis compensated group,the levels of WBC,NE#,LY#,MO#,RBC,HGB,PLT,ALT,AST,CHE,ALB,GGT,ALP,TC,TG,and PTA were lower in PBC cirrhosis decompensated group(P<0.05).②The levels of NLR,TBIL,DBIL,TBA PT,INR,TT,CREA,IgA,IgM,ARPI score,and FIB-4 index levels were all higher in PBC cirrhosis decompensated than in PBC cirrhosis compensated patients(P<0.05).③By logistic regression,age,PLT,ALB,and IgA was found to be independent risk factors for the development of cirrhotic decompensation in PBC patients,with the ratio and 95%CI of 3.332(1.556~7.094),2.702(1.391~5.247),3.895(1.607~9.445),2.431(1.075~5.496).Conclusion:Aging,decreasing PLT and ALB levels,and increasing IgA are independent risk factors for the development of cirrhotic decompensation in patients with PBC and are a reflection of disease progression.