Prognostic scores in primary biliary cholangitis patients with advanced disease

BACKGROUND Due to the chronic progressive disease characteristics of primary biliary cholangitis(PBC),patients with advanced PBC should not be ignored.Most prognostic score studies have focused on early stage PBC.AIM To compare the prognostic value of various risk scores in advanced PBC to help PBC patients obtain more monitoring and assessment.METHODS This study considered patients diagnosed with PBC during hospitalization between 2015 and 2021.The clinical stage was primarily middle and late,and patients usually took ursodeoxycholic acid(UDCA)after diagnosis.The discriminatory performance of the scores was assessed with concordance statistics at baseline and after 1 year of UDCA treatment.Telephone follow-up was conducted to analyze the course and disease-associated outcomes.The follow-up deadline was December 31,2021.We compared the risk score indexes between those patients who reached a composite end point of death or liver transplantation(LT)and those who remained alive at the deadline.The combined performance of prognostic scores in estimating the risk of death or LT after 1 year of UDCA treatment was assessed using Cox regression analyses.Predictive accuracy was evaluated by comparing predicted and actual survival through Kaplan-Meier analyses.RESULTS We included 397 patients who were first diagnosed with PBC during hospitalization and received UDCA treatment;most disease stages were advanced.After an average of 6.4±1.4 years of follow-up,82 patients had died,and 4 patients had undergone LT.After receiving UDCA treatment for 1 year,the score with the best discrimination performance was the Mayo,with a concordance statistic of 0.740(95%confidence interval:0.690-0.791).The albumin-bilirubin,GLOBE,and Mayo scores tended to overestimate transplant-free survival.Comparing 7 years of calibration results showed that the Mayo score was the best model.CONCLUSION The Mayo,GLOBE,UK-PBC,and ALBI scores demonstrated comparable discriminating performance for advanced stage PBC.The Mayo score showed optimal discriminatory performance and excellent predictive accuracy.

Cardioprotective effect of Danshen injectable powder on pressure overloadinduced ventricular remodeling in rats and isoproterenol induced myocardial injury in mice

OBJECTIVE To determine the effects of Danshen injectable powder on myocardial remodeling in pressure overload rats and isoproterenol(ISO) injection mice.METHODS SD Rats were subject to abdominal aortic constriction(AAC) surgery to develop pressure overload.Therapeutic effect of Danshen injectable powder was assessed six weeks after AAC surgery.The lactic dehydrogenase(LDH) and creatine kinase(CK) levels in serum,biometric,echocardiographic parameters,interstitial fibrosis,the expression of DJ-1 and SOD2 were then measured.The myocardial impairment in mice was induced by ISO injection.LDH and CK in serum,biometric,interstitial fibrosis were measured to investigate the cardioprotective effect of Danshen injectable powder.Matrix-assisted laser desorption mass spectrometry imaging(MALDI-MSI) was used to detect the changes of 60-1000 Da molecules in mice heart tissue.RESULTS In AAC rats,we observed compensatory hypertrophy and perivascular fibrosis,however cardiac function had not progressed to deterioration.The levels of LDH and CK were decreased significantly in the Danshen injectable powder groups(P<0.05,P<0.05).Danshen injectable powder could alleviate the perivascular collagen deposits but not cardiac hypertrophy in AAC rats.Furthermore,Danshen injectable powder enhanced the expression levels of SOD2 and DJ-1 in cardio.myocytes(P<0.05,P<0.01).In ISO injection mice,the levels of HWI and LDH were decreased signifi.cantly in drug treatment group compared with model group(P<0.01,P<0.01).In the MALDI-MSI of mice heart section,Danshen injectable powder can improve the reduction of energy metabolism-related substances including adenosine,creatine and ADP induced by ISO impairment.CONCLUSION Danshen injectable powder can attenuate perivascular fibrosis and improve the expression of antioxidative stress-related proteins SOD2,DJ-1 in the rats with pressure overload-induced left ventricular remodeling.Danshen injectable powder has cardioprotective effect on ISO impairment in mice which is probably related to improvement of energy metabolism.