摘要
目的观察熊去氧胆酸(ursodeoxyeholic acid,UDCA)对具有自身免疫性肝炎(autoimmune hepatitis,AIH)重叠特征的原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)和单纯PBC患者的疗效以及对生存期的影响。方法回顾性分析20例因PBC死亡的患者,以患者死亡为研究终点,采用简化评分标准进行分组。其中12例诊断可能为AIH,将此12例具重叠特征和8例无重叠特征的PBC患者分别进行研究,分析2组在UDCA初治及研究终点时的临床特征、UDCA治疗的生化学应答及生存期情况。结果 2组在UDCA治疗基线的PLT、ALP、GGT、ALT、AST、ALB、TBIL、TBA、CRE、PT、INR水平及梅奥风险评分差异均无统计学意义,而抗核抗体或抗平滑肌抗体≥1∶80的阳性率、血清球蛋白或IgG≥1.1倍正常值上限的百分比及AIH治疗前的简化评分差异均有统计学意义。UDCA治疗后有重叠特征组的生存时间为(24.4±16.5)个月,中位生存时间为22.0个月;无重叠特征组生存时间为(60.6±43.3)个月,中位生存时间为50.5个月。采用Kaplan-Meier生存分析显示,重叠特征组经过UDCA治疗后预后较差,Log-rank检验结果显示2组生存时间差异有统计学意义。在导致死亡的原因中,2组发病率差异均无统计学意义,但数据显示上消化道出血仍为主要死亡原因。结论对于巴黎标准不能确诊而简化评分标准可确诊的AIHPBC患者,单纯UDCA治疗预后差,生存时间较无重叠特征的PBC患者短。
Objective To investigate the efficacy of ursodeoxycholic acid （UDCA） therapy in patients with primary biliary cir- rhosis （PBC）-autoimmune hepatitis （AIH） overlap features and PBC patients without PBC-AIH overlap features, and the effect of UDCA therapy on survival. Methods The data of 20 patients who died of PBC were analyzed retrospectively. With death as the endpoint of the study, the patients were divided in 2 groups using the simplified AIH scoring system, PBC-AIH group consisting of 12 patients diagnosed with a possible AIH, and PBC group consisting of 8 patients without PBC-AIH overlap features. The clini- cal characteristics at baseline and endpoint of the study, biochemical response to UDCA therapy and survival of the 2 groups were compared and analyzed. Results The baseline levels of PLT, ALP, GGT, ALT, AST, ALB, TBIL, TBA, CRE, PT, international normalized ratio and Mayo risk score were not significantly different between PBC-AIH group and PBC group. The positive rates of antinuclear antibody or smooth muscle antibody i〉 1：80, the percentage of serum globulin or IgG 〉 1.1 times upper limit of nor- mal and the pre-treatment simplified AIH scores were significantly different. After UDCA therapy, the survival of PBC-AIH group was 24.4＋16.5 months, with a median survival of 22.0 months, and that of PBC group 60.6＋43.3 months, with a median survival of 50.5 months. Kaplan-Meier survival analysis showed that PBC-AIH group had a significantly worse prognosis after UDCA thera- py, and log-rank test showed that the survival was significantly different between the 2 groups. The incidence rates of the complica- tions causing death were not significantly different, but it was shown that the upper gastrointestinal bleeding remained a major cause of death. Conclusions Patients with PBC-AIH overlap features diagnosed with simplified scoring system instead of Paris standards have a poor prognosis after UDCA therapy and shorter survival as compared with PBC patients without PBC-AIH overlap features.
出处
《传染病信息》
2013年第5期284-287,共4页
Infectious Disease Information
基金
解放军第三〇二医院院内课题(YNKT2001008)
关键词
肝硬化
胆汁性
熊脱氧胆酸
预后
liver cirrhosis, biliary
ursodeoxycholic acid
prognosis
