目的探究全身免疫炎症指标,包括全身免疫炎症指数(systemic immune-inflammation index,SII)、中性粒细胞-淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)及单核细胞-淋巴...目的探究全身免疫炎症指标,包括全身免疫炎症指数(systemic immune-inflammation index,SII)、中性粒细胞-淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)及单核细胞-淋巴细胞比值(monocyte-lymphocyte ratio,MLR)对原发性胆汁性胆管炎(primary biliary cholangitis,PBC)患者肝癌发生的预测价值。方法回顾性分析了从2010年至2021年北京佑安医院835例来院诊疗的PBC患者,并且收集了他们初次来我院被诊断为PBC时的人口统计学相关信息和实验室检查结果。首先,比较了最终发生肝癌组和未发生肝癌组间基线水平的血常规、肝生化及免疫相关抗体指标的差异性,随后利用Cox回归模型筛选出了PBC相关肝癌的危险因素,最后根据ROC曲线下面积(AUC)比较不同指标对PBC相关肝癌发生的预测价值。结果年龄、存在肝硬化是PBC相关肝癌的危险因素。此外,对于预测肝癌发生的全身免疫炎症指标,我们的结果表明MLR较其他指标可以更好地预测PBC患者肝癌的发生。结论在PBC患者中,将MLR添加到目前的计算指标中,用于PBC发生肝癌的高危患者的早期预警,增加该部分患者的常规检测频率,可能有助于及时监测到患者的肝癌发生,以提供早期且更合适的治疗选择。展开更多
Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Me...Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.展开更多
基金This study was supported by a grant from the National Natural Science Foundation of China(81870457).
文摘Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.
文摘目的:探究阿法骨化醇联合熊去氧胆酸(UDCA)对原发性胆汁性胆管炎(PBC)的疗效及抗肝纤维化作用。方法:2022年6月至2023年6月山西省汾阳医院收治的符合纳入标准的25羟维生素D即25(OH)D_(3)<50 nmol/L的PBC患者70例,随机分为治疗组35例和对照组35例,治疗组为阿法骨化醇联合UDCA治疗;对照组为UDCA单独治疗。持续治疗6月后检查患者的25(OH)D_(3)、血小板、肝功能、免疫球蛋白、肝硬度(LSM)和药物不良反应,计算FIB-4指数(fibrosis 4 score)、天冬氨酸转氨酶和血小板比率指数(aspartate aminotransferase to platelet ratio index,APRI)评分、GLOBE评分和UK-PBC评分,满足正态分布的计量资料采用均数±标准差(x±s)表示,两组间比较用独立样本t检验;不满足正态分布的计量资料采用M(P_(25),P_(75))表示,两组间比较采用Mann-Whitney U检验;应答率比较用卡方检验。结果:治疗后对照组和治疗组应答率分别为42.85%和71.42%;γ-谷氨酰转肽酶(GGT)分别为160(128,194)、85(72,102)U/L,碱性磷酸酶(ALP)分别为156(123,264)、110(56,141)U/L;免疫球蛋白M(IgM)分别为(3.51±0.84)、(2.71±0.81)g/L;25(OH)D_(3)分别为(40.21±3.25)、(57.06±14.76)nmol/L;肝硬度分别为10.8(8.3,15.1)、8.9(6.7,12.2)Kpa;FIB-4指数分别为2.28(0.99,3.66)、1.46(0.97,2.55);APRI评分分别为0.65(0.33,1.09)、0.30(0.17,0.53);GLOBE评分分别为0.85±0.73、0.13±0.51;UK-PBC评分分别为0.024(0.018,0.060)、0.021(0.012,0.033),差异均有统计学意义(均P<0.05)。结论:阿法骨化醇联合UDCA较单独应用UDCA可显著提高PBC患者治疗应答率,而且阿法骨化醇一定程度上可改善肝纤维化,有助于PBC的病情改善,无不良反应。
