■探讨原发性胆汁性胆管炎(PBC)合并血脂异常患者对熊去氧胆酸(UDCA)治疗反应不良的影响因素及预后特征。
■进行了一项回顾性研究,涵盖512名确诊为PBC的患者,在华西医院接受治疗,四川大学2009年1月至2022年3月。根据他们对UDCA治疗的实际反应,患者分为两组,UDCA完全响应组(n=305)和UDCA无响应组(n=207)。比较两组的数据以预测影响患者反应的不良因素和受试者工作特征(ROC)曲线的曲线下面积(AUC),确定总胆固醇(TC)的临界值,并分析基线实验室检查结果和治疗反应率的差异。根据TC截止值,患者分为TC≥5.415mmol/L组和TC<5.415mmol/L组。此外,通过比较UK-PBC和GLOBE评分评估两组的预后差异.
■基线数据,包括丙氨酸转氨酶(ALT),天冬氨酸转氨酶(AST),总胆红素(TB),碱性磷酸酶(ALP),γ-谷氨酰转肽酶(GGT),甘油三酯(TG),TC,高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),与完全反应组相比,UDCA无反应组显着增加(所有P<0.005),与完全反应组相比,UDCA无反应组的白蛋白水平降低(P=0.012)。多因素logistic回归分析结果显示,TC(比值比[OR]=1.501,95%置信区间[CI]:1.275~1.767,P<0.01)和ALP(OR=1.005,95%CI:1.003~1.006,P<0.01)是影响患者疗效的独立危险因素。ROC曲线分析提示TC≥5.415mmol/L患者预后较差(AUC:0.727,95%CI:0.680-0.775,敏感性63.8%,76.4%特异性)。此外,高TC组(TC≥5.415mmol/L)治疗1年UK-PBC风险评分高于低TC组(TC<5.415mmol/L)(P<0.05)。
■高胆固醇血症是PBC患者对UDCA反应不良的独立危险因素。当基线TC等于或高于5.415mmol/L时,PBC患者对UDCA反应相对较差,预后较差。
UNASSIGNED: To examine the influencing factors and prognostic features of poor response to ursodeoxycholic acid (UDCA) treatment in primary biliary cholangitis (PBC) patients with dyslipidemia.
UNASSIGNED: A retrospective study was conducted, covering 512 patients who had a confirmed diagnosis of PBC, and who received treatment at West
China Hospital, Sichuan University between January 2009 and March 2022. According to their actual response to UDCA treatment, patients were divided into two groups, UDCA full-response group ( n=305) and UDCA non-responding group ( n=207). The data from the two groups were compared to predict the adverse factors influencing patient response and the area under the curve ( AUC) of the receiver operating characteristic (ROC) curve, identify the cut-off value of total cholesterol (TC), and analyze the differences in baseline laboratory test findings and the rate of responses to treatment. According to the TC cut-off value, patients were divided into a group with TC≥5.415 mmol/L and another group with TC<5.415 mmol/L. In addition, differences in the prognosis of the two groups were assessed by comparing the UK-PBC and GLOBE scores.
UNASSIGNED: The baseline data, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), triglycerides (TG), TC, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were significantly increased in the UDCA non-responding group compared to those in the full-response group (all P<0.005), while the albumin level of the UDCA non-responding group was decreased compared to that of the full-response group ( P=0.012). Findings of multi-factor logistic regression analysis suggested that TC (odds ratio [ OR]=1.501, 95% confidence interval [ CI]: 1.275-1.767, P<0.01) and ALP ( OR=1.005, 95% CI: 1.003-1.006, P<0.01) were independent risk factors influencing patient response. The ROC curve analysis suggested worse prognosis for patients with TC≥5.415 mmol/L ( AUC: 0.727, 95% CI: 0.680-0.775, 63.8% sensitivity, 76.4% specificity). In addition, the UK-PBC risk score at 1 year of treatment was higher in the high-TC group (TC≥5.415 mmol/L) than that in the low-TC group (TC<5.415 mmol/L) ( P<0.05).
UNASSIGNED: Hypercholesterolemia is an independent risk factor for poor response to UDCA in PBC patients. When the baseline TC is equal to or higher than 5.415 mmol/L, PBC patients have a relatively poor response to UDCA and poor prognosis.