背景:原发性胆汁性胆管炎(PBC)患者常出现抑郁症状。在PBC中尚未完全注意到抑郁症状在肝硬化中的作用。我们旨在建立考虑抑郁症状的肝硬化风险模型。
方法:采用17项汉密尔顿抑郁量表(HAMD-17)评估抑郁症状。分析HAMD-17评分与临床参数的关系。使用最小绝对收缩和选择算子(Lasso)-逻辑回归和决策树模型来探索抑郁症状对肝硬化的影响。
结果:PBC患者(n=162)的抑郁症状发生率高于健康对照组(n=180)(52.5%vs.16.1%;p<.001)。HAMD-17评分与C4水平呈负相关,与碱性磷酸酶(ALP)水平呈正相关,γ-谷氨酰转肽酶(GGT),总胆红素(TB),免疫球蛋白(Ig)G,和IgM(r=-0.162,0.197,0.355,0.203,0.182,0.314,p<.05)。在Lasso-logistic回归分析中,HAMD-17得分,人类白细胞抗原(HLA)-DRB1*03:01等位基因,年龄,ALP水平,和IgM水平(比值比[OR]=1.087、7.353、1.075、1.009、1.005;p<0.05)是肝硬化的独立危险因素。在决策树模型中,升高的HAMD-17评分也是PBC患者肝硬化高风险的判别因素。
结论:抑郁症状与疾病严重程度相关。HAMD-17评分升高是PBC患者肝硬化的危险因素。
BACKGROUND: Depressive symptoms are frequently observed in patients with primary biliary cholangitis (PBC). The role of depressive symptoms on cirrhosis has not been fully noticed in PBC. We aimed to establish a risk model for cirrhosis that took depressive symptoms into account.
METHODS: Depressive symptoms were assessed by the 17-item Hamilton Depression Rating Scale (HAMD-17). HAMD-17 score was analyzed in relation to clinical parameters. Least absolute shrinkage and selection operator (Lasso)-logistic regression and decision tree models were used to explore the effect of depressive symptoms on cirrhosis.
RESULTS: The rate of depressive symptom in patients with PBC (n = 162) was higher than in healthy controls (n = 180) (52.5% vs. 16.1%; p < .001). HAMD-17 score was negatively associated with C4 levels and positively associated with levels of alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), total bilirubin (TB), Immunoglobulin (Ig) G, and IgM (r = -0.162, 0.197, 0.355, 0.203, 0.182, 0.314, p < .05). In Lasso-logistic regression analysis, HAMD-17 score, human leukocyte antigen (HLA)-DRB1*03:01 allele, age, ALP levels, and IgM levels (odds ratio [OR] = 1.087, 7.353, 1.075, 1.009, 1.005; p < 0.05) were independent risk factors for cirrhosis. Elevated HAMD-17 score was also a discriminating factor for high risk of cirrhosis in patients with PBC in decision tree model.
CONCLUSIONS: Depressive symptoms were associated with disease severity. Elevated HAMD-17 score was a risk factor for cirrhosis in patients with PBC.