肝纤维化进展预测经熊去氧胆酸治疗的原发性胆汁性肝硬化患者的长期预后

摘要

目的 探讨肝纤维化进展预测经熊去氧胆酸(UDCA)治疗的原发性胆汁性肝硬化患者(PBC)长期预后的效果.方法 回顾性分析1992年至2013年于延安大学附属医院接受UDCA规范化治疗[13～15 mg/ (kg·d)]的108例PBC患者的临床资料.根据γ-谷胺酰转酞酶(GGT)减少率ROC截断值将PBC患者分为UDCA应答组和UDCA不应答组.运用Kaplan-Meier曲线比较两组患者累积生存率的差异,Logistic回归分析PBC患者UDCA不应答的危险因素,比较不同纤维化Scheuer和Nakanuma病理分期PBC患者的生存率.结果 GGT减少率的ROC截断值为69％,UDCA应答组54例(GGT减少率≥69％),UDCA不应答组54例(GGT减少率＜69％).UDCA应答组累积生存率显著高于不应答组(x2=9.783,P=0.002).Scheuer分期和Nakanuma分期是UDCA不应答的独立危险因素.Scheuer 1期和2期PBC患者的预后显著优于3期和4期(P均＜0.05).Nakanuma 1期和2期PBC患者的预后显著优于4期(x2值分别为3.998、14.78,P值分别为0.046、0.001).结论 Scheuer 3期和Nakanuma 4期可预测经UDCA治疗的PBC患者的长期预后.%Objective To investigate the effects of liver fibrosis progress on prediction of long-term prognosis in patients with primary biliary cirrhosis who were treated with ursodeoxycholic acid (UDCA).Methods Clinical data of 108 patients with primary biliary cirrhosis (PBC) who received UDCA standardized treatment [13～ 15 mg/(kg·d)] from 1992 to 2013 in the Affiliated Hospital of Yan'an University were retrospectively analyzed.The patients were divived into UDCA response group and UDCA non-response group according to ROC cut-off value of γ-glutamyl transpeptidase (GGT) reduction rate.The cumulative survival rate was compared by Kaplan-Meier curve.The risk factors of UDCA non-response were analyzed by the Logistic regression.The cumulative survival rates of PBC patients with different pathological stage of Scheuer and Nakanuma system were compared.Results The ROC cut-off value of GGT reduction rate was 69％.There were 54 cases in UDCA response group (GGT reduction rate ≥ 69％) and 54 cases in UDCA non-response group (GGT reduction rate ＜ 69％).The cumulative survival rate of patients in UDCA response group were higher than that of UDCA non-response group (x2 =9.783,P =0.002).Scheuer stage and Nakanuma stage were the independent risk factors of UDCA non-response.The survival prognosis of patients in Scheuer stage 1 and 2 were better than those in stage 3 and 4 (P ＜ 0.05).The survival prognosis of patients in Nakanuma stage 1 and 2 were better than those in stage 4 (x2 =3.998,14.78;P =0.046,0.001).Conclusion Long-term prognosis of patients with PBC who were treated with UDCA therapy could be predicted by Scheuer stage 3 and Nakanuma stage 4.