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原发性胆汁性胆管炎合并肝炎病毒感染患者的临床及预后特征
Clinical features and prognosis of patients with primary biliary cholangitis complicated by hepatitis virus infection
文章发布日期:2017年07月07日  来源:  作者:赵丹彤,闫惠平,刘燕敏,等  点击次数:198次  下载次数:15次

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【摘要】:目的 探讨原发性胆汁性胆管炎(PBC)患者合并肝炎病毒感染的临床及预后特征。方法 选取2004年10月-2012年10月北京佑安医院收治的确诊PBC合并肝炎病毒感染患者16例(7例合并慢性HBV感染,3例合并丙型肝炎,4例合并戊型肝炎,1例合并乙型肝炎和丙型肝炎,1例合并甲型肝炎),同时随机选择住院确诊无肝炎病毒感染的单纯PBC患者76例作为对照。比较两组患者临床特征、实验室指标、自身抗体结果,随访分析预后特征。正态分布计量资料两组间比较采用独立样本t检验,非正态分布计量资料两组间比较采用Mann-Whitney U秩和检验;计数资料组间比较采用χ2检验或Fisher精确概率法。组间生存率比较采用Kaplan-Meier法作log-rank检验。结果 PBC合并肝炎病毒感染患者与单纯PBC患者比较,其女性患者比例、ALP、CHO、IgG水平偏低(χ2=12.22,P=0.002;U=225.00,P<0.001;U=363.50,P=0.036;t=2.79,P=0.007);未出现腹壁静脉曲张、上消化道出血、肝性脑病症状;存在抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗胃壁细胞抗体(APCA)、抗肝特异蛋白抗体(LSP)、抗心肌抗体等多种自身抗体,APCA阳性率高于对照组(25.0% vs 3.9%,χ2=5.608,P=0.016);随访时间中位数为49.5个月(2~312个月),PBC合并肝炎病毒感染患者不良事件阳性率明显低于单纯PBC患者(25.0% vs 64.5%,χ2=8.43,P=0.005),两组患者的累积生存率和累积不良事件未发生率差异均无统计学意义(P值均>0.05)。结论 PBC合并肝炎病毒感染患者多数处于PBC早期,血清中存在非特异性自身抗体,目前未见肝炎病毒感染对PBC患者生存预后有影响。
【Abstract】:Objective To investigate the clinical features and prognosis of patients with primary biliary cholangitis(PBC) complicated by hepatitis virus infection. Methods A total of 16 patients who were admitted to Beijing YouAn Hospital from October 2004 to October 2012 and diagnosed with PBC complicated by hepatitis virus infection were enrolled, among whom 7 had chronic hepatitis B virus infection, 3 had hepatitis C, 4 had hepatitis E, 1 had hepatitis B and hepatitis C, and 1 had hepatitis A. A total of 76 hospitalized patients with PBC alone were enrolled as controls. The two groups were compared in terms of clinical features, laboratory markers, and autoantibodies, and follow-up visits were performed to investigate prognostic features. The independent samples t-test was used for comparison of normally distributed continuous data, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data; the chi-square test or Fisher′s exact test was used for comparison of categorical data. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used to compare survival rates between groups. Results Compared with the control group, the PBC-hepatitis virus infection group had significantly lower proportion of female patients (χ2=12.22, P=0.002), alkaline phosphatase (U=225.00, P<0.001), CHO (U=363.50, P=0.036), and IgG level (t=2.79, P=0.007), and no patients in the PBC-hepatitis virus infection group experienced abdominal wall varices, upper gastrointestinal bleeding, or hepatic encephalopathy. The PBC-hepatitis virus infection group had various autoantibodies including anti-nuclear antibody, smooth muscle antibody, anti-parietal cell antibody (APCA), anti-liver specific protein antibody, and anti-myocardial antibody, as well as a significantly higher APCA positive rate than the control group (25% vs 3.9%, χ2=5.608, P=0.016). The median follow-up time was 49.5 months (2-312 months). The PBC-hepatitis virus infection group had a significantly lower incidence rate of adverse events than the control group (25.0% vs 64.5%, χ2=8.43, P=0.005), and there were no significant differences between the two groups in cumulative survival rate and proportion of patients who did not experience any adverse event (both P>0.05). Conclusion Most patients with PBC complicated by hepatitis virus infection are in the early stage of PBC and have various nonspecific autoantibodies. Current study does not indicate that hepatitis virus infection has influence on the survival of PBC patients.
【关键字】:肝硬化,胆汁性;肝炎病毒;预后
【Key words】:liver cirrhosis, biliary; hepatitis viruses; prognosis
【引证本文】:赵丹彤, 闫惠平, 刘燕敏, 等. 原发性胆汁性胆管炎合并肝炎病毒感染患者的临床及预后特征[J]. 临床肝胆病杂志, 2017, 33(8): 1532-1536.

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