Clinical features and prognosis of patients with primary biliary cholangitis complicated by hepatitis virus infection

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 You An 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 Ig G 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.