原发性胆汁性胆管炎合并代谢相关脂肪性肝病的临床特征及危险因素分析
DOI: 10.12449/JCH240815
Primary biliary cholangitis with metabolic associated fatty liver disease: Clinical features and risk factors
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摘要:
目的 分析原发性胆汁性胆管炎(PBC)合并代谢相关脂肪性肝病(MAFLD)的临床特征及危险因素,探讨两种疾病合并时的相互影响。 方法 选取2019年1月—2022年12月于昆明医科大学第一附属医院确诊为PBC和MAFLD的患者187例,分为PBC组70例,PBC合并MAFLD组38例,MAFLD组79例。收集病例的一般资料、临床症状、血清学指标、瞬时弹性纤维成像(FibroScan)及非侵入性纤维化指标,分析比较三组间的不同特点。计量资料三组间比较采用单因素方差分析或Kruskal-Wallis H检验;计数资料组间比较使用χ2检验或Fisher精确检验。多因素分析采用二元Logistic回归分析。 结果 三组在性别、年龄、身高、体质量、BMI、自身免疫性疾病病史方面差异均有统计学意义(P值均<0.05)。PBC合并MAFLD组以女性患者多见(89.5%),平均年龄为(57.26±12.72)岁,BMI为(23.35±3.70) kg/m2;PBC组中自身免疫性疾病病史检出率为25.7%(18例)。三组乏力、纳差、瘙痒、黄疸、静脉曲张、腹水、脾大发生率比较,差异均有统计学意义(P值均<0.05)。PBC合并MAFLD组患者常见的症状为乏力、纳差、腹痛、腹胀,分别为18例(47.4%)、15例(39.5%)、14例(36.8%)、16例(42.1%);MAFLD组患者常见的症状为腹痛、腹胀,分别为34例(43%)、32例(40.5%);PBC组患者常见的症状及并发症为乏力、纳差、黄疸、腹痛、腹胀、静脉曲张、腹水、脾大,分别为37例(52.9%)、25例(35.7%)、25例(35.7%)、18例(25.7%)、25例(35.7%)、19例(27.9%)、23例(32.9%)、44例(62.9%)。PBC合并MAFLD组的CAP值高于PBC组(P<0.05);PBC组的LSM值、APRI、FIB-4均高于MAFLD组(P值均<0.05)。将不存在多重共线性的因素纳入回归分析,以PBC组为参照组,FIB-4(OR=0.218,95%CI:0.069~0.633)、自身免疫性疾病病史(OR=0.229,95%CI:0.067~0.810)为PBC合并MAFLD的独立影响因素(P值均<0.05);以MAFLD组为参照组,ALT(OR=0.157,95%CI:0.025~1.000)、TBil(OR=0.995,95%CI:0.990~0.999)为PBC合并MAFLD的独立影响因素(P值均<0.05)。 结论 PBC合并MAFLD临床表现并不特异,但PBC患者的临床表现更为严重,且肝功能失代偿发生率更高。两种疾病合并不一定会加重PBC的疾病进展。 Abstract:Objective To investigate the clinical features and risk factors of primary biliary cholangitis (PBC) comorbid with metabolic associated fatty liver disease (MAFLD) and the interaction between the two diseases. Methods A total of 187 patients who were diagnosed with PBC, MAFLD, or PBC with MAFLD in The First Affiliated Hospital of Kunming Medical University from January 2019 to December 2022 were enrolled and divided into PBC group with 70 patients, PBC+MAFLD group with 38 patients, and MAFLD group with 79 patients. Related data were collected, including general information, clinical symptoms, serological parameters, transient elastography (FibroScan), and non-invasive fibrosis markers, which were compared between the three groups. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between groups, the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups, and the binary Logistic regression analysis was used for multivariate analysis. Results There were significant differences between the three groups in sex, age, height, weight, body mass index (BMI), and history of autoimmune diseases (P<0.05). In the PBC+MAFLD group, female patients accounted for 89.5%, with a mean age of 57.26±12.72 years and a BMI of 23.35±3.70 kg/m2, and in the PBC group, the detection rate of autoimmune diseases was 25.7% (18 patients). There were significant differences between the three groups in the incidence rates of weakness, poor appetite, pruritus, jaundice, varices, ascites, and splenomegaly (all P<0.05). The PBC+MAFLD group had the common symptoms of weakness in 18 patients (47.4%), poor appetite in 15 patients (39.5%), abdominal pain in 14 patients (36.8%), and abdominal distension in 16 patients (42.1%); the MAFLD group had the common symptoms of abdominal pain in 34 patients (43%) and abdominal distension in 32 patients (40.5%); the PBC group had the common symptoms of weakness in 37 patients (52.9%), poor appetite in 25 patients (35.7%), jaundice in 25 patients (35.7%), abdominal pain in 18 patients (25.7%), abdominal distension in 25 patients (35.7%), varices in 19 patients (27.9%), ascites in 23 patients (32.9%), and splenomegaly in 44 patients (62.9%). The PBC+MAFLD group had a controlled attenuation parameter (CAP), which was higher than that of the PBC group, and the PBC group had significantly higher levels of liver stiffness measurement, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) than the MAFLD group (all P<0.05). The factors without multicollinearity were included in the regression analysis, and with the PBC group as the reference group, FIB-4 (odds ratio [OR]=0.218, 95% confidence interval [CI]: 0.069 — 0.633, P<0.05) and history of autoimmune diseases (OR=0.229, 95%CI: 0.067 — 0.810, P<0.05) were influencing factors for the onset of PBC with MAFLD; with the MAFLD group as the reference group, ALT (OR=0.157, 95%CI: 0.025 — 1.000, P<0.05) and TBil (OR=0.995, 95%CI: 0.990 — 0.999, P<0.05) were influencing factors for the onset of PBC with MAFLD. Conclusion PBC with MAFLD lacks specific clinical manifestations, and PBC patients tend to have more severe clinical manifestations and a higher incidence rate of liver function decompensation. PBC comorbid with MAFLD may not aggravate the disease progression of PBC. -
慢加急性肝衰竭(ACLF)指伴有或者不伴肝硬化的慢性肝病患者,合并肝脏和肝外器官功能衰竭。2023年11月9日Hepatology在线发表了由美国肝病学会(AASLD)专家小组制定的ACLF实践指南[1],对于ACLF和肝硬化危重症患者管理相关主题的文献进行了全面审查和分析,并提出了指导意见。
1. ACLF定义
指导意见:
(1)ACLF定义中需要包括以下方面:①临床症状急性出现,迅速恶化。②存在或不存在肝硬化患者出现肝衰竭的表现,定义为胆红素升高以及国际标准化比值(INR)延长。③至少存在1个肝外器官功能衰竭(神经、循环、呼吸或者肾脏)。
(2)本文指导意见主要是聚焦于ACLF和严重器官衰竭患者的管理,这些患者通常需要在重症监护室(ICU)治疗。
2. 预后预测模型
指导意见:
(3)与肝硬化相关预后评分(如MELD或MELD-Na)相比,推荐使用肝和肝外器官衰竭评分(例如NACSELD、CLIF-C或AARC ACLF评分),以评估肝硬化和/或ACLF危重患者的预后。
(4)连续计算ACLF特异性评分可能有助于进一步评估ACLF住院患者的预后。
3. 肝硬化合并ACLF和/或危重症患者脏器功能衰竭管理建议
3.1 脑衰竭
指导意见:
(5)应使用West Haven肝性脑病(HE)分级标准和格拉斯哥(Glasgow)昏迷评分来描述肝硬化危重症患者脑功能衰竭情况。根据West Haven标准3级或4级HE和Glasgow昏迷评分<8分表示严重脑损伤。
(6)3级和4级HE患者考虑收住到ICU治疗。
(7)疑似HE患者应查找潜在的诱发因素,并进行经验性治疗。
(8)肝硬化合并意识障碍的患者,应同时查找肝脏无关的病因(如酒精戒断、结构性脑损伤等),特别是第一次发生意识障碍或者对充分的经验性治疗效果不好的患者。
(9)ACLF/危重患者HE治疗包括乳果糖(口服或直肠给药),如果患者有肠梗阻/腹胀的风险,可以使用聚乙二醇。ACLF患者中,使用利福昔明作为乳果糖/聚乙二醇的联合治疗方案值得进一步研究。
(10)半衰期较短的药物(例如异丙酚、右美托咪定)可用于肝硬化患者气管插管和机械通气时镇静镇痛治疗。
(11)对症状与既往HE发作相似的患者,无需常规进行头颅影像学检查。
(12)不建议对肝硬化意识状态改变患者行常规检测血氨水平。
3.2 心血管衰竭
指导意见:
(13)所有肝硬化危重患者均应进行容量状态、器官灌注和心血管功能的早期基线评估。
(14)伴有肝硬化、低血压或休克的患者,床旁超声心动图有助于评估容量状态和心脏功能。
(15)对于肝硬化合并休克的危重患者,应利用血流动力学监测工具实施谨慎的容量复苏策略,以优化容量状态。如果需要复苏,建议使用平衡晶体(例如乳酸林格液)和/或白蛋白(选择适应证)。
(16)考虑将肝硬化和脓毒性休克患者目标平均动脉压(MAP)设定为65 mmHg,并持续评估器官终末灌注。当需要充分评估心功能、滴定血管活性药以及指导液体复苏时可进行有创血流动力学监测(动脉和中心静脉导管)。
(17)推荐将去甲肾上腺素作为经适当液体复苏后仍存在低血压患者的首选血管升压药。当需要增加去甲肾上腺素剂量时,推荐使用血管升压素作为二线药物。
(18)对于需要使用高剂量血管升压药的难治性休克患者,可考虑筛查肾上腺功能不全或者经验性给予氢化可的松50 mg静脉注射,每6 h一次或200 mg静脉滴注7 d或直到转出ICU。
3.3 呼吸衰竭
指导意见:
(19)对于肝硬化合并呼吸衰竭患者,应对与肝硬化相关的呼吸合并症(胸腔积液、腹水、肝肺综合征)进行检查和治疗。对于与胸腔积液或张力性腹水相关的呼吸合并症患者,建议进行治疗性胸腔穿刺术/腹腔穿刺术。
(20)在治疗ACLF合并急性低氧性呼吸衰竭时,应考虑使用经鼻高流量吸氧治疗,并密切监测,以评估是否需要升级为有创机械通气(例如呼吸急促、难治性低氧血症)。
(21)对于非急性肺损伤(ALI)需要机械通气的肝硬化和/或ACLF患者,提倡采用低平台压(潮气量,6~10 mL/kg预测体质量)的肺保护性通气策略,以尽可能防止呼吸机相关肺损伤。提倡尽可能保留患者自主呼吸。
(22)在需要机械通气的ACLF合并ALI患者中,推荐采用低潮气量(6 mL/kg预测体质量)和低平台压(<30 cm H2O)的肺保护策略。
(23)在ACLF合并轻度ALI(PaO2/FiO2:200~300 mmHg)患者机械通气期间,应考虑采用低呼气末正压策略,以尽量减少对静脉回流和心脏前负荷的影响。对于中重度ALI患者可能需要高低呼气末正压策略。
3.4 肾衰竭
指导意见:
(24)对于肝硬化和急性肾损伤(AKI)患者,在停用利尿剂并治疗细菌感染、低容量等诱发因素后,可给予1 g/kg白蛋白输注,最大剂量为100 g/d,建议持续48 h。
(25)对于符合2期或更高程度的肝肾综合征-急性肾损伤(HRS-AKI)诊断标准的患者,在排除禁忌证后,推荐使用血管收缩剂联合白蛋白(20~40 g/d)。目前,还不建议在1期AKI患者中使用血管收缩剂。在使用血管收缩剂治疗HRS过程中,输注白蛋白的最佳疗程尚不清楚。
(26)特利加压素(0.5~2.0 mg静脉注射,每6 h一次或者2 g/24 h持续输注)适用于HRS-AKI 2级及以上,且不存在EASL-CLIF标准ACLF-3级或主要心脏、肺部及血管疾病的住院患者。
(27)去甲肾上腺素可作为特利加压素的替代品用于HRS-AKI患者,对于存在休克的患者可能是更好的选择。
(28)肝硬化合并AKI患者进行肾替代治疗应该个体化。总体而言,肾替代治疗推荐用于药物治疗失败及已经列入或考虑列入肝移植等待名单的HRS-AKI患者。
(29)肝移植是肝硬化HRS-AKI的最终治疗方法,但需要结合多器官功能衰竭情况和肝移植的整体候选情况来考虑。
3.5 感染的控制
指导意见:
(30)对于因肝硬化并发症住院的患者,特别是ACLF患者,建议对感染进行全面检查,包括诊断性穿刺、血培养、尿检、尿液培养和胸部X线检查。
(31)对于临床状态发生改变(新出现或者恶化的腹水、HE、AKI、器官衰竭和/或ACLF)的患者,应重复进行感染筛查。
(32)应根据感染的病因、严重程度、感染方式和当地的耐药模式来选择抗生素。
(33)为预防肝硬化住院患者的感染和继发ACLF,应尽量减少使用质子泵抑制剂和导尿。
(34)对适当抗生素治疗48 h后仍无反应的院内感染和/或ACLF患者,考虑扩大抗菌药物的覆盖范围,包括多重耐药菌和/或真菌感染。
3.6 凝血功能障碍
指导意见:
(35)凝血酶生成或全血黏弹性测定等凝血功能全面检测,能更好地反映肝硬化患者的总体止血状况,但尚未得到临床验证。
(36)INR不应用于评估肝硬化/ACLF患者的出血风险。
(37)肝硬化患者治疗性抗凝后出血并发症的发生率与一般人群治疗性抗凝后出现非门静脉高压性出血并发症的发生率相同。对于患有ACLF和严重血小板减少(血小板计数<50×109/L)的患者,应根据具体情况决定全身抗凝治疗的安全性。
3.7 营养支持
指导意见:
(38)建议营养支持团队及早参与ACLF住院患者诊疗方案制订。
(39)应在肝硬化和/或ACLF患者进入ICU时对其营养状况和风险进行客观评估(如NUTRIC评分)。
(40)如果有间接热量计,则应测量能量和蛋白质需求量;如果没有间接热量计,则应使用预测方程计算能量和蛋白质需求量。
(41)在使用预测方程计算肝硬化和/或ACLF患者能量和蛋白质需求量时,建议使用理想体质量而不是实际体质量。
(42)应考虑将ACLF患者的初始热量目标设定为12~25 kcal/kg,但上限应适合无肥胖症的患者,并随着临床病程的发展逐步提高目标值。
(43)不建议限制蛋白质摄入;推荐肝硬化和/或ACLF患者在重症监护病房的蛋白质摄入标准为每天1.2~2.0 g/kg理想体质量。
(44)如果没有禁忌证,建议使用肠内营养而非肠外营养。
(45)对于需要大剂量血管加压支持的患者(例如>0.15 μg·kg-1·min-1的去甲肾上腺素或其他同等剂量药物),应继续使用肠内营养支持。
(46)开始营养支持后,应监测营养不良患者的再喂养综合征(如低钾血症、低磷血症、心律失常等),进行常规电解质/心电图监测。
(47)建议肝硬化危重患者或ACLF患者的目标血糖值为140~180 mg/dL(7.8~10.0 mmol/L)。
3.8 肝移植治疗
指导意见:
(48)对于肝硬化和ACLF和/或危重患者,可在选定的患者中快速进行肝移植治疗。但目前,与可接受结果相关的具体预测因素尚不明确。
(49)在决定是否进行治疗时,应根据是否适合快速肝移植的可用资源和ACLF的潜在可逆性来决定。
3.9 姑息治疗
指导意见:
(50)对于伴有肝硬化和/或ACLF的重症患者,应考虑进行姑息治疗咨询,以确定和解释预后,并确定护理目标。
(51)患者护理团队的任何成员都可以通过晚期护理计划和症状管理来提供基本的姑息关怀。在条件允许的情况下,姑息关怀专家和肝病专家应通力合作,为每位患者实现预期的关怀目标。
(52)以疾病为导向的关怀,可对患者进行移植评估,并将患者列入等待名单,也可以同时提供姑息关怀服务或姑息关怀专科咨询。
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表 1 MAFLD组、PBC合并MAFLD组与PBC组一般资料的比较
Table 1. Comparisons of clinical information among MAFLD group and MAFLD combined with PBC group and MAFLD group
项目 MAFLD组(n=79) PBC合并MAFLD组(n=38) PBC组(n=70) 统计值 P值 性别[例(%)] χ2=39.297 <0.001 男 42(53.2) 4(10.5) 8(11.4) 女 37(46.8) 34(89.5) 62(88.6) 民族[例(%)] χ2=2.313 0.339 汉族 72(91.1) 37(97.4) 67(95.7) 其他 7(8.9) 1(2.6) 3(4.3) 年龄(岁) 50.92±18.26 57.26±12.72 56.90±11.24 F=3.874 0.023 身高(m) 1.66±0.81 1.60±0.63 1.57±0.07 F=24.106 <0.001 体质量(kg) 68.48±12.22 59.83±12.31 53.61±9.23 F=32.995 <0.001 BMI(kg/m2) 24.87±3.56 23.35±3.70 21.58±3.11 F=17.006 <0.001 高血压[例(%)] 34(43.0) 16(42.1) 23(32.9) χ2=1.805 0.406 糖尿病[例(%)] 11(13.9) 7(18.4) 5(7.1) χ2=3.239 0.198 自身免疫性疾病[例(%)] 3(3.8) 4(10.5) 18(25.7) χ2=15.726 <0.001 吸烟史[例(%)] 12(15.2) 2(5.3) 5(7.1) χ2=3.886 0.143 表 2 三组患者临床特征比较
Table 2. Distribution of clinical manifestations in MAFLD group and MAFLD combined with PBC group and MAFLD group
临床表现 MAFLD组(n=79) PBC合并MAFLD组(n=38) PBC组(n=70) χ2值 P值 乏力[例(%)] 7(8.9) 18(47.4) 37(52.9) 36.763 <0.001 纳差[例(%)] 8(10.1) 15(39.5) 25(35.7) 17.500 <0.001 瘙痒[例(%)] 0(0.0) 2(5.3) 12(17.1) 16.088 <0.001 黄疸[例(%)] 0(0.0) 3(7.9) 25(35.7) 39.060 <0.001 腹痛[例(%)] 34(43.0) 14(36.8) 18(25.7) 4.927 0.085 腹胀[例(%)] 32(40.5) 16(42.1) 25(35.7) 0.547 0.761 静脉曲张[例(%)] 0(0.0) 6(15.8) 19(27.9) 23.850 <0.001 腹水[例(%)] 0(0.0) 5(13.2) 23(32.9) 31.596 <0.001 脾大[例(%)] 0(0.0) 8(21.1) 44(62.9) 74.130 <0.001 表 3 MAFLD组、PBC合并MAFLD组与PBC组血清学及体液免疫指标的比较
Table 3. Distribution of biochemical indices in MAFLD group and MAFLD combined with PBC group and MAFLD group
指标 MAFLD组(n=79) PBC合并MAFLD组(n=38) PBC组(n=70) 统计值 P值 WBC(×109/L) 6.07±1.49 5.21±1.791) 4.79±1.621) F=12.355 <0.001 RBC(×1012/L) 4.92±0.63 4.37±0.611)2) 3.97±0.741) F=36.845 <0.001 HGB(g/L) 149.80±20.20 133.26±17.951)2) 120.79±20.891) F=39.220 <0.001 PLT(×109/L) 238.00(206.00~284.00) 186.50(152.75~246.25)1) 148.00(102.50~217.75)1) χ2=38.405 <0.001 INR 0.97(0.93~1.02) 1.01(0.96~1.60) 1.00(0.93~1.08) χ2=5.701 0.058 TP(g/L) 74.11±6.08 74.01±14.241)2) 71.92±8.781) F=713.086 <0.001 Alb(g/L) 44.43±3.89 41.96±5.862) 36.37±7.081) F=5.754 0.004 AST(U/L) 22.50(19.00~29.40) 30.45(21.45~54.67) 57.50(33.35~88.70)1) χ2=18.684 <0.001 ALT(U/L) 27.50(17.90~48.20) 29.70(21.60~48.50)1)2) 37.75(23.50~73.95)1) χ2=29.228 <0.001 TBil(μmol/L) 10.90(9.10~14.90) 13.40(10.25~16.15)1)2) 21.15(10.57~43.27) χ2=30.580 <0.001 DBil(μmol/L) 4.50(3.60~6.40) 6.05(4.20~7.62)1) 13.20(6.10~36.80)1) χ2=14.147 <0.001 IBil(μmol/L) 6.40(5.00~9.10) 6.90(5.57~9.25)1)2) 5.55(4.10~9.65)1) χ2=48.398 <0.001 TBA(μmol/L) 4.00(2.00~6.10) 12.00(4.60~26.10)1)2) 29.90(12.35~70.85)1) χ2=145.829 <0.001 ALP(U/L) 75.40(65.80~92.20) 89.20(68.92~118.15)1) 220.10(125.50~372.60)1) χ2=133.490 <0.001 CHE(KU/L) 8.97±2.08 7.48±2.261) 5.71±2.391) F=111.814 <0.001 GGT(U/L) 35.00(20.00~70.00) 73.00(36.75~171.75)1) 234.35(99.00~510.00)1) χ2=135.308 <0.001 Urea(mmol/L) 5.15±1.29 4.50±1.211) 4.92±2.061) F=501.376 <0.001 Cr(μmol/L) 78.10±17.03 72.82±16.511) 68.70±19.121) F=200.216 <0.001 UA(μmol/L) 392.58±107.38 351.49±118.631) 309.02±103.841) F=700.969 <0.001 GLU(mmol/L) 5.01±1.28 5.24±1.19 4.87±0.86 F=1.073 0.344 CHOL(mmol/L) 4.75(4.01~5.38) 5.31(3.84~5.97)1) 4.79(4.03~6.01)1) χ2=125.700 <0.001 TG(mmol/L) 1.56(1.31~2.35) 1.91(1.48~2.61)1) 1.48(1.05~2.01)1) χ2=23.096 <0.001 HDL-C(mmol/L) 1.08(0.94~1.34) 1.21(0.95~1.40)1) 1.29(1.06~1.71)1) χ2=104.357 <0.001 LDL-C(mmol/L) 2.83(2.34~3.56) 2.86(1.91~3.91)1) 2.74(2.13~3.61)1) χ2=133.879 <0.001 IgG(g/L) 12.00(10.37~13.62) 13.80(10.12~17.65)1) 15.00(12.77~18.72)1) χ2=130.111 <0.001 IgA(g/L) 2.20(1.75~2.89) 2.35(1.61~3.38) 2.72(1.93~3.69) χ2=3.421 0.181 IgM(g/L) 0.77(0.50~1.19) 1.83(0.94~3.14) 1.99(1.49~3.45)1) χ2=11.227 0.004 C3(g/L) 1.13±0.22 1.06±0.421) 1.07±0.351) F=564.158 <0.001 C4(g/L) 0.24(0.20~0.29) 0.22(0.13~0.26) 0.18(0.13~0.24)1) F=4.262 0.016 注:与MAFLD组比较,1)P<0.05;与PBC组比较,2)P<0.05。
表 4 PBC合并MAFLD组与PBC组自身免疫性肝炎抗体谱的比较
Table 4. Comparisons of circulating immune indices in liver between MAFLD combined with PBC group and MAFLD group
抗体 PBC合并MAFLD组(n=38) PBC组(n=70) χ2值 P值 ANA阳性[例(%)] 37(97.4) 67(95.7) 0.189 0.559 AMA阳性[例(%)] 22(57.9) 51(77.1) 3.742 0.053 AMA-M2阳性[例(%)] 22(57.9) 56(80.0) 6.481 0.011 AMA-3E阳性[例(%)] 20(52.6) 56(80.0) 8.848 0.003 gp210阳性[例(%)] 15(39.5) 20(28.6) 1.336 0.248 Sp100阳性[例(%)] 2(5.3) 10(14.3) 2.030 0.154 表 5 PBC合并MAFLD组与PBC组ANA分型的比较
Table 5. Comparisons of ANA typing-indices between MAFLD combined with PBC group and MAFLD group
ANA分型 PBC合并MAFLD组(n=37) PBC组(n=67) χ2值 P值 胞浆颗粒型[例(%)] 5(13.5) 8(11.9) 0.054 >0.05 核膜型[例(%)] 10(27.0) 16(23.9) 0.126 0.723 核颗粒型[例(%)] 7(18.9) 11(16.4) 0.104 0.747 核仁型[例(%)] 2(5.4) 1(1.5) 1.303 0.288 核点型[例(%)] 5(13.5) 3(4.5) 2.741 0.129 着丝点型[例(%)] 7(18.9) 18(26.9) 0.824 0.364 线粒体型[例(%)] 20(54.1) 54(80.6) 8.182 0.004 均质型[例(%)] 1(2.7) 2(3.0) 0.007 >0.05 纺锤体型[例(%)] 0(0.0) 1(1.5) 0.558 >0.05 棒环状高尔基体型[例(%)] 1(2.7) 0(0.0) 1.828 0.356 溶酶体型[例(%)] 0(0.0) 1(1.5) 0.558 >0.05 肌动蛋白型[例(%)] 0(0.0) 2(3.0) 1.126 0.537 表 6 MAFLD组、PBC合并MAFLD组与PBC组FibroScan参数的比较
Table 6. Comparisons of FibroScan among MAFLD group and MAFLD combined with PBC group and MAFLD group
指标 MAFLD组(n=79) PBC合并MAFLD组(n=38) PBC组(n=70) 统计值 P值 CAP(db/m) 288.12±37.18 264.09±62.172) 195.53±31.591) F=39.642 <0.001 LSM(kPa) 5.30(3.70~7.40) 8.00(5.10~19.70)1) 12.00(8.05~30.30)1) χ2=27.916 <0.001 APRI 0.28(0.23~0.40) 0.44(0.27~0.93)1)2) 1.34(0.50~2.11)1) χ2=58.665 <0.001 FIB-4 0.56(0.40~0.60) 1.57(1.04~2.78)1)2) 3.66(3.57~5.65)1) χ2=66.028 <0.001 注:与MAFLD组比较,1)P<0.05;与PBC组比较,2)P<0.05。
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