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抗线粒体抗体阴性与阳性原发性胆汁性胆管炎患者临床特征比较

乔可欣 周桂琴 刘亚兴 冯颖 刘尧 李斌 王宪波

引用本文:
Citation:

抗线粒体抗体阴性与阳性原发性胆汁性胆管炎患者临床特征比较

DOI: 10.12449/JCH240910
基金项目: 

国家中医药管理局高水平中医药重点学科建设项目 (zyyzdxk-2023005)

伦理学声明:本研究方案于2022年12月30日经由北京地坛医院伦理委员会审批,批号:京地伦科字[2022]-第(010)-01号。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:乔可欣负责病例收集及数据整理、统计分析,并撰写论文;刘亚兴、刘尧、李斌协助完成病例收集;周桂琴、王宪波、冯颖负责拟定写作思路;周桂琴负责指导撰写文章、修改论文并最后定稿。
详细信息
    通信作者:

    周桂琴, zhouguiqin@ccmu.edu.cn (ORCID: 0000-0002-1035-0181)

Clinical features of primary biliary cholangitis patients with negative or positive anti-mitochondrial antibody: A comparative study

Research funding: 

National Administration of Traditional Chinese Medicine High Level Key Discipline Construction Project of Traditional Chinese Medicine (zyyzdxk-2023005)

More Information
  • 摘要:   目的  对抗线粒体抗体(AMA)阴性与阳性原发性胆汁性胆管炎(PBC)患者免疫与生化指标进行分析,比较其临床特征的差异。  方法  收集2013年1月—2022年12月就诊于首都医科大学附属北京地坛医院的PBC患者的临床资料,分为AMA阴性组(139例,24.5%)及AMA阳性组(428例,75.5%),以年龄及性别为匹配因素,匹配容差设置为0.06,进行1∶1倾向性评分匹配,分析入院时肝功能、凝血、免疫等指标,同时分析治疗6个月的肝功能等指标变化及治疗6、12个月时对于熊去氧胆酸(UDCA)的应答情况。符合正态分布的计量资料两组间比较采用成组t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U秩和检验。计数资料两组间比较采用χ2检验。  结果  倾向性评分匹配后AMA阴性及AMA阳性PBC患者各139例。AMA阴性组与阳性组入院时比较:AMA阴性组DBil、球蛋白(Glo)低于AMA阳性组,Alb、白蛋白/球蛋白(A/G)、前白蛋白(pre-A)、纤维蛋白原(FIB)高于AMA阳性组,差异均有统计学意义(P值均<0.05)。应用UDCA治疗6个月后,AMA阴性组与阳性组比较,Glo、pre-A水平差异均有统计学意义(P值均<0.05)。AMA阴性组与阳性组治疗6个月后pre-A较入院时均有上升,但上升程度不同,AMA阴性组上升更明显(U=41.00,P=0.015)。应用UDCA治疗6、12个月后,AMA阴性组和阳性组患者对UDCA治疗应答差异均无统计学意义(P值均>0.05)。  结论  在年龄及性别匹配条件下,AMA阴性PBC患者相对AMA阳性患者,肝脏炎症损伤程度轻,经UDCA治疗后炎症改善更明显,肝脏合成能力改善更明显,对于UDCA应答显现更佳趋势。

     

  • 表  1  AMA阳性及AMA阴性组患者一般资料比较

    Table  1.   Comparison of general information between AMA (-) and AMA (+) groups of patients

    指标 AMA阴性组(n=139) AMA阳性组(n=139) 统计值 P
    性别[例(%)] χ2=0.112 0.867
    20(14.4) 22(15.8)
    119(85.6) 117(84.2)
    年龄(岁) 55.67±13.13 58.47±12.85 t=0.728 0.074
    下载: 导出CSV

    表  2  AMA阴性及AMA阳性组患者实验室指标比较

    Table  2.   Comparison of laboratory indicators between AMA (-) and AMA (+) groups of patients

    实验室指标 AMA阴性组(n=139) AMA阳性组(n=139) 统计值 P
    血常规
    WBC(×109/L) 4.29(3.08~5.92) 4.21(3.19~5.42) U=91.00 0.654
    NE(×109/L) 2.56(1.78~3.47) 2.42(1.68~3.43) U=86.50 0.431
    LY(×109/L) 1.22(0.84~1.66) 1.16(0.83~1.72) U=91.50 0.952
    RBC(×1012/L) 3.81(3.24~4.29) 3.55(3.00~4.23) U=80.50 0.080
    Hb(g/L) 115.80(96.50~128.25) 111.00(93.00~124.23) U=82.50 0.154
    PLT(×109/L) 131.00(78.15~214.00) 125.00(80.00~208.10) U=85.50 0.860
    肝功能
    ALT(U/L) 39.55(22.13~67.05) 40.20(19.90~79.80) U=89.00 0.581
    AST(U/L) 50.20(29.20~93.60) 58.50(35.00~97.20) U=82.00 0.114
    TBil(μmol/L) 19.65(11.93~34.85) 24.80(13.80~56.40) U=83.50 0.165
    DBil(μmol/L) 8.45(4.73~22.40) 12.20(6.10~34.50) U=78.50 0.032
    Alb(g/L) 36.24±5.71 34.29±6.38 t=2.66 0.008
    Glo(g/L) 30.90(27.43~36.45) 33.00(28.40~40.80) U=72.50 0.002
    A/G 1.20(1.00~1.40) 1.00(0.80~1.30) U=65.50 <0.001
    GGT(U/L) 112.80(56.38~250.10) 137.40(52.10~369.55) U=79.00 0.277
    ALP(U/L) 156.60(101.60~270.98) 161.60(107.85~312.15) U=82.50 0.628
    ChE(U/L) 4 766.50(3 175.00~7 496.75) 4 456.50(2 983.25~6 352.75) U=81.00 0.197
    TBA(μmol/L) 27.80(9.58~67.13) 31.40(10.05~86.95) U=80.00 0.332
    pre-A(mg/L) 99.50(70.00~153.10) 93.00(64.60~136.20) U=67.50 0.003
    血脂系列
    TCHO(mmol/L) 4.30(3.43~5.32) 4.25(3.37~5.59) U=84.00 0.985
    TG(mmol/L) 1.10(0.72~1.58) 1.05(0.65~1.62) U=82.50 0.763
    HDL-C(mmol/L) 1.10(0.70~1.34) 1.06(0.70~1.30) U=78.50 0.669
    LDL-C(mmol/L) 2.32(1.69~3.15) 2.38(1.67~2.98) U=84.00 0.921
    凝血系列
    PT(s) 11.65(10.98~13.20) 12.20(11.10~13.63) U=80.00 0.202
    PTA(%) 95.00(79.75~108.25) 88.00(75.00~103.00) U=76.50 0.067
    APTT(s) 32.33±4.16 33.10±3.65 t=1.09 0.279
    FIB(g/L) 270.00(225.50~318.00) 239.00(189.00~304.00) U=47.50 0.047
    INR(s) 1.05(0.97~1.19) 1.07(0.98~1.21) U=81.50 0.544
    TT(s) 16.05(14.95~17.78) 16.75(15.63~18.38) U=42.50 0.051
    肿瘤标志物
    AFP(ng/mL) 2.70(2.00~3.90) 2.95(1.90~4.00) U=83.50 0.970
    CEA(ng/mL) 2.40(1.40~3.50) 2.40(1.60~3.60) U=80.00 0.824
    肾功能及血氨
    UREA(mmol/L) 4.69(3.79~6.43) 4.72(3.67~6.54) U=86.00 0.534
    Cr(μmol/L) 54.00(49.00~64.55) 57.00(49.60~65.50) U=86.50 0.610
    NH3(mmol/L) 25.00(20.25~32.00) 26.00(20.25~33.75) U=45.00 0.685

    注:NE,中性粒细胞;LY,淋巴细胞;ChE,胆碱酯酶;TBA,胆汁酸;TCHO,总胆固醇;APTT,活化部分凝血活酶时间;INR,国际标准化比值;TT,凝血酶时间;CEA,癌胚抗原;UREA,血尿素氮;Cr,肌酐。

    下载: 导出CSV

    表  3  AMA阴性及AMA阳性组患者免疫指标比较

    Table  3.   Comparison of immunological indicators between AMA (-) and AMA (+) groups of patients

    指标 AMA阴性组(n=139) AMA阳性组(n=139) 统计值 P
    IgA(g/L) 2.78(1.90~3.83) 2.86(1.81~3.93) U=80.50 0.760
    IgM(g/L) 2.15(1.20~3.39) 2.32(1.33~3.83) U=72.00 0.074
    补体C3 0.80(0.63~1.07) 0.84(0.59~1.07) U=79.00 0.633
    补体C4 0.17(0.12~0.21) 0.15(0.11~0.21) U=76.50 0.312
    ANA[例(%)] χ2=1.03 0.501
    阴性 133(95.7) 136(97.8)
    阳性 6(4.3) 3(2.2)
    ACA[例(%)] χ2=0.08 0.886
    阴性 107(77.0) 109(78.4)
    阳性 32(23.0) 30(21.6)
    抗SSA抗体[例(%)] χ2=1.53 0.289
    阴性 117(84.2) 124(89.2)
    阳性 22(15.8) 15(10.8)
    抗SSB抗体[例(%)] χ2=0.30 0.785
    阴性 131(94.2) 133(95.7)
    阳性 8(5.8) 6(4.3)

    注:ACA,抗心磷脂抗体。

    下载: 导出CSV

    表  4  治疗6个月后AMA阴性及AMA阳性组患者肝功能指标比较

    Table  4.   Comparison of liver function indicators and changes between AMA (-) and AMA (+) groups of patients after 6 months of treatment

    指标 AMA阴性组(n=139) AMA阳性组(n=139) 统计值 P
    ALT(U/L) 22.15(12.10~39.10) 26.00(16.05~38.25) U=126.50 0.324
    AST(U/L) 33.50(24.20~59.68) 38.20(28.25~54.80) U=133.50 0.570
    TBil(μmol/L) 15.50(12.15~26.30) 21.35(10.83~30.75) U=130.50 0.450
    DBil(μmol/L) 7.50(5.25~10.85) 8.60(4.65~18.00) U=124.00 0.328
    Alb(g/L) 40.50(33.65~42.95) 38.70(32.03~44.63) U=137.00 0.736
    Glo(g/L) 32.92±5.88 35.63±6.20 t=2.27 0.023
    A/G(g/L) 1.20(0.90~1.30) 1.10(0.90~1.30) U=137.50 0.753
    GGT(U/L) 56.70(23.50~114.85) 69.00(27.40~156.40) U=125.00 0.525
    ALP(U/L) 128.70(90.55~218.75) 145.50(95.50~198.10) U=129.00 0.708
    TBA(μmol/L) 28.20(12.30~59.00) 34.70(17.00~68.20) U=117.50 0.268
    pre-A(mg/L) 117.80(73.63~175.43) 102.65(73.93~166.78) U=42.50 0.016
    下载: 导出CSV

    表  5  治疗6个月后AMA阴性及AMA阳性组患者肝功能指标差值比较

    Table  5.   Comparison of liver function index differences between AMA negative and AMA positive groups after 6 months of treatment

    指标 AMA阴性组(n=139) AMA阳性组(n=139) U P
    ALT(U/L) -12.55(-42.40~0.73) -11.00(-54.70~-0.70) 135.50 0.890
    AST(U/L) -12.20(-39.70~3.10) -11.60(-71.20~1.80) 137.00 0.985
    TBil(μmol/L) -4.10(-17.40~-0.03) -4.10(-12.25~1.75) 128.00 0.365
    DBil(μmol/L) -2.80(-11.95~0.15) -1.80(-10.60~0.50) 126.50 0.600
    Alb(g/L) 4.25(-0.20~7.10) 3.40(-0.70~7.60) 137.50 0.738
    Glo(g/L) 0.56(-3.70~4.90) 0.20(-4.40~4.50) 135.00 0.880
    A/G(g/L) 0.10(0.00~0.20) 0.00(-0.10~0.10) 119.50 0.237
    GGT(U/L) -22.80(-245.65~-0.05) -23.90(-111.78~5.35) 97.00 0.198
    ALP(U/L) -28.85(-82.35~-2.03) -14.70(-120.15~33.90) 98.30 0.236
    TBA(μmol/L) 3.35(-29.93~12.43) 6.20(-18.13~26.00) 106.00 0.537
    pre-A(mg/L) 18.00(-11.48~39.30) 8.70(-1.90~53.00) 41.00 0.015
    下载: 导出CSV

    表  6  治疗6个月及12个月后AMA阴性及AMA阳性组患者UDCA应答情况比较

    Table  6.   Comparison of UDCA response cases between AMA (-) and AMA (+) groups of patients after 6 and 12 months of treatment

    项目 治疗6个月 治疗12个月

    总计

    n=278)

    AMA阴性

    n=139)

    AMA阳性

    n=139)

    χ2 P

    总计

    n=278)

    AMA阴性

    n=139)

    AMA阳性

    n=139)

    χ2 P
    UDCA应答[例(%)] 103(37.1) 57(41.0) 46(33.1) 1.866 0.172 110(39.6) 61(43.9) 49(35.3) 2.158 0.141
    UDCA无应答[例(%)] 175(62.9) 82(59.0) 93(66.9) 168(60.4) 78(56.1) 90(64.7)
    下载: 导出CSV
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  • 收稿日期:  2023-12-10
  • 录用日期:  2024-01-29
  • 出版日期:  2024-09-25
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