无症状原发性胆汁性肝硬化临床特征分析  

Clinical features of asymptomatic primary biliary cirrhosis

作　　者：孙颖[1] 常彬霞[1] 滕光菊[1] 张伟[1] 赵军[1] 邹正升[1] 李保森[1] 

机构地区：[1]解放军第三○二医院非感染性肝病诊疗中心,北京100039

出　　处：《肝脏》2013年第8期507-509,516,共4页Chinese Hepatology

摘　　要：目的明确无症状原发性胆汁性肝硬化的临床特征。方法回顾性分析2010年1月至2012年12月住院的原发性胆汁性肝硬化(PBC)患者94例,通过收集患者人口学特征、实验室检查、肝脏组织学分期和梅奥风险评分、终末期肝病模型评分和Child-Pugh评分来评估无症状与有症状PBC患者临床特征的差异。结果初始无症状与有症状PBC患者在性别构成和年龄上差异均无统计学意义(χ2=0.411,P=0.522;t=-1.081,P=0.282),在生化指标中初始无症状与有症状PBC患者在总胆红素(t=-3.224,P=0.002)、白蛋白(t=4.804,P=0.000)、总胆汁酸(t=-3.018,P=0.003)、胆碱酯酶(t=4.263,P=0.000)、凝血时间(t=-2.853,P=0.005)、国际标准化比值(t=-2.581,P=0.011)之间差异均有统计学意义,在门脉高压表现中,腹水(χ2=6.810,P=0.033)和食管或胃底静脉曲张(χ2=4.870,P=0.027)的发生率差异有统计学意义。两组患者组织学分期的构成差异有统计学意义(χ2=15.618,P=0.000),自身抗体AMA/AMA-M2(χ2=5.811,P=0.016)和SP100(χ2=4.281,P=0.039)阳性率在两组之间差异亦有统计学意义。结论大部分初始无症状PBC患者在生化及组织学方面表现较轻,但仍有一些无症状PBC患者出现门脉高压并发症,且组织学分期处于进展期,因此无症状患者并非具有较好的预后,对于这部分患者应尽早给予熊去氧胆酸治疗。Objective To describe the clinical features of the PBC patients with initially asymptomatic primary bili ary cirrhosis （PBC）. Methods The clinical features of 94 patients with PBC from January 2010 to December 2012 were retrospectively analyzed, including demographics, laboratory tests, histological stage, as well as mayo risk modelscore, end-stage liver disease （MELD） and Child-Pugh scores, which were used to evaluate the differences between the asymp- tomatic PBC （a-PBC） and symptomatic PBC （s-PBC）. Results There were no statistically differences in sex ratio and age between the a PBC and s PBC patients （Z2 = 0. 411,P = 0. 522;t = -1. 081 ,P = 0. 282）. There were significant differ- ences in TBil total bilirubin （t = -3. 224, P = 0. 002）, albumin （t = 4. 804, P = 0. 000）, total bile acid （t = -3.018, P = 0. 003）, cholinesterase （t= 4. 263,P= 0. 000）, prothrombin （t = 2. 853, P = 0. 005）and international normalized ratio （t = -2. 581 , P = 0.011 ）. Among the clinical manifestations of portal hypertension, the incidences of ascites （Z2 = 6. 810, P = 0. 033） and esophageal or gastric varices （Z2 = 4. 870, P = 0. 027） between the two groups were observed statistically significant difference （P（0.05）. A significant difference was observed in the histological stage score between the a-PBC and s PBC groups. The positive rates of antimitochondrial antibodies/antimitochondrial antibodies-M2 （ 2 = 5.811, P = 0. 016）and anti-spl00 （X2 = 4. 281 ,P = 0. 039）have been showed significant differences between the two groups. Conclusion Although most of a PBC patients had have a mild stage in biochemistry and histology some a-PBC patients still demonstrate manifestations of portal hypertension and histological development. Prognosis of a PBC is not very well, and UDCA should be administrated if a-PBC is diagnosed.

关 键 词：原发性胆汁性肝硬化 无症状 

分 类 号：R575.2[医药卫生—消化系统]