不同IgM水平的原发性胆汁性胆管炎患者治疗应答及预后特点分析  

Analysis of treatment response and prognosis characteristics of patients with primary biliary cholangitis in different IgM levels

作　　者：张玉婷[1] 李嘉泰 宋晓静[2] 丁方回 岳平[2] 闫少林 李俊峰[3] 张立婷[3] 李汛[1,2,4,5,6,7,8,9] ZHANG Yuting;LI Jiatai;SONG Xiaojing;DING Fanghui;YUE Ping;YAN Shaolin;LI Junfeng;ZHANG Liting;LI Xun(The First Clinical Medical College of Lanzhou University,Lanzhou 730099;Department of General Surgery,the First Hospital of Lanzhou University;Department of Hepatology,the First Hospital of Lanzhou University;The First Hospital of Lanzhou University General Surgery National Key Clinical Specialist;Cancer Prevention and Treatment Center,Medical College of Lanzhou University;Precision Medicine Laboratory of the First Hospital of Lanzhou Uni-versity;Gansu Provincial Key Laboratory of Biotherapy and Regenerative Medicine;Gansu Provincial Institute of Hepatobiliary and Pancreatic Surgery;Gansu Provincial General Surgery Clinical Medical Research Center,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730099 [2]兰州大学第一医院普外科 [3]兰州大学第一医院肝病科 [4]兰州大学第一医院普通外科国家临床重点专科 [5]兰州大学医学院肿瘤防治中心 [6]兰州大学第一医院精准医学实验室 [7]甘肃省生物治疗与再生医学重点实验室 [8]甘肃省肝胆胰外科研究所 [9]甘肃省普通外科临床医学研究中心

出　　处：《胃肠病学和肝病学杂志》2025年第2期250-253,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨基线不同血清IgM水平的原发性胆汁性胆管炎(primary biliary cholangitis,PBC)患者的临床特点,探索基线IgM水平评估PBC患者对熊去氧胆酸(ursodexycholic acid,UDCA)生化应答及预后的价值。方法回顾性队列研究分析经UDCA治疗1年及以上资料完整的109例PBC患者,收集其基线时和治疗后的数据;UDCA应答情况采用巴塞罗那标准进行评价,根据基线时IgM值是否高于正常上限(15.0%),将患者分为IgM升高组和IgM对照组,分析比较两组患者实验室特征,分析基线IgM水平与PBC患者肝功能指标之间的相关性,并使用Mayo风险评分、UK-PBC评分、GLOBE评分评估两组预后的差异。统计学方法采用t检验、Mann-Whitney检验、χ^(2)检验和Spearman秩相关分析。结果109例PBC患者中,IgM水平升高组50例,IgM对照组患者59例,IgM对照组患者与IgM升高组患者相比,ALB较高(P=0.003),TBIL、DBIL、ALP、GGT、TBA较低,差异有统计学意义(P均<0.05)。IgM水平与PBC患者AST、ALP、GGT、TBIL、DBIL、TBA呈正相关(P<0.05),IgM水平与PBC患者ALB呈负相关(P<0.05)。IgM对照组患者与IgM升高组患者相比,Mayo风险评分较低(P<0.05)。UDCA规律治疗1年后,IgM升高组患者对UDCA生物化学应答率较低,5、10、15年肝移植率风险更高(P均<0.05)。结论基线时IgM升高的PBC患者生化异常更明显,对UDCA治疗的应答及预后较差。Objective To investigate the clinical characteristics of patients with primary biliary cholangitis(PBC)in different serum IgM levels at baseline.To explore the value of baseline IgM level in evaluating the biochemical response and prognosis of PBC patients to UDCA.Methods A retrospective cohort study was conducted to analyze 109 PBC patients with complete data after UDCA treatment for 1 year or more.Data at baseline and after treatment were collected.UDCA response was evaluated using the Barcelona criteria.According to whether the IgM value at baseline was higher than the upper limit of normal(15.0%).The patients were divided into IgM elevated group and IgM control group.The laboratory characteristics of the two groups were analyzed and compared.The correlation between baseline IgM level and liver function indexes of PBC patients was analyzed.The differences in prognosis between the two groups were evaluated by Mayo risk score,UK-PBC score and GLOBE score.All data were analyzed by t-test,Mann-Whitney test,χ^(2) test and Spearman rank correlation analysis.Results Among the 109 patients with PBC,50 patients had elevated IgM levels,and 59 patients in IgM control group.Compared with IgM elevated group,IgM control group had higher ALB,TBIL,DBIL,ALP,GGT,and TBA were lower.The results of correlation analysis showed that IgM level was positively correlated with AST,ALP,GGT,TBIL,DBIL and TBA in PBC patients,and IgM level was negatively correlated with ALB in PBC patients.The Mayo risk score was lower in IgM control group than that in IgM elevated group.After 1 year of regular treatment with UDCA,the patients in IgM elevation group had a lower biochemical re-sponse rate to UDCA,and the risk of liver transplantation at 5,10 and 15 years was higher.Conclusion The biochem-ical abnormalities of PBC patients with elevated IgM at baseline are more obvious,and the response to UDCA treatment and prognosis is poor.

关 键 词：熊去氧胆酸 原发性胆汁性胆管炎 血清免疫球蛋白M 生物化学应答 

分 类 号：R575.6[医药卫生—消化系统]