中国人群中性别对原发性胆汁性胆管炎患者远期预后的影响  

Impact of gender on long-term prognosis in Chinese patients with primary biliary cholangitis

作　　者：李瑶 刘昱旸 钱俊 马雄[1,2] 王绮夏[2] LI Yao;LIU Yuyang;QIAN Jun;MA Xiong;WANG Qixia(Department of Gastroenterology and Hepatology,Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Institute of Digestive Disease,Shanghai 200001,China;Department of Infectious Diseases,Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院消化内科、上海市消化疾病研究所,200001 [2]上海交通大学医学院附属仁济医院感染科、上海市消化疾病研究所,200001

出　　处：《国际消化病杂志》2025年第2期94-98,共5页International Journal of Digestive Diseases

基　　金：国家自然科学基金(82070581、81790634);上海申康医院发展中心研究型医师创新转化能力培训项目(SHDC2022CRT002)。

摘　　要：目的探讨性别对中国原发性胆汁性胆管炎(PBC)患者远期预后的影响。方法选择2016年至2020年上海交通大学医学院附属仁济医院消化内科收治的394例PBC患者作为研究对象。采用巢式病例对照研究方法,以年龄作为匹配条件,将患者分为男性组(n=86)和女性组(n=308)。收集并比较2组的生物化学指标和熊去氧胆酸(UDCA)治疗应答情况。采用logistic回归分析探讨性别对于PBC患者生物化学应答的影响。采用Cox回归分析探讨性别对于PBC患者远期预后的影响。结果男性组的不良事件发生率均显著高于女性组(P均<0.05),其他自身免疫病患病率显著低于女性患者(P=0.030)。男性组的基线血清ALT、GGT、总胆红素(TBil)水平及抗gp210抗体阳性率均较女性组高(P均<0.05)。UDCA治疗1年后,男性组的应答率显著低于女性组(P<0.05)。logistic回归分析结果显示,男性是UDCA应答不佳的独立危险因素。Cox回归分析结果显示,男性是PBC患者发生肝硬化失代偿并发症、死亡和(或)肝移植的独立危险因素。结论在中国PBC患者中,男性是发生肝硬化失代偿并发症、死亡和(或)肝移植的独立危险因素。Objective This paper intends to explore the impact of gender on the long-term prognosis of Chinese patients with primary biliary cholangitis(PBC).Methods A total of 394 PBC cases from the Department of Gastroenterology and Hepatology in Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital,collected between 2016 and 2020,were assigned to a male group(n=86)and a female group(n=308)after matching by age.Clinical data and assessment scores were collected and compared between the two groups.Logistic regression analysis was performed to assess the effect of gender on biochemical response,while Cox regression analysis was used to explore the impact of gender on the long-term prognosis of PBC patients.Results The incidence of adverse events is significantly higher in the male group than that in the female group(P<0.05),while the occurrence of other autoimmune diseases is significantly lower than that in the female group(P=0.030).The baseline serum levels of ALT,GGT,total bilirubin(TBil),and anti-gp210 antibody positivity are significantly higher in the male group than those in the female group(P<0.05).After one year of UDCA treatment,the response rate is significantly lower in the male group than that in the female group(P<0.05).Logistic regression analysis indicates that being male is an independent risk factor for poor UDCA response.Cox regression analysis shows that male gender is an independent risk factor for hepatic decompensated complications,death,and/or liver transplantation in PBC patients.Conclusion In the Chinese PBC population,male gender is an independent risk factor for hepatic decompensated complications,death,and/or liver transplantation.

关 键 词：原发性胆汁性胆管炎 性别 预后 危险因素 巢式病例对照研究 

分 类 号：R575.7[医药卫生—消化系统]