The Analysis Of Clinical Features And Prognostic Factors In Patients With Primary Biliary Cholangitis

Objective1.To analyze the clinical characteristics of primary biliary cholangitis(PBC)patients;2.To explore the related risk factors of PBC patients complicated with esophagogastric varices;3.To study the related factors affecting the prognosis of PBC patients.Method1.We retrospectively analyzed the clinical records of the first hospitalization of243 PBC patients in the First Hospital of Lanzhou University,and performed statistical analysis on general clinical data,combined extrahepatic diseases,complications,imaging examinations,laboratory tests,and liver function-related scoring of PBC patients.2.148 PBC patients underwent electronic gastroscopy were divided into a group with concurrent esophagogastric varices and a group without esophagogastric varices.The general clinical data,laboratory examinations,imaging examinations,complications and liver function-related scores of the two groups of patients were analyzed by univariate analysis.The statistically significant indicators after univariate analysis were included in Logistic regression analysis for multivariate analysis,and the risk factors related to esophagogastric varices in PBC patients were obtained.3.139 patients were screened by telephone interviews or in-patient medical records for follow-up.The 1-year,3-year,and 5-year survival rates were calculated using the life table method.Significant indicators after Log-Rank test were included in the COX regression model,to analyze the risk factors related to the prognosis of PBC patients.Result1.Among the 243 PBC patients,the male to female ratio was 1:5.08,and the average age was 55.67±11.09 years.The chief complaint of 150 cases(61.7%)were non-specific symptoms,and 79 cases(32.5%)were diagnosed with complications related to liver cirrhosis such as jaundice,gastrointestinal bleeding,and disorder of consciousness,only 10 cases(4.1%)were examined elevated transaminase by physical examination.There were 59 PBC patients(24.3%)with connective tissue disease,including 44 cases(18.1%)of Sjogren’s syndrome,5 cases(2.1%)of rheumatoid arthritis,5 cases(2.1%)of systemic lupus erythematosus,2 cases(0.8%)of systemic sclerosis,1 case(0.4%each)of adult Still’s disease,polymyositis,Raynaud’s syndrome.ALP increased in 227 cases(93.4%),TBIL increased in 170 cases(70.0%),ALB decreased in 84 cases(34.6%),AMA was positive in 75 cases(72.0%),AMA-M2 was positive in 214 cases(88.1%).Immunoglobulin testing was performed in 139 cases.IgM was elevated in 85 cases(61.2%),IgG was elevated in 68 cases(48.9%),and IgA was elevated in 56 cases(40.3%).There were 214 cases(88.1%)of liver cirrhosis in243 PBC patients,of which 110 cases(45.3%)were compensated,104 cases(42.8%)were decompensated.74 patients(30.5%)had peritoneal effusion and 195 patients(80.2%)had splenomegaly.148 of 243 PBC patients underwent electronic gastroscopy immediately after hospitalization,76 cases(51.4%)had esophageal and gastric varices,of which 21 cases(14.2%)were mild,10 cases(6.8%)were moderate,and 45 cases(30.4%)were severe.There were 23 cases(15.5%)with red signs and 9 cases(6.1%)with portal hypertension gastric disease.2.76 cases had esophageal gastric fundus veins in the 148 PBC patients who underwent electronic gastroscopy.After univariate analysis,it was found that ALB,PLT,APRI,and ALBI were all related to esophagogastric varices.Multi-factor results show that ALB<34.5g/L and PLT<118×10~9/L are independent predictors of esophago gastric varices.Draw the ROC curve of the above four indicators,the areas under the curve are:0.756,0.754,0.613,0.709.3.The mean follow-up time of 139 PBC cases was 42.87±12.27 months.Endpoint events occurred in 21 cases(15.1%),2 cases(1.4%)had liver transplantation,and 19cases(13.7%)died.The 1-year,3-year,and 5-year survival rates were 95%,91%,and74%,respectively.Univariate analysis revealed that there were 10 factors including that ALB,Na~+,PT levels,NLR,APRI,Child-Pugh classification of liver function,and combined with abdominal effusion,esophagogastric varices,gastrointestinal bleeding,and hepatic encephalopathy related to the prognosis of PBC patients.It was substituted into the multi-factor COX model for analysis,and the three indicators ALB(RR:0.033,P=0.002),NLR(RR:9.352,P=0.002),and APRI(RR:6.255,P=0.005)were significantly related to the prognosis of patients with PBC.The ROC curve was drawn and the cutoff values are:ALB=34.0g/L,NLR=2.82,APRI=1.58.Therefore,when ALB≤34.0g/L,NLR>2.82,APRI>1.58,the patient’s prognosis is poor.Conclusion1.PBC occurs in middle-aged women,male:female=1:5.08.The most common clinical manifestations of patients at the time of consultation are non-specific symptoms,such as fatigue and itching skin.Serum indicators were mainly elevated in ALP and GGT.PBC patients are susceptible to extrahepatic diseases such as connective tissue disease and thyroid disease.2.The detection rate of esophagogastric varices in PBC patients was 51.4%.ALB<34.5g/L and PLT<118×10~9/L are independent predictors of esophago gastric varices.Therefore,for patients who meet the above conditions,electronic gastroscopy should be performed at the time of initial diagnosis.If there are esophageal and gastric fundus varices,timely intervention measures should be given to prevent varicose vein rupture and bleeding early.3.The greater the values of APRI and ALBI scores,the greater the possibility of esophageal and gastric varices in patients with PBC.4.The 1-year,3-year,and 5-year survival rates of PBC patients were 95%,91%,and 74%,respectively.Decreased ALB and elevated NLR and APRI were significantly associated with poor prognosis in patients with PBC.