The Analysis Of Risk Factors Complicated With Esophagogastric Varices And Prognostic Factors In Patients With Primary Biliary Cholangitis

Aims:1.To analyze the clinical features of PBC patients;2.To study the related risk factors of PBC complicated with esophagogastric varices;3.To explore the related factors that affect the prognosis and survival of PBC patients.Methods:1.A retrospective study of PBC patients who were hospitalized for the first time in the First Hospital of Jilin University from January 2012 to December 2019.Among them,236 patients were screened as research subjects according to the inclusion and exclusion criteria.Collect and statistically analyze patients’general information(age,gender,symptoms,physical signs,etc),PBC-related complications,whether combined with extrahepatic diseases,liver function scores,laboratory indicators(immunological indicators,biochemical,etc)and imaging related examinations(abdominal ultrasound/CT/MRI).2.Among 236 patients,146 patients with PBC who underwent gastroscopy at the first admission were divided into a varicose group and a varicose-free group according to the presence or absence of esophagogastric varices.First,univariate analysis of general data,liver function scores,related complications,laboratory indicators,and imaging-related examinations of the two groups of patients,and then multivariate analysis of statistically significant indicators to explore the combination of PBC risk factors for esophagogastric varices.3.Among 236 patients,long-term follow-up of 111 cases of patients by telephone or consulting outpatient/inpatient medical records,and their 1-year,3-year and 5-year survival rates were calculated.The relevant factors were included in the Log-Rank test for univariate analysis,and the statistically significant indicators were included in the multivariate COX regression model for multivariate analysis to study the factors related to the prognosis and survival of PBC patients.Results:1.236 patients with PBC were included in this study.The male to female ratio was 1:5.38,and the average age was(57.21±10.96)years old.The main complaints were fatigue,abdominal distension,and pruritus,among which 125 patients(53.0%)felt fatigued,which was the most common complaint.Forty-four cases(18.6%)of PBC patients had connective tissue diseases,of which 32 cases(13.6%)of Sjogren’s syndrome were the most common,followed by 4 cases(1.7%)of rheumatoid arthritis.48 patients(20.3%)of PBC patients had thyroid disease,and 29 patients(12.3%)had Hashimoto’s thyroiditis the most common.192(81.2%)patients had elevated ALP,142(60.2%)patients had elevated TBIL,and 212(89.8%)patients had reduced ALB;143(60.6%)patients had positive AMA,and 196(83.0%)patients had AMA-M2 was positive,52 cases(22.0%)were anti-Gp210 positive,39cases(16.5%)were anti-Sp100 positive;188 cases(79.4%)had elevated Ig M.Among 236 patients with PBC,163(69.1%)had liver cirrhosis,and 110(46.6%)patients had ascites.2.Of the 146 PBC patients who underwent electronic gastroscopy on admission,69(47.3%)had esophagogastric varices.Univariate analysis showed that 25 factors such as AST,GGT,ALP,ALB,anti-Sp100 antibody,splenomegaly,and ascites were all related to PBC patients with esophagogastric varices.The multivariate analysis found that GGT,CHE,ALB,Na~+,PLT and splenomegaly are all independent risk factors for PBC patients with esophagogastric varices.3.The average follow-up time of 111 patients who received follow-up was(58.32±14.26)months,and 19 patients(17.1%)had an endpoint event,including 18deaths(16.2%)and 1 liver transplantation(0.9%).The 1-year,3-year,and 5-year survival rates of the patients respectively were 98%,94%,and 87%.The results of univariate analysis revealed that 9 factors including age at the time of consultation,ALB,PLT,Child-Pugh classification,APRI,ALBI,NLR,risk grouping,and combined ascites were all related to the prognosis of PBC patients,and they were included in the COX model.The multivariate analysis revealed that the age at the time of consultation(HR:4.518,P=0.037),ALB(HR:0.096,P=0.044),PLT(HR:0.168,P=0.047),NLR(HR:4.290,P=0.006)were the independent risk factors affecting the prognosis and survival of PBC patients.Conclusions:1.PBC is more common in middle-aged women,with a male to female ratio of1:5.38.The most common main complaints of patients are fatigue,abdominal distension,loss of appetite,pruritus and other non-specific symptoms.The increase of GGT and ALP is the most important serological feature.In addition,patients with PBC are prone to complication of extrahepatic autoimmune diseases such as thyroid disease and connective tissue disease,and the most common diseases respectively are Hashimoto’s thyroiditis and Sjogren’s syndrome.2.42.3% of PBC patients had esophagogastric varices in this study.GGT,CHE,ALB,Na~+,PLT reduction and splenomegaly were independent risk factors for PBC patients with esophagogastric varices.3.PBC patients’1-year,3-year,and 5-year survival rates respectively were98%,94%,and 87%.The age at the time of consultation,the increase of NLR and the decrease of PLT and ALB are significantly related to the poor prognosis of PBC patients.