The Study Of Relationship Between Autoantibodies And Biochemical Response To Different Doses Of UDCA In The Treatment Of Primary Biliary Cholangitis

Objective:To investigate the relationship between autoantibodies and biochemical responses to different doses of UDCA in the treatment of primary biliary cholangitis,and to determine whether different antibody types in peripheral blood have an impact on the biochemical response to UDCA of different doses.Methods:A total of 122 patients with PBC admitted to the Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University from January 2013 to August 2020 were selected.Then,collecting all of the patients clinical data,including sex,age,age of onset,BMI,biochemistry analysis,blood cell analysis and blood coagulation function,immune globulin,antinuclear antibodies,antimitochondrial antibodies,anti-glycoprotein 210 antibody,antiribosome 100 antibody,anti-SSA antibody,anti-SSB antibody,anti-RO-52 antibody,anti-centromeric antibody and other indicators.According to the different treatment doses of UDCA,71 cases were divided into the high-dose UDCA group(15-30mg/kg/day)and 51 cases in the low-dose UDCA group(9-15mg/kg/day).The relationship between antibody types and treatment response in the large and small dose groups and the effect of UDCA dose on biochemical and immune indexes of PBC patients were analyzed retrospectively.Results:Baseline comparison between the two groups before treatments,BMI,albumin,ratio of albumin to globulin,prealbumin in the large dose group were lower than the low-dose group.However,aspartate aminotransferase(AST)and alkaline phosphatase(ALP),gamma glutamyl transpeptidase(GGT),total bile acid,total bilirubin(TBIL),RBC distribution width(RDW-CV),RDW-SD,immunoglobulin M(IgM).gp210 positive rate,the AMA-M2 positive rate were higher than in small dose group(P<0.05),the difference is statistically significant.In terms of the proportion,the pathological stages of the high-dose group were mainly stage Ⅲ and Ⅳ.while those of the low-dose group were mainly stage Ⅰ and Ⅱ.After 1 year of treatment,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),glutamyl transpeptidase(GGT),total bilirubin(TBIL),immunoglobulin M(IgM)and the positive rate of ANA in the high-dose group were significantly lower than those before treatment,while the levels of prealbumin were significantly higher(P<0.05).After 1 year of treatment,the levels of prealbumin in the low-dose group were significantly increased compared with that before treatment,and the levels of ALP,GGT,and the positive rate of AMA-M2 were significantly decreased(P<0.05),the difference is statistically significant.Chi-square results showed that there was a significant difference in baseline anti-SSA positiveness between the high-dose response group and the high-dose non-response group(P<0.05),and the difference was statistically significant.Pathological stage Ⅱ showed significant differences between low-dose response group and low-dose non-response group(P<0.05),and the difference was statistically significant.In terms of proportion,regardless of the dosage of UDCA,the positive rate of anti-gp210 in the non-responding group was higher than that in the responding group.Conclusion:Positive of baseline anti-SSA is an effective indicator to evaluate the efficacy of UDCA(15-30mg-kg-1.D-1)in the treatment of primary biliary cholangitis.The histopathological stage Ⅱ is an effective indicator to evaluate the efficacy of the treatment response with UDCA(9-15mg-kg-1.d-1)in primary biliary cholangitis.Both large and small doses of UDCA treatment can improve the biochemical and immune indexes of PBC patients,but for patients with severe disease and pathological endstage,high-dose UDCA treatment is recommended.For patients with refractory PBC,early detection and treatment are recommended to delay the progression of the disease.