Clinical Features Of Primary Biliary Cholangitis And Correlation Between Serological Antibodies And Prognosisc

Objective1.Summarize the clinical characteristics of primary biliary cholangitis(PBC)patients in our hospital in recent 6 years;2.To investigate the value of anti-GP210 antibody in the diagnosis and evaluation of PBC patients;3.To study the related factors that may affect the prognosis of PBC.Methods1.The clinical medical records of 153 PBC patients who met the admission criteria in the Affiliated Hospital of Inner Mongolia Medical University from January 2015 to December2020 were retrospectively collected.The general data of patients(age and gender),the major clinical manifestations(fatigue,anorexia,jaundice,itchy skin,abdominal distention,edema,and other conditions),laboratory indexes(liver function,blood routine,auto-antibodies,immu noglobulin,blood coagulation,etc.),electronic gastroscopy results,abdominal ultrasound or C T,live r tissue pathology projects such as statistics and merger of liver disease.2.A total of 153 PBC patients were divided into the anti-GP210 antibody positive group and the anti-GP210 antibody negative group,and the differences in gender,age,main clinical manifestations and laboratory indicators between the two groups were compared.Then,the subjects were re-divided into the anti-mitochondrial antibody(AMA)/AMA-M2 positive grou p and negative group(the negative group was confirmed by liver puncture),and the expressio n of anti-GP210 antibody between the two groups was statistically analyzed.3.The patients were followed up by telephone or by referring to inpatient or out patient medical records,and the main outcome events(liver transplantation or liver disease related de ath)and survival time were counted.After K-M univariate analysis,the indicators that may aff ecct the prognosis were further included in Cox multivariate analysis to determine the risk fac tors related to the prognosis of PBC.Results1.Among 153 PBC patients who met the criteria,138 were female and 15 were male(male: female = 1:9.2),with an average age of 54.99±8.12 years.There were 43 case of fatigue(28.1%),24 cases of poor appetite(15.7%),16 cases of jaundice(10.4%),13 cases of pruritus(8.4%),18 cases of abdominal distension(11.8%),9 cases of edema of lower limbs(5.9%),and physical examination discovery transaminase exaltation,consciousness obstacle,black stool patient in all 30 cases(19.6%).GGT increased in 134 patients(87.6%),ALP increased in 147 patients(96.1%),ALB decreased in 90 patients(58.8%),TBIL increased in105 patients(68.8%),PLT decreased in 60 patients(39.2%),and PT prolonged in 92 patients(60.1%).All patients were tested for immunoglobulin,and there were 112 cases(73.2%)with elevated Ig M,107 cases(69.9%)with elevated Ig G,and 69 cases(45.1%)with elevated Ig A.AMA/M2 was positive in 138 patients(90.2%)and negative in 15 patients(9.8%),which were confirmed by liver histopathological examination.Among other auto-antibodies,147 cas es(96.1%)were ANA positive,56 cases(36.6%)were anti-GP210 positive,36 cases(23.5%)were anti-SP100 positive.Among 153 patients,97(63.4%)had cirrhosis of varying degrees,including 48(31.4%)in compensatory stage and 49(32.0%)in decompensated stage.21 patie nts(13.7%)had abdominal cavity effusion.Among the patients with cirrhosis,48 cases(31.4%)were grade A,44 cases(28.7%)were grade B,and 5 cases(3.3%)were Grade C.Of the 85 patients who underwent electronic gastroscopy,31(36.5%)had esophagogastric varice s.There were 38 cases(2 4.8%)with extrahepatic autoimmune diseases,including 24 cases(15.7%)with sjogren’s syndrome,8 cases(5.3%)with rheumatoid arthritis,3 cases(2.0%)with systemic lupus erythematosus,1 case(0.6%)with Raynaud’s syndrome,1 case(0.6%)with systemic sclerosis,and 1 case(0.6%)with ulcerative colitis.2.The positive rate of anti-GP210 antibody was 36.6%(56/153).The positive rate of anti-GP210 antibody was 46.7%(7/15)in 15 AMA-negative PBC patients.Fatigue and jaundi ce symptoms had statistical significance in the expression of anti-GP210 antibody(P < 0.05).The levels of ALP,GGT and TBIL in the positive group were higher than those in the negative group(P < 0.05),while the levels of ALB and PLT were lower than those in the negative group(P < 0.05).3.Among 153 PBC patients,39 cases were lost to follow-up,and 114 cases could be followed up,with an average follow-up time of 41.21±11.67 months,and 12 patients(13.8%)developed end-point events,including 1 patient(1.1%)with liver transplantation and 11patients(12.6%)who died.The main causes of death were liver failure,gastrointestinal bleeding and hepatic encephalopathy.K-M univariate analysis showed that the decrease of P LT,ALB,the increased of TBIL,Ig M,APRI and positive anti-GP210 antibody were correlate d with the prognosis of PBC patients(P < 0.05).The above indexes were analyzed by multiva riate Cox regression model.Positive anti-GP210 antibody is an independent risk factor for po or prognosis in PBC patients.Conclusion1.PBC tends to occur in middle-aged women around 50 years old,with a male to female ratio of 1:9.2.Patients often presented with non-specific clinical picture such as fatigue,poor appetite and jaundice.Serological indicators were mainly elevated GGT and ALP,and about h alf of the patients had cirrhosis of different degrees when they saw a doctor.Clinical complica tions of other autoimmune diseases,such as sjogren’s syndrome,thyroid disease is also more c ommon.2.Anti-gp210 antibody may have diagnostic value for PBC,and contribute to the evalua tion of the disease and prognosis,which is a valuable indicator of clinical application.3.Liver failure,gastrointestinal bleeding and hepatic encephalopathy are the main causes of death in PBC patients.The main risk factors affecting the prognosis of PBC patients were decreased PLT,decreased ALB,increased TBIL,increased Ig M,increased APRI,and positive ant i-GP210 antibody.Multivariate Cox regression analysis indicated that positive anti-GP210 antibody was an independent risk factor for poor prognosis of PBC.