| ObjectivesPrimary biliary cholangitis(PBC)is an chronic liver disease with the participation of immune,environmental,genetic and other factors,and it is characterized by progressive cholestasis caused by small and medium-sized intrahepatic bile duct injury.Most patients often have dyslipidemia,and the clinical manifestations are complex.Although the current research mainly focuses on the risk of cardiovascular events in patients with PBC hyperlipidemia or dyslipidemia,the results are controversial.Some scholars believe that dyslipidemia will increase the coronary events of patients,but others think that patients with PBC have a lower risk of cardiovascular and cerebrovascular diseases.Therefore,this study aims to analyze the clinical characteristics of blood lipid metabolism in PBC patients,explore the occurrence of cardiovascular and cerebrovascular diseases and related risk factors in PBC patients.At the same time,we quantified the prognosis of PBC patients with Mayo risk score to explore the impact of blood lipid levels on the prognosis of PBC patients,so that clinicians can formulate more appropriate blood lipid management strategies.MethodsPatients diagnosed with PBC in The Second Affiliated Hospital of Kunming Medical University from April 2014 to April 2022 were included retrospectively.The diagnostic criteria of PBC refer to the guidelines for diagnosis and treatment of Primary cholangitis(2021).Patients with the following criteria were excluded: complicated with other liver diseases(viral hepatitis,drug-induced liver injury,metabolic related liver disease,autoimmune hepatitis,primary sclerosing cholangitis and so on);patients with previous history of hormone use;patients who used lipid-lowering drugs for more than one month before admission;patients complicated with other diseases causing dyslipidemia;patients treated with previous regular UDCA.In this project,the general data,underlying disease history and clinical data of PBC patients were collected.The PBC patients were grouped according to gender,age group,liver function Child-Pugh grade,BMI,and whether they were complicated with ascites,gastrointestinal bleeding,cardiovascular and cerebrovascular diseases and other complications.And then compare the clinical routine detection of total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),non-high-density lipoprotein cholesterol(NONHDL),lipoprotein a(LP(a)),apolipoprotein A1(Apo A1),apolipoprotein B(Apo B)lipid indexes,analyzed the blood lipid metabolism characteristics of PBC patients,and discussed the relationship between PBC lipid level and cardiovascular and cerebrovascular diseases and the impact on prognosis.SPSS 26.0 and Graph Pad Prism9 were used for statistical analysis.P<0.05 was considered statistically significant.Results1.A total of 333 patients were enrolled in this study,with an average age of 55.94±11.41 years,including 44 males and 289 females,with a male-to-female ratio of 6.6.There were 83 patients with hypertension,41 patients with diabetes and 58 patients with other autoimmune diseases.There were 182 patients with Child-Pugh classification A,134 patients with Child-Pugh classification B,and 17 patients with Child-Pugh classification C.2.Clinical characteristics of Blood Lipid Metabolism in PBC patients2.1 Distribution of dyslipidemia in patients with PBCIn this study,272 patients(81.68%)with dyslipidemia,including 138 patients(50.74%)with mixed hyperlipidemia,78 patients(28.68%)with low HDL-C,16patients(5.88%)with hypercholesterolemia,14 patients(5.15%)with hypertriglyceridemia,4 patients(1.47%)with elevated LDL-C.2.2 Clinical characteristics of patients with dyslipidemia in PBCThe incidence of jaundice,ALT,AST,ALP,GGT,TBA,TBIL,DBIL,IBIL and Child-Pugh score in PBC patients with dyslipidemia were significantly higher than those in patients without dyslipidemia(P <0.05).There were no significant differences in general clinical data and complications(P>0.05).2.3 Comparison of blood lipid levels in PBC patients with different gender groupsThe levels of TG,LDL-C,NONHDL and Apo B in postmenopausal women were lower than those in premenopausal women and male patients,and the TC levels in male patients were significantly lower than those in premenopausal female patients(P <0.05).2.4 Comparison of blood lipid levels in PBC patients with different age groupsThere were differences in blood lipid levels between young group(≤ 44 years old),middle-aged group(45-59 years old)and old group(≥ 60 years old).The older the age,the lower the levels of TC,TG,LDL-C,NONHDL and Apo B in PBC patients,and the difference was statistically significant(P <0.001).2.5 Comparison of blood lipid levels in PBC patients with different BMI groupsThere was no significant difference in the levels of TC,TG,HDL-C,LDL-C,NONHDL,LP(a),Apo A1 and Apo B among underweight patients(BMI<18.5),normal patients(18.5≤BMI<24.0),overweight or obese patients(BMI≥24.0)(P >0.05).2.6 Comparison of blood lipid levels in PBC patients without cirrhosis and different liver function Child-Pugh classCompared with patients with Child-Pugh classification B/C,the patients without cirrhosis and Child-Pugh classification A had lower levels of TC,HDL-C,LDL-C,LP(a),Apo A1.The levels of TG in patients without cirrhosis and the levels of NONHDL with Child-Pugh classification A were higher(P<0.05).2.7 Comparison of blood lipid levels in PBC patients with different TBA groupsThe levels of TC,HDL-C,LP(a)and Apo A1 in TBA ≤ UNL group and TBA 1-2UNL group were higher than those in TBA> 2UNL group,while NONHDL level was lower(P<0.01).2.8 Comparison of blood lipid levels in PBC patients with or without gastrointestinal bleeding and ascitesThe levels of TC,TG,HDL-C,LDL-C,NONHDL,Apo A1 and Apo B in patients with gastrointestinal bleeding were significantly lower than those without gastrointestinal bleeding,and the levels of TC,TG,HDL-C,LDL-C,NONHDL,LP(a),Apo A1 and Apo B in patients with ascites were lower than those without ascites(P<0.05).3.Analysis of risk factors of cardiovascular and cerebrovascular diseases in PBC patientsPBC patients were divided into two groups according to Whether it is complicated with cardio-cerebrovascular disease.There was no significant difference in the levels of TC,TG,HDL-C,LDL-C,NONHDL,LP(a),Apo A1 and Apo B between the two groups.Binary Logistic regression analysis showed that male,advanced age and history of hypertension were the risk factors of cardiovascular and cerebrovascular diseases in patients with PBC(P<0.05).4.Analysis of prognostic factors in patients with PBCMayo risk score was used to evaluate the prognosis of PBC.Multiple linear regression analysis showed that gastrointestinal bleeding,ascites,advanced age,high level of AST,TBA,TBIL,IBIL,PT prolongation,elevated Child-Pugh score,low level of BMI,ALB,HDL-C and LP(a)were independent risk factors for increased Mayo risk score in patients with PBC,suggesting a poor prognosis(P<0.05).Conclusions1.81.68% of PBC patients had dyslipidemia,and the main clinical manifestation was mixed hyperlipidemia,followed by low high-density lipoprotein and hypercholesterolemia.Gender,age,gastrointestinal bleeding,ascites,and degree of liver function affect lipid levels in patients with PBC.2.No association was found between blood lipid levels and the risk of cardiovascular and cerebrovascular disease in PBC patients.Male,advanced age and history of hypertension were risk factors for cardio-cerebrovascular diseases in PBC patients,which should be paid more attention to this population.3.The decreased levels of HDL-C and LP(a)are risk factors for the increase of Mayo risk score in patients with PBC,indicating a poor prognosis.In clinical practice,dynamic monitoring of blood lipid levels such as HDL-C and LP(a)is necessary. |
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