The Analysis And Research Of Clinical Features And Prognosis In Patients With Primary Biliary Cirrhosis

Objective1. To investigate the association of expression of anti-gp210 antibody and the diagnosis and prognosis of patients with primary biliary cirrhosis(PBC). 2. To explore the risk factors for PBC patients with esophageal gastric varices. 3. To understand the main cause of death and survival rate in patients with PBC, analysis of risk factors related to the prognosis of patients with PBC, provide clinical basis for improving the prognosis of the patients.Methods1. Clinical study on the correlation between the expression of anti-gp210 antibody and primary biliary cirrhosis: 161 cases of PBC patients who treated in our hospital from January 2008 to November 2015 were collected. According to the expression of anti-gp210 antibody, it were divided those patients into positive anti-gp210 antibody group and negative group. Statistical analysis was performed to investigate the correlation between the expression of anti-gp210 antibody and with PBC clinical manifestion, liver, biochemical test and liver function between the two groups. 2. Clinical study of the risk factors for primary biliary cirrhosis patients with esophageal gastic varices: From January 2008 to November2015, 118 PBC patients underwent gastroscopy examination and among them 36 received liver biopsy. The correlation between esophageal gastric varices and histological stage, age, gender, anti-centromere antibodies(ACA), platelet(PLT), albumin(Al B), total bilirubin(TBil), alkalinephosphatase(ALP),γ-glutamyltransferase(GGT),aspartateaminotransferase(AST),alanineaminotransferase(ALT), prothrombin time(PT) and Mayo score were analyzed. Logistic regression analysis was used to identify independent risk factors predicting esophageal gastric varices in PBC patients. 3. Analysis of prognostic factors and survival in PBC patients: Through previous visits or telephone follow-up records and follow-up data were collected from 161 PBC patients. Kaplain-Meier(K-M) was used to calculate the survival rate. Cox regression analysis was used to identify the independent risk factors associated with the prognosis of PBC patients. 4. The Spearman’s rank correlation coefficient test was used to analysis the correlation between APRI and liver histological stage in patients with PBC. The ROC curve of APRI was used to predict liver related death in PBC patients, to assess the relationship between APRI and the prognosis of PBC.Results1. In161 patients of PBC, the positive rate of anti-gp210 antibody was 42.9%, whereas 18 patients showed positive anti-gp210 antibody among 33 PBC cases with negative AMA-M2(54.5%). The expression of anti-gp210 antibody with the appearance of jaundice and fatigue had statistical significance(P<0.05). In anti-gp210 antibody negative group, the mean levels of serum TBIL, DBIL and Mayo score were significantly higher than that in anti-gp210 antibody positive group(P<0.05). 2. Among 118 patients with PBC, varices was found in 66 patients(51 pure esophageal varices, 10 esophageal gastric varices and 5 pure gastric varices). Among 36 patients with liver biopsy, 21 had varices(4 at early histological stage I and II, 17 at later histological stage III and IV). The ACA positive rate, PT, TBil and Mayo score of patients with varices were higher than those of patients without varices. While Alb, GGT and PLT were lower than those of patients without varices, the differences were statistically significant(all P<0.01). Multivariate Logistic regression analysis revealed that positive ACA(odds ratio(OR)13.481, 95% cofidence interval(CI):2.202 to82.536), Mayo score over 4.51(OR=11.948, 95% CI:1.534 to 93.027), PLT count less than 93.5×10^9/L(OR=9.602, 95% CI :2.235 to 41.255), TBil level over 25.92 μmol/L(OR=15.306, 95% CI :3.271 to 71.633)were independent risk factors predicting varices. 3. The average follow up(30.99 ± 22.46) months, 39 cases of liver related death events, 37 cases(7.3%), 2 cases of liver transplantation(1 cases died of pulmonary infection after liver transplantation). From the calculation of PBC patients in our hospital diagnosed for the first time, the average survival time was 22.23 ± 22.76(month), the overall 1 year, 3 years, 5 years survival rate were 88.0%, 76.7%, 60.8%.and from the patient’s symptoms when the initial visits to calculate the average survival time was 43.94±37.84(month), the overall 1 year, 3 years, 5 years survival rate was 94.3%, 80.8%, 74.3%. In this study, 59 patients first diagnosed as Hepatic decompensation, when patients progress to decompensation, 1 years, 3 years and 5 years survival rates were 69.1%, 48%, 24%. Liver failure, SBP,(EGVB, esophagealgastricvariceal bleeding) and Hepatic coma were the leading cause of death in patients with PBC, accounting for the total number of deaths of 54.1%(20/37) and 18.9%(7/37), 13.5%(5/37), 13.5%(5/37), respectively. Univariate analysis results showed that the stage III and IV, esophageal gastric varices varices, ascites, liver cirrhosis compensatory complications(esophageal and gastric variceal bleeding, hepatic encephalopathy)and Mayo score increased, low platelet count, APRI increased, total bilirubin increased, PT prolonged, elevated low albumin level, immune globulin protein G(Ig G), anti-gp210 antibody positive associated with the prognosis of patients with PBC(P<0.05). Multivariate Cox regression analysis showed that Hepatic decompensation, the ratio of AST/platelet ratio index increased and the PT prolonged were independent risk factor of PBC poor prognosis. Spearman’s rank correlation coefficient test showed that APRI positively correlated with histological disease progression. APRI at diagnosis provided high prognostic accuracy in predicting liver related death in PBC patients(AUROC:0.773,95% confidence interval: 0.690-0.856).Conclusion1. The anti-gp210 antibody in serum can not only help early diagnosis of AMA-M2 negative PBC cases, but also be helpful for clinical assessment and prognosis. It is indicated that anti-gp210 antibody has a clinical application value in PBC. 2. ACA positive, PLT count less than 93.5×10^9/L, TBil level over25.92 μmol/L and Mayo score over 4.51 can help to predict esophageal gastric varices in patients with PBC. 3. The survival time of patients with PBC was gradually shortened, with symptoms first outpatient and inpatient and entering the Hepatic decompensation. 4. Liver failure, SBP, EGVB and Hepatic coma were the leading cause of death in patients with PBC. The stage III and IV, esophageal gastric varices, ascites, liver cirrhosis compensatory complications(esophageal and gastric variceal bleeding, hepatic encephalopathy) and Mayo score increased, low platelet count, APRI increased, total bilirubin increased, PT prolonged, elevated low albumin level, immune globulin protein G(Ig G), anti-gp210 antibody positive associated with the prognosis factors of patients with PBC. Of these factors, Ascites, AST/platelet ratio index increased and the PT prolonged were independent risk factor of PBC. 5. APRI is related to the severity of PBC, and it is a valuable index to predict the liver related death in patients with PBC.