Clinical Analysis Of 37 Male Patients With Primary Biliary Cirrhosis

Objective:Primary biliary cirrhosis(PBC) is a chronic progressive cholestasis associated with autoimmune liver disease, which pathological characteristics was mainly for damage of small intrahepatic bile duct of without suppurative inflammatory, further develop to liver fibrosis, cirrhosis, and liver failure. And its pathogenesis is not entirely clear. Fatigue, skin itching, portal hypertension were the major clinical manifestations and serum antimitochondrial(AMA) positive was the specificity index. of diagnosis. Ursodeoxycholic acid is the safe and effective drug for the treatment of PBC. Epidemiological investigation data shows that the PBC patients are mainly women, male patients is relatively rare. Male patients are more likely to be ignored because of the low incidence of male patients with PBC. This study retrospectively analyzed the clinical manifestation, biochemical indexes, immunological indexes of 37 male patients and 202 female patients with PBC, in order to further explore the clinical characteristics of male patients with PBC.Methods:To retrospectively analyse the clinical manifestations, biochemical index, immunological index of 37 male PBC patients that were hospitalized in Beijing 302 hospital from July 1, 2013 to June 30,2014.Results:1. The ratio of male to female patients is about 1:5 in Beijing 302 hospital from July 2013 to June 2014. The age of male patients who were first diagnosed is 58.5 ± 14.5 years old, and the difference of age compared with female patients was no statistical significance(P > 0.05).2. The main symptoms of male PBC patients were fatigue(45.9%), abdominal distension(32.4%), appetite(29.7%), skin itching(24.3%), the main signs were liver palm(67.7%), splenomegaly(56.8%), and jaundice(45.9%). The incidence of liver palm in male patients was higher than women, the difference was statistical significance(P < 0.05).3. The male patients’ biochemical indexes with PBC were that elevated rates of ALT,AST, ALP, GGT,TBil were 78.4%,89.2%, 78.4%,86.5%, 54.1% respectively. Compared with female patients, the value of ALT, AST, GGT was higer in male patients, the difference was statistical significance(P < 0.05). And there was no statistical difference of value of ALP, TBil, TC, TG, ALB, CHE between male and female(P > 0.05).4. The male patients’ immunological indexes showed that the elevated rate of Ig M, Ig G and Ig A was 54.8%, 38.7% and 29.0%. Compared with women, the difference of the value of Ig M,Ig G and Ig A was no statistical significance(P > 0.05). The positive rate of AMA, ANA,ANTI-AMA-M, BPO, SP100, GP210, 52 KD was 97.1%,70.3%, 81.3%, 93.75%, 18.75%, 43.2%, 43.75% respectively.5. The male patients with no cirrhosis were 13 cases(35.1%), 24 cases(64.9%) with cirrhosis. The value of ALT, ALB, CHE, TC, TG with no cirrhosis were higher than that with cirrhosis. And TBil were lower compared with cirrhosis(P < 0.05), while the difference of AST, ALP, GGT, Ig M, Ig G, Ig A between no cirrhosis and cirrhosis was no statistical significance(P > 0.05).6. Male patients with PBC in decompensated cirrhosis were 18 cases(48.7%), merging 17 cases(45.9%) of ascites, 3 cases(8.1%) with hepatic encephalopathy, 3 cases(8.1%) with hepatorenal syndrome, 2 cases(5.4%) with gastrointestinal bleeding.Conclusion:Male patients with PBC have increased in recent years, mostly were middle-aged. There were no obvious difference of the diagnosed age between male and female patients. The main clinical manifestation is fatigue, abdominal distension, appetite, skin itching, liver palm, splenomegaly, and jaundice. The incidence of liver palm in male patients was higher than that of women.The value of ALT, AST, ALP, GGT was increased, and the value of ALT, AST, GGT was higer than that of women. Immunological indexes is given priority to with Ig M increases, and the AMA, ANA,ANTI-AMA-M, BPO, SP100, GP210, 52 KD was with differencet positive rate. As the development of the disease, the serum bilirubin level of PBC patients is on the rise, and the level of albumin, cholinesterase decreased obviously. The majority of patients had reached to cirrhosis, even to decompensated cirrhosis with ascites, hepatic encephalopathy, gastrointestinal bleeding, hepatorenal syndrome, hence, it led the treatment more difficultiy.