Clinical Analysis Of Hepatitis B Virus Infection In Patients With Primary Biliary Cholangitis

Objective:To investigate hepatitis B virus and hepatitis C virus infection in primary biliary cholangitis patients and the influence of HBV infection on the progress of PBC disease.Methods:Retrospectively analyze 915 hospitalized patients diagnosed as PBC at the First Hospital of Jilin University from January 2008 to January 2016.Patients enrolled test hepatitis B markers or HBs Ag with CMAI or ELISA(HBs Ag all detected with CMAI),and detect anti-HCV with CMAI.There are 18 PBC patients with HBs Ag positive selected as PBC+HBV group,72 PBC patients with HBs Ag negative as PBC group and36 simple hepatitis B patients as HBV group matched by sex-age.Study and compare the demographic information,clinical manifestations,laboratory tests,MELD score and noninvasive liver fibrosis index(include APRI,FIB-4 and RPR)between groups.Result:The study collected 915 cases of PBC patients,with 782 cases of female and 133 cases of males,the ratio was about 5.88:1.The age ranged from 20 to 90 years old,the mean age was(57.18±12.16)and the median age was 57 years old.There were 18 cases of PBC patients with HBs Ag positive,accounting for 1.97%(18/915).What’s more,the positive rate of HBs Ag in female PBC patients was 1.66%(13/782)and 3.76%(5/133)in male patients,the difference was not statistically significant(1.66% vs 3.76%,χ~2=2.592,P=0.107).A total of 894 PBC patients detected anti-HCV,and there were 37 cases with anti-HCV positive,accounting for 4.14%(37/894).The clinical manifestations of the three group were fatigue,jaundice,urinary tract infection,abdominal distension,anorexia,skin itching,liver discomfort,lower extremity edema,ascites,dry mouth and dry eyes,diarrhea,nausea,abdominal pain,liver palms and spider angioma.Among them,PBC+HBV group had more lower extremity edema and ascites than PBC group(33.3% vs 12.5%,P=0.034 and 44.4% vs 20.8%,P=0.04).Compared with HBV group,PBC+HBV group had more fatigue and lower extremity edema(55.6% vs 27.8%,P=0.046 and 33.3% vs 8.3%,P=0.02).PBC group had more fatigue and skin itching than HBV group(54.2% vs 27.8%,P=0.009 and 27.8% vs 5.6%,P=0.007)and HBV group had more liver discomfort and abdominal pain than PBC group(27.8% vs 11.1%,P=0.028 and 22.2% vs 8.3%,P=0.043%),differences between groups were statistically significant.About laboratory examination,PBC+HBV group had lower hemoglobin and platelet(111 vs 119,P=0.038 and 115 vs 180.5,P=0.002),prolonged thrombin time(16.6 vs 15.6,P=0.021),lower albumin and cholesterol(33.7 vs 38.8,P=0.025 and3.15 vs 4.54,P=0.001),lower γ-GT and ALP(168.7 vs 362.5,P=0.04 and 130.05 vs298.4,P=0.001)than PBC group.Compared with HBV group,PBC+HBV group had lower hemoglobin and platelet(111 vs 120,P=0.03 and 115 vs 167.5,P=0.042),higher AST and ALT(78.95 vs 37.55,P=0.016 and 64.5 vs 30.4,P=0.021),significantly increased γ-GT and ALP(168.7 vs 39.5,P=0.00 and 130.05 vs 89.85,P=0.001).γ-GT,ALP,cholesterol and triglycerides was significantly increased in PBC group than in HBV group,differences were statistically significant.About the scores,PBC+HBV group had higher APRI score and RPR score than PBC group and HBV group,differences were statistically significant.Conclusion:1.PBC patients could had a stronger clearance of infected HBV.2.PBC infected with HBV may aggravate the progression of hepatitis B.The age when diagnosed as hepatitis B was generally earlier than the age of PBC,when CHB patients found γ-GT and ALP increased significantly with no obvious incentive during the follow-up,further screening for anti-M2 was needed to determine whether incorporated with PBC.3.HBV infection may aggravate the progression of PBC disease,PBC patiens should screen for hepatitis B markers and treated positively.