| Objective:To retrospectively analyze the changes of clinical,biochemical and immunological parameters and prognosis and survival of PBC patients before and after UDCA treatment,to explore the effect of UDCA in the treatment of PBC and its influence on prognosis and survival,in order to improve the quality of life and prolong the survival time of PBC patients,and provide scientific basis for the early standard treatment of PBC.Methods:A total of 152 patients diagnosed as PBC in the inpatient department and outpatient department of the First Affiliated Hospital of Nanchang University from January 01,2012 to May 31,2017 were selected,including 124 females and 28 males,aged 28-80 years,mean age is 54.43±11.05 years old,median age is 53 years old.All patients received UDCA(250 mg/time,Tid)for more than one year,and were followed by inpatient/outpatient medical records and telephone follow-ups with an average follow-up 39.96±18.12 months.Collecting general information(sex,age,etc.),symptoms,signs,serological tests(biochemical,immunological,coagulation),imaging examinations(CT/MRI),outcome/prognosis,survival,and symptoms after 1 year of initial treatment,signs,serological tests(biochemical,immunological),imaging examinations(CT/MRI)and other data.The above data were analyzed statistically to evaluate the efficacy of UDCA in the treatment of PBC,and the survival rate of PBC patients was calculated.The factors that may influence the prognosis and survival of patients were analyzed by multivariate analysis.Results:1.152 patients with primary biliary cholangitis were diagnosed.Among them,124(81.5%)were female and 28(18.5%)were male.The male to female ratio was 1:4.4.2.Comparing symptoms and signs at the time of initial diagnosis: fatigue in 116 cases,accounting for 76.3%;skin itching in 51 cases,accounting for 33.5%;abdominal pain in 20 cases,accounting for 13.1%;jaundice in 42 cases,accounting for 27.6%;splenomegaly or splenectomy in 68 cases,accounting for 44.7%;hepatomegaly in 17 cases,accounting for 11.1%.Some patients had cirrhosis with decompensated performances,including 37 cases of esophageal varices,accounting for 24.3%,69 cases of ascites,accounting for 45.3%.Nineteen patients(12.5%)had hepatic encephalopathy and 16 patients(10.5%)had other autoimmune diseases.3.Immunological detection of PBC patients showed that the positive rate of AMA/AMA-M2 was extremely high,and IgG and IgM were elevated.Biochemical examination showed that ALP,GGT,TBIL,and DBIL were significantly elevated,AST,ALT,TC,TG can also increase.4.One year after UDCA treatment,fatigue,itching and jaundice were significantly improved(P<0.05),and ALP,GGT,ALT levels were significantly lower than before treatment(P<0.01),and AST levels were decreased(P<0.05).5.A total of 17 deaths occurred in 152 patients.The 2-year,3-year,and 5-year survival rates after UDCA treatment were 93%,91%,and 89%.Univariate analysis suggested that age,esophageal varices,ascites,and GGT,TBIL,ALB,Na+,PT,APTT,LDL,HDL were correlated with the prognosis and survival of patients(P<0.05).Multivariate COX model analysis revealed that TBIL,ALB,PT,and Na+ were important factors affecting the prognosis and survival of PBC patients(P<0.05).Conclusion:1.The clinical manifestations of PBC are mostly fatigue,pruritus,and jaundice,abdominal pain are less common,and signs are mostly manifested as splenomegaly,jaundice,liver enlargement are relatively rare.2.The positive rate of AMA/AMA-M2 in patients with PBC is extremely high,and IgG,IgM may be elevated.The biochemical indicators including ALP,GGT,TBIL,DBIL,AST,ALT,TC,and TG may all increase,ALP,GGT,TBIL,and DBIL increased more significantly.3.Symptoms and serological indicators of PBC patients improved after UDCA treatment.Among them,fatigue,itching,and jaundice were significantly improved compared with those before treatment.Serological indicators including ALP,GGT,and ALT levels were significantly elevated from those before treatment,There are also increase in AST levels.4.The prognosis of PBC was good,the 2-year,3-year,and 5-year survival rates after UDCA treatment were 93%,91%,and 89%.TBIL,ALB,PT,and Na+ were important factors affecting the prognosis and survival of PBC. |
