Comparative Analysis Of Primary Biliary Cirrhosis Combined With Other Autoimmune Diseases

Background: Primary biliary cirrhosis of primary biliary cirrhosis belongs to itself an immunological liver disease characterized by progressive non-suppurative small bile duct destruction and portal vein inflammation,which can eventually lead to liver fibrosis,cirrhosis,poor prognosis or even liver failure.Even hepatocellular carcinoma(PBC)often overlaps with other autoimmune liver diseases and extrahepatic autoimmune diseases,which make diagnosis and treatment significantly more difficult.Ursodeoxycholic acid(UDCA)is still the most widely used in the treatment of primary biliary cirrhosis.Objective: To analyze and compare the clinical characteristics and treatment strategies of PBC with other autoimmune diseases in patients with PBC and PBC with other autoimmune diseases.The difference of therapeutic effect can improve the understanding of this kind of disease and provide some reference for clinical work.Methods: A total of 119 PBC patients admitted to the second affiliated Hospital of Dalian Medical University from 2008 to 2017 were collected according to other autoimmune diseases,Patients were divided into simple PBC group(group N)and group with other autoimmune diseases(group Y).The occurrence of other autoimmune diseases was analyzed,and the general situation,biochemical indexes and treatment methods were compared between the two groups.Differences in therapeutic effects.According to the expression of AMA,divided into AMA(+)group and AMA(-)group,the difference between the two groups of biochemical indicators and therapeutic effect.Results: I.Comparison and analysis of clinical data of first diagnosis1.General comparison In this study,a total of 119 PBC patients who met the inclusion criteria were collected,63 of whom were complicated with other autoimmune diseases,accounting for 52.94% of the total data.Among them,30 cases were complicated with Sjogren's syndrome,21 cases were complicated with autoimmune hepatitis(Y-AIH group),12 cases were complicated with autoimmune thyroid disease,and 6 cases were complicated with rheumatoid arthritis.There were 24 patients with two or more other autoimmune diseases at the same time,accounting for 20.17% of the total.The age of group Y was 60.77 ±11.20 years old was 62.10 ±11.59 years old,there was no significant difference between the two groups(P > 0.05).But the age of Y-SS group was 66.30 ±11.20 years old,which was significantly larger than that of N group.There was significant difference between the two groups(P < 0.05).There was no significant difference in sex ratio between group N and group Y(P > 0.05).The main symptoms of abdominal distension in group N were more than that in group Y at the first visit,and the difference between the two groups was statistically significant(P <0.05).2.Comparison of biochemical indexes The mean value of alt in group Y was 100.32 ±106.27U/L 117.31 ±153.54U/L,which was significantly higher than that in group N(P < 0.05).The level of alt in Y-SS group was significantly higher than that in 0.05).Y-SS group(P < 0.05).There were 19 patients with asymptomatic liver dysfunction in this study.The mean values of ALB in the two groups were 566 ±438.99 U / L,243.11 ±104.36 U/ L,99.96±61.07U/L,40.32±5.21g/L,which were significantly higher than those in the Y group(P<0.05).There were 32 patients with liver cirrhosis at the first diagnosis,The mean value of UCB in patients with liver cirrhosis at first diagnosis was 63.22±62.07umol/L,45.08 ±54.95 umol/L,15.01 ±8.94 umol/L,which was significantly higher than that in patients without cirrhosis(P < 0.05).3.Immunological index In this study,91 cases of AMA or AMA-M2 were positive and 28 cases were negative.The positive rate was 76.47%.The positive rate of AMA in group N was78.57%,and the positive rate of AMA in group Y was 74.60%.There was no significant difference between the two groups(P > 0.05).Compared with AMA+group and AMA-group,the mean value of ALP ALT was 344.82 ±327.19U/L 116.45±124.93U/L 153.84 ±194.82U/L,which was higher than that of AMA+group,There was significant difference between the two groups(P < 0.05).2.Follow up clinical data A total of 57 patients were followed up after regular treatment for more than 6months.Without considering the difference of treatment plan,the improvement of ALB level in group N and group Y was the most obvious after treatment,and there was significant difference in the level of ALB in group N and group Y(P < 0.05).The improvement of UCB level in group Y was more obvious than that in group Y after treatment.The difference between the two groups was statistically significant(P <0.05).There were 19 cases with one autoimmune disease and 12 cases with 2 or more autoimmune diseases in group Y.Separation and treatment The results showed that the level of aminotransferase in patients with autoimmune diseases was significantly improved after treatment,and there was a significant difference between the two groups(P < 0.05).There was a tendency of deterioration of ALB level in group N,and there was a significant difference between the two groups(P < 0.05).Comparing the biochemical level of AMA +group and AMA-group after treatment,it was found that the improvement of UCB level in AMA +group was better than that in group AMA-group(P<0.05).Improvement of GGT,ALP level in UDCA hormone immunosuppressant group in follow-up patients The improvement of PLT level in UDCA group and UDCA combined with glucocorticoid group was better than that in UDCA group and UDCA hormone immunosuppressant group.Conclusions:1.The age of PBC patients with Sjogren's syndrome is generally older.2.The degree of cholestasis of PBC was not aggravated by other autoimmune diseases,but the degree of liver damage was aggravated.3.Liver damage in AMA(-)group was more serious than that in AMA(+)group,and the therapeutic effect was poor.4.Glucocorticoid had no significant effect on the prognosis of PBC.