Clinical Characteristics Of Patients With Primary Biliary Cirrhosis And Liver Cirrhosis After Viral Hepatitis Complicated With Pulmonary Hypertension

Aims:Clinical features of primary biliary cirrhosis with pulmonary hypertension,(PBC-PH),Liver cirrhosis after viral hepatitis with pulmonary hypertension(LCVH-PH)were analyzed and research,to explore the clinical characteristics of the complications of different causes and to improve the understanding of the complications.Methods:Through the medical record inquiry system,168 patients with primary biliary cirrhosis(PBC)were examined by color Doppler echocardiography in the First Clinical Hospital of Jilin University from October 1,2012 to October 1,2018,and176 patients with Liver cirrhosis after viral hepatitis(LCVH)were examined by color Doppler echocardiography from October 1,2017 to October 1,2018.The clinical data of all patients included general data,clinical symptoms,laboratory examinations,imaging examinations,complications,and severity of disease etc.According to the2004 CAAP evidence-based guidelines,PBC patients were divided into 24 patients with PBC-PH,144 patients with primary biliary cirrhosis without pulmonary hypertension(PBC-non PH),LCVH patients were were divided into 14 patients with LCVH-PH and 162 patients with Liver cirrhosis after viral hepatitis without pulmonary hypertension.The clinical data of PBC-PH group and PBC-non PH group,LCVH-PH group and LCVH-non PH group were analyzed by SPSS22.0 software.Results:First part:1.Among 168 PBC cases,there were 24 in PBC-PH group and 144 in PBC-non PH group,the prevalence of PBC-PH in this study was 14.3%.2.The average age of PBC-PH group was 68.13 ±10.60 years old,and that of PBC-non PH group was 62.48 ±11.11 years old,there was significant difference between the two groups(P=0.022).3.The levels of total protein,albumin and cholinesterase in PBC-PH group were lower than those in PBC-non PH group,bilirubin level in PBC-PH group was higher than that in PBC-non PH group,the prothrombin time and international standardized ratio in PBC-PH group were higher than those in PBC-non PH group,the difference was statistically significant(P < 0.05).4.There was no significant difference between PBC-PH group and PBC-non PH group in sex,symptoms,course of disease,blood lipid,immunological indexes,anti-M2 titer,anti-nuclear antibody karyotype,autoantibody,electrocardiogram abnormality and severity of disease(P < 0.05).In PBC-PH group(23 cases,1 case missing),anti-mitochondrial M2 antibody and anti-mitochondrial M2-3E antibody were all positive.5.Abdominal imaging in PBC-PH group showed that 13 cases were ascites positive,accounting for 59.1% of the total number of patients in PBC-PH group.48 cases were ascites positive,accounting for 35.8% of the total number of patients in PBC-non PH group.There was significant difference between the two groups(P=0.038).The imaging findings showed 15 cirrhosis patients(68.2%),7 portal hypertension patients(31.8%)in PBC-PH group,and 68 cirrhosis patients(50.7%)and 36 portal hypertension patients(26.9%)in PBC-non PH group.There was no significant difference between the two groups.6.Among the complications,the proportion of hypersplenism and spontaneous peritonitis in PBC-PH group was higher than that in PBC-non PH group(P=0.011,P=0.039).7.Multivariate logistic regression model analysis showed that age was an independent correlative factor of PBC with PH(P < 0.05).Combined with regression coefficient(B)and OR value,age was positively correlated with PBC-PH.The second part:8.Among 168 cases of LCVH,there were 14 cases in LCVH-PH group and 162 cases in PBC-nonPH group.The prevalence of LCVH-PH in this study was 8.0%.9.There was no significant difference in sex,age,transaminase level,blood lipid,viral quantification,electrocardiogram abnormality and disease severity between LCVH-PH group and LCVH-non PH group.10.In LCVH-PH group,the albumin value was 27.1±7.55g/L,and31.14±6.99g/L in LCVH-non PH group.There were significant differences between the two groups(P=0.04).The prothrombin time and international standardized ratio in LCVH-PH group were higher than those in LCVH-non PH group,with statistical significance(P=0.010,P=0.012).The prothrombin activity and fibrinogen in LCVH-PH group were lower than those in LCVH-non PH group(P=0.014,P=0.016).11.In LCVH-PH group,there were 32 cases of gastrointestinal bleeding,accounting for 19.8% of the complications.In LCVH-non PH group,there were 6cases of gastrointestinal bleeding,accounting for 42.9% of the complications.There was a significant difference between the two groups(P=0.044).12.In LCVH-PH group,11(78.6%)cases were diagnosed as portal hypertension,while in LCVH-non PH group,93(60.0%)cases were diagnosed as portal hypertension.There was no significant difference between the two groups.13.Multivariate Logistic regression model analysis showed no independent correlation factors between LCVH and PH.Conclusions:Compared with non-pulmonary hypertension,primary biliary cirrhosis and liver cirrhosis hepatisis with pulmonary hypertension had lower liver synthesis ability and severe cholestasis,but there was no significant difference in Child-Pugh score.At the same time,there are quite a number of patients with primary biliary cirrhosis with pulmonary hypertension without evidence of portal hypertension,which does not exclude other mechanisms involved in the occurrence of this complication.Further research is needed.