原发性胆汁性胆管炎合并肝炎病毒感染患者的临床及预后特征

赵丹彤; 闫惠平; 刘燕敏; 黄春洋; 张海萍; 赵艳; 廖慧钰

doi:10.3969/j.issn.1001-5256.2017.08.025

原发性胆汁性胆管炎合并肝炎病毒感染患者的临床及预后特征

DOI: 10.3969/j.issn.1001-5256.2017.08.025

1. 首都医科大学附属北京佑安医院自身免疫性肝病临床研究中心暨临床检验中心
2. 首都医科大学附属北京佑安医院肝病免疫科

基金项目:

国家自然科学基金青年科学基金项目(81400609)；北京市医院管理局临床医学发展专项——“扬帆”计划资助项目(ZYLX201711)；

详细信息

中图分类号: R512.6;R575.22
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出版历程
- 收稿日期: 2017-02-27
- 出版日期: 2017-08-20

Clinical features and prognosis of patients with primary biliary cholangitis complicated by hepatitis virus infection

Clinical Research Center for Autoimmune Liver Disease, Beijing YouAn Hospital, Capital Medical University

Research funding:

摘要

摘要:
目的探讨原发性胆汁性胆管炎（PBC）患者合并肝炎病毒感染的临床及预后特征。方法选取2004年10月-2012年10月北京佑安医院收治的确诊PBC合并肝炎病毒感染患者16例（7例合并慢性HBV感染,3例合并丙型肝炎,4例合并戊型肝炎,1例合并乙型肝炎和丙型肝炎,1例合并甲型肝炎）,同时随机选择住院确诊无肝炎病毒感染的单纯PBC患者76例作为对照。比较两组患者临床特征、实验室指标、自身抗体结果,随访分析预后特征。正态分布计量资料两组间比较采用独立样本t检验,非正态分布计量资料两组间比较采用Mann-Whitney U秩和检验;计数资料组间比较采用χ2检验或Fisher精确概率法。组间生存率比较采用Kaplan-Meier法作log-rank检验。结果 PBC合并肝炎病毒感染患者与单纯PBC患者比较,其女性患者比例、ALP、CHO、IgG水平偏低（χ2=12.22,P=0.002;U=225.00,P<0.001;U=363.50,P=0.036;t=2.79,P=0.007）;未出现腹壁静脉曲张、上消化道出血、肝性脑病症状;存在抗核抗体、抗...
- 肝硬化,胆汁性 /
- 肝炎病毒 /
- 预后
Abstract:
Objective To investigate the clinical features and prognosis of patients with primary biliary cholangitis ( PBC) complicated by hepatitis virus infection. Methods A total of 16 patients who were admitted to Beijing You An Hospital from October 2004 to October 2012 and diagnosed with PBC complicated by hepatitis virus infection were enrolled, among whom 7 had chronic hepatitis B virus infection, 3 had hepatitis C, 4 had hepatitis E, 1 had hepatitis B and hepatitis C, and 1 had hepatitis A. A total of 76 hospitalized patients with PBC alone were enrolled as controls. The two groups were compared in terms of clinical features, laboratory markers, and autoantibodies, and follow-up visits were performed to investigate prognostic features. The independent samples t-test was used for comparison of normally distributed continuous data, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data; the chi-square test or Fisher's exact test was used for comparison of categorical data. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used to compare survival rates between groups. Results Compared with the control group, the PBC-hepatitis virus infection group had significantly lower proportion of female patients ( χ2= 12. 22, P = 0. 002) , alkaline phosphatase ( U = 225. 00, P < 0. 001) , CHO ( U = 363. 50, P = 0. 036) , and Ig G level ( t = 2. 79, P = 0. 007) , and no patients in the PBC-hepatitis virus infection group experienced abdominal wall varices, upper gastrointestinal bleeding, or hepatic encephalopathy. The PBC-hepatitis virus infection group had various autoantibodies including anti-nuclear antibody, smooth muscle antibody, anti-parietal cell antibody ( APCA) , anti-liver specific protein antibody, and anti-myocardial antibody, as well as a significantly higher APCA positive rate than the control group ( 25% vs 3. 9%, χ2= 5. 608, P = 0. 016) . The median follow-up time was 49. 5 months ( 2-312 months) . The PBC-hepatitis virus infection group had a significantly lower incidence rate of adverse events than the control group ( 25. 0% vs 64. 5%, χ2= 8. 43, P = 0. 005) , and there were no significant differences between the two groups in cumulative survival rate and proportion of patients who did not experience any adverse event ( both P > 0. 05) . Conclusion Most patients with PBC complicated by hepatitis virus infection are in the early stage of PBC and have various nonspecific autoantibodies. Current study does not indicate that hepatitis virus infection has influence on the survival of PBC patients.
- liver cirrhosis, biliary /
- hepatitis viruses /
- prognosis

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参考文献(19)

[1]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and management of primary biliary cirrhosis (cholangitis) (2015) [J].J Clin Hepatol, 2015, 31 (12) :1980-1988. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会.原发性胆汁性肝硬化 (又名原发性胆汁性胆管炎) 诊断和治疗共识 (2015) [J].临床肝胆病杂志, 2015, 31 (12) :1980-1988.

[2]LINDOR KD, GERSHWIN ME, POUPON R, et al.Primary biliary cirrhosis[J].Hepatology, 2009, 50 (1) :291-308.

[3]van de WATER J, ISHIBASHI H, COPPEL RL, et al.Molecular mimicry and primary biliary cirrhosis:premises not promises[J].Hepatology, 2001, 33 (4) :771-775.

[4]GERSHWIN ME, SELMI C, WORMAN HJ, et al.Risk factors and comorbidities in primary biliary cirrhosis:a controlled interviewbased study of 1032 patients[J].Hepatology, 2005, 42 (5) :1194-1202.

[5]PRINCE MI, DUCKER SJ, JAMES OF.Case-control studies of risk factors for primary biliary cirrhosis in two United Kingdom populations[J].Gut, 2010, 59 (4) :508-512.

[6]CORPECHOT C, CHRTIEN Y, CHAZOUILLRES O, et al.Demographic, lifestyle, medical and familial factors associated with primary biliary cirrhosis[J].J Hepatol, 2010, 53 (1) :162-169.

[7]European Association for the Study of the Liver.EASL Clinical Practice Guidelines:management of cholestatic liver diseases[J].J Hepatol, 2009, 51 (2) :237-267.

[8]Chinese Society of Hepatology and Chinese Society of Infectious Disease, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[9]Chinese Society of Hepatology and Chinese Society of Infectious Disease, Chinese Medical Association.The guideline of prevention and treatment for hepatitis C:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1961-1979. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.丙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1961-1979.

[10]Chinese Society of Infectious Diseases and Parasitology, Chinese Society of Hepatology, Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Infect Dis, 2001, 19 (1) :56-62. (in Chinese) 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19 (1) :56-62.

[11]DICKSON ER, GRAMBSCH PM, FLEMING TR, et al.Prognosis in primary biliary cirrhosis:model for decision making[J].Hepatology, 1989, 10 (1) :1-7.

[12]SHAO Y, YU ZL, ZHANG ST.Primary biliary cirrhosis complicated by viral hepatitis:an analysis of 8 cases[J].J Clin Intern Med, 2002, 19 (3) :231-232. (in Chinese) 邵颖, 于中麟, 张澍田.原发性胆汁性肝硬化与病毒性肝炎重叠症八例[J].临床内科杂志, 2002, 19 (3) :231-232.

[13]LUO L, WANG CD, WANG YZ.A case of primary biliary cirrhosis complicated by acute hepatitis E[J].J Clin Intern Med, 2003, 20 (3) :153-154. (in Chinese) 罗莉, 王承党, 王叶舟.原发性胆汁性肝硬化并急性戊型病毒性肝炎一例[J].临床内科杂志, 2003, 20 (3) :153-154.

[14]CALVARUSO V, CRAXI A.Immunological alterations in hepatitis C virus infection[J].World J Gastroenterol, 2013, 19 (47) :8916-8923.

[15]MARCONCINI ML, FAYAD L, SHIOZAWA MB, et al.Autoantibody profile in individuals with chronic hepatitis C[J].Rev Soc Bras Med Trop, 2013, 46 (2) :147-153.

[16]CIESEK S, BECKER T, MANNS MP, et al.Anti-parietal cell autoantibodies (PCA) in primary biliary cirrhosis:a putative marker for recurrence after orthotopic liver transplantation?[J].Ann Hepatol, 2010, 9 (2) :181-185.

[17]GHONAIM M, AL-GHAMDI A, EL-BANA H, et al.Autoantibodies in chronic liver disease[J].Egypt J Immunol, 2005, 12 (2) :101-111.

[18]LIU N, TAN LM, DONG Y, et al.Clinical application of autoantibodies in patients with primary biliary liver cirrhosis[J].World Chin J Dig, 2007, 15 (21) :2358-2361. (in Chinese) 刘宁, 谭立明, 董叶, 等.原发性胆汁性肝硬化患者自身抗体测定的意义[J].世界华人消化杂志, 2007, 15 (21) :2358-2361.

[19]RIGOPOULOU EI, ZACHOU K, GATSELIS NK, et al.Primary biliary cirrhosis in HBV and HCV patients:clinical characteristics and outcome[J].World J Hepatol, 2013, 5 (10) :577-583.

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