中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

血清补体C3对原发性胆汁性胆管炎相关肝纤维化分期的诊断价值

周辉 牛斌 宓余强 刘勇钢 李萍

引用本文:
Citation:

血清补体C3对原发性胆汁性胆管炎相关肝纤维化分期的诊断价值

DOI: 10.3969/j.issn.1001-5256.2023.11.013
基金项目: 

‍天津市医学重点学科(专科)建设项目 (TJYXZDXK-059B)

中国肝炎防治基金会王宝恩肝纤维化研究基金 (2021038)

伦理学声明:本研究方案于2019年12月25日经由天津市第二人民医院伦理委员会审批,批号:[2019]58。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:周辉负责收集数据、资料分析及撰写论文;牛斌负责收集数据和指导统计分析;宓余强负责指导文章撰写;刘勇钢负责病理评分;李萍负责课题设计和最后定稿。
详细信息
    通信作者:

    ‍李萍, tjlplxg@163.com (ORCID: 0000-0001-9930-6429)

Value of serum complement C3 in the diagnosis of liver fibrosis associated with primary biliary cholangitis

Research funding: 

‍Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-059B);

Chinese Foundation for Hepatitis Prevention and Control (2021038)

More Information
    Corresponding author: LI Ping, tjlplxg@163.com (ORCID: 0000-0001-9930-6429)
  • 摘要:   目的  探讨血清补体C3水平对原发性胆汁性胆管炎(PBC)肝纤维化分期的诊断价值。  方法  收集2012年1月—2022年10月在天津市第二人民医院就诊并行肝穿刺活检的108例PBC患者临床资料。依据Scheuer评分系统评估肝纤维化程度(S0~4),其中≥S2定义为显著肝纤维化,≥S3定义为进展期肝纤维化,S4定义为肝硬化。符合正态分布的计量资料两组间比较采用独立样本t检验,多组间比较采用单因素方差分析。不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H秩和检验。计数资料组间比较采用χ2检验或Fisher精确检验。通过受试者工作特征曲线下面积(AUC)评估补体C3对PBC患者肝纤维化的诊断效能。采用Spearman相关分析评估补体C3与肝纤维化分期的相关性。  结果  本研究108例PBC患者中女性87例(80.6%),自身抗体阳性102例(94.4%)。肝纤维化分期S0期5例(4.6%),S1期41例(38.0%),S2期23例(21.3%),S3期25例(23.1%)、S4期14例(13.0%)。补体C3在不同肝纤维化分期患者中具有统计学差异(H=42.891,P<0.001)。随着肝纤维化程度的加重,补体C3的水平逐渐降低,呈负相关(r=-0.565,P<0.001)。LSM、AAR、APRI及FIB-4与补体C3的相关系数分别为-0.439(P<0.001)、-0.323(P=0.001)、-0.206(P=0.033)和-0.291(P=0.002)。多因素Logistic回归显示补体C3水平均为显著肝纤维化、进展期肝纤维化和肝硬化的独立预测因素,而LSM是显著肝纤维化和进展期肝纤维化的独立预测因素。ROC曲线分析显示,补体C3诊断显著肝纤维化、进展期肝纤维化及肝硬化的AUC分别为0.731、0.832和0.968,对应的cut-off值分别为1.445、1.235和1.005;补体C3联合LSM诊断显著肝纤维化、进展期肝纤维化及肝硬化的AUC分别为0.811、0.941和0.976。C3联合LSM诊断显著纤维化的AUC与补体C3的相比,差异具有统计学意义(Z=2.604,P=0.009);C3联合LSM诊断进展期肝纤维化的AUC与补体C3的相比,差异具有统计学意义(Z=3.033,P=0.002);C3联合LSM诊断肝硬化的AUC与补体C3的相比,差异不具有统计学意义(Z=1.050,P=0.294),而C3联合LSM诊断肝硬化的AUC与LSM的相比,差异具有统计学意义(Z=2.326,P=0.020)。  结论  血清补体C3水平对评估PBC患者肝纤维化程度有一定的临床价值,C3联合LSM能进一步提高补体C3或LSM对PBC肝纤维化的诊断效能。

     

  • 图  1  免疫功能指标与不同肝纤维化分期的ROC曲线

    注: a,显著肝纤维化;b,进展期肝纤维化;c,肝硬化。

    Figure  1.  ROC curves of immune function indexes and different stages of liver fibrosis

    图  2  补体C3与肝纤维化分期、肝硬度及3种无创肝纤维化评分的相关性

    注: a,C3与肝纤维化分期相关关系的箱式图;b,C3与LSM的相关关系;c,C3与AAR评分的相关关系;d,C3与APRI评分的相关分析;e,C3与FIB-4评分的相关关系。

    Figure  2.  The correlation between C3 and liver fibrosis stage, LSM, AAR score, APRI score and FIB-4 score

    表  1  PBC患者的一般特征

    Table  1.   General characteristics of PBC patients

    指标 数值(n=108) 指标 数值(n=108)
    人口学数据 ALT(U/L) 47.0(23.5~100.1)
    年龄(岁) 53.6±10.4 AST(U/L) 57.0(34.0~90.8)
    男[例(%)] 21(19.4) GGT(U/L) 207.4(113.0~460.3)
    女[例(%)] 87(80.6) ALP(U/L) 219.9(124.5~414.0)
    BMI (kg/m2 22.3(20.3~24.7) CHE(U/L) 6187.0±2154.3
    吸烟史[例(%)] 16(14.8) Alb(g/L) 38.7±6.1
    饮酒史[例(%)] 10(9.3) TBil(μmol/L) 19.3(12.5~31.5)
    糖尿病[例(%)] 13(12.0) DBil(μmol/L) 6.8(3.3~15.4)
    高血压[例(%)] 25(23.1) IBil(μmol/L) 11.4(7.7~15.4)
    临床表现[例(%)] 免疫功能指标(g/L)
    乏力 42(38.9) C3 1.2(1.1~1.5)
    纳差 12(11.1) C4 0.2±0.1
    瘙痒 10(9.3) IgG 17.5±5.8
    尿黄 16(14.8) IgA 3.1(2.1~3.7)
    腹胀 12(11.1) IgM 2.8(1.8~4.8)
    肝区不适 16(14.8) 纤维化指标及评分
    其他1) 16(14.8) LSM(kPa) 11.7(7.2~18.9)
    自身抗体指标[例(%)] AAR(分) 1.1(0.8~1.6)
    自身抗体阳性 102(94.4) APRI(分) 0.9(0.4~1.5)
    ANA阳性 100(92.6) FIB-4(分) 2.3(1.4~4.3)
    AMA阳性 58(53.7) 肝纤维化分期[例(%)]
    抗M2阳性 54(50.0) S0 5(4.6)
    抗Sp100阳性 10(9.3) S1 41(38.0)
    抗Gp210阳性 24(22.2) S2 23(21.3)
    血清学指标 S3 25(23.1)
    PLT(×109/L) 197.0(120.3~258.3) S4 14(13.0)
    注:1)其他包括黄疸、厌油、口干、眼干、关节痛。
    下载: 导出CSV

    表  2  PBC患者肝纤维化分期的一般特征

    Table  2.   General characteristics of hepatic fibrosis stage in patients with PBC

    指标 S0/1(n=46) S2(n=23) S3(n=25) S4(n=14) 统计值 P
    年龄(岁) 53.0±9.7 54.5±8.9 53.2±13.7 54.8±9.2 F=0.173 0.914
    性别[例(%)] χ2=0.365 0.985
    9(19.6) 5(21.7) 5(20.0) 2(14.3)
    37(80.4) 18(78.3) 20(80.0) 12(85.7)
    自身抗体阳性[例(%)] 43(93.5) 22(95.7) 23(92.0) 12(85.7) χ2=1.992 0.641
    BMI(kg/m2 22.2(20.3~24.9) 22.6(20.1~25.0) 22.9(21.3~24.4) 22.7(19.4~24.5) H=0.253 0.969
    PLT(×109/L) 230.5(186.3~264.5) 209.0(134.0~253.0) 166.0(95.5~244.5) 87.0(57.8~172.3)1) H=16.880 0.001
    ALT(U/L) 49.0(27.7~90.0) 53.0(27.1~118.4) 37.5(18.3~131.8) 28.5(15.2~61.1) H=4.002 0.261
    AST(U/L) 58.0(34.3~83.5) 51.2(33.0~65.8) 62.4(35.0~109.5) 80.1(41.8~116) H=2.704 0.440
    GGT(U/L) 237.0(118.0~541.0) 198.0(142.0~650.0) 207.4(116.5~369.6) 190.0(86.0~339.0) H=1.368 0.713
    ALP(U/L) 278.0(128.6~423.0) 203.0(122.0~414.0) 215.8(118.4~367.0) 236.1(143.5~371.8) H=0.345 0.951
    CHE(U/L) 6 711.9±2 124.6 7 044.6±2 037.5 5 869.9±1 663.3 3 906.91±1 526.61)2)3) F=9.124 <0.001
    Alb(g/L) 39.9±5.6 40.6±5.0 39.4±5.3 30.9±5.21)2)3) F=11.873 <0.001
    TBil(μmol/L) 17.1(13.3~31.5) 13.1(11.2~20.4) 22.7(16.2~30.7) 28.3(17.9~56.7) H=8.092 0.044
    DBil(μmol/L) 7.3(2.9~15.9) 4.1(3.2~6.6) 7.7(3.4~13.1) 14.5(7.1~27.3) H=6.890 0.075
    IBil(μmol/L) 11.2(7.7~13.6) 9.3(6.7~12.4) 13.9(9.6~18.9) 13.3(7.2~31.4) H=6.361 0.095
    C3(g/L) 1.5(1.2~1.7) 1.3(1.2~1.5) 1.2(1.1~1.3) 1) 0.8(0.6~1.0)1)2)3) H=42.891 <0.001
    C4(g/L) 0.21±0.11 0.22±0.09 0.20±0.08 0.15±0.08 F=1.797 0.152
    IgG(g/L) 16.9±6.6 17.1±4.7 18.2±5.3 19.0±5.6 F=0.651 0.584
    IgA(g/L) 3.1(2.2~3.6) 2.7(1.9~3.3) 3.1(1.9~3.8) 4.4(3.1~7.0)2) H=9.454 0.024
    IgM(g/L) 2.7(1.5~5.0) 4.0(2.0~5.2) 3.2(2.4~4.8) 2.2(1.6~2.8) H=5.768 0.123
    LSM(kPa) 8.4(6.5~12.1) 8.9(6.6~9.8) 18.4(14.3~24.6)1)2) 34.0(16.8~45.1)1)2) H=50.642 <0.001
    AAR 1.0(0.7~1.3) 1.0(0.8~1.1) 1.2(0.9~2.1) 2.2(1.8~3.2)1)2)3) H=28.304 <0.001
    APRI 0.7(0.4~1.2) 0.9(0.5~1.2) 1.1(0.4~1.7) 1.7(1.0~4.3)1) H=12.461 0.006
    FIB-4 1.7(1.1~3.2) 2.3(1.4~3.0) 2.8(1.2~5.2) 8.0(5.4~10.9)1)2)3) H=27.015 <0.001
    注:与S0/1分期比较,1)P<0.05;与S2分期比较,2)P<0.05;与S3分期比较,3)P<0.05。
    下载: 导出CSV

    表  3  不同肝纤维化分期患者补体C3水平的一般特征

    Table  3.   General characteristics of complement C3 levels in patients with different stages of hepatic fibrosis

    指标 ≥S2 ≥S3 S4
    C3≤1.445 g/L组 (n=76) C3>1.445 g/L组 (n=32) P C3≤1.235 g/L组 (n=52) C3>1.235 g/L组 (n=56) P C3≤1.005 g/L组 (n=22) C3>1.005 g/L组 (n=86) P
    年龄(岁) 56.0(48.0~63.0) 55.0(45.0~57.6) 0.187 56.0(48.0~63.0) 55.0(47.3~59.8) 0.538 56.1±11.8 53.0±10.0 0.206
    女性[例(%)] 63(82.9) 24(75.0) 0.344 43(82.7) 44(78.6) 0.589 16(72.7) 71(82.6) 0.461
    自身抗体阳性[例(%)] 72(94.7) 28(87.5) 0.190 48(92.3) 52(92.9) 1.000 20(90.9) 80(93.0) 1.000
    BMI(kg/m2 22.9(21.1~24.8) 21.7(19.7~24.3) 0.090 22.8±3.1 22.6±3.4 0.675 22.5±3.1 22.7±3.2 0.739
    PLT(×109/L) 177.2±82.5 244.0±84.4 <0.001 149.5(87.0~230.0) 231.5(170.3~274.5) <0.001 100.5(72.3~172.3) 217.0(153.5~263.3) <0.001
    ALT(U/L) 36.0(21.5~84.4) 57.6(36.3~115.3) 0.053 30.4(21.5~91.6) 50.9(31.3~105.5) 0.068 34.4(20.8~63.1) 49.0(24.0~103.5) 0.233
    AST(U/L) 52.0(33.9~91.0) 67.4(42.1~92.8) 0.234 51.5(33.9~91.0) 60.5(34.3~92.8) 0.593 64.8(38.2~99.8) 57.0(33.1~87.8) 0.407
    GGT(U/L) 190.4(92.8~324.1) 391.3(170.5~748.5) 0.006 173.5(84.0~308.7) 286.5(166.2~705.0) 0.003 168.4(96.5~324.1) 222.5(122.3~563.5) 0.173
    ALP(U/L) 200.1(121.0~341.2) 391.1(195.0~494.8) 0.004 200.5(121.2~341.7) 312.8(135.3~440.5) 0.079 212.5(132.3~341.7) 240.7(122.4~416.4) 0.643
    CHE(U/L) 6 065.1±2 090.8 6 471.4±2 307.2 0.390 5 379.3±1 865.4 6 903.2±2 155.3 <0.001 4 320.1±1 690.7 6 683.2±1 992.5 <0.001
    Alb(g/L) 37.9±6.5 40.6±4.8 0.037 36.6±6.4 40.7±5.2 <0.001 32.8±6.3 40.3±5.1 <0.001
    TBil(μmol/L) 17.0(11.3~28.6) 20.4(16.6~40.7) 0.041 17.7(11.8~27.7) 19.6(13.4~34.6) 0.448 25.3(14.5~35.6) 17.9(12.4~30.6) 0.265
    DBil(μmol/L) 5.8(2.9~13.5) 8.0(4.8~21.5) 0.069 6.6(2.7~14.4) 7.4(3.9~15.6) 0.421 12.5(3.9~19.3) 5.8(3.2~13.1) 0.101
    IBil(μmol/L) 11.2(7.1~14.9) 11.6(9.0~15.7) 0.498 11.7(7.5~15.4) 11.2(7.9~15.2) 0.749 13.3(7.2~18.1) 11.1(7.9~14.6) 0.377
    C4(g/L) 0.19±0.09 0.24±0.12 0.007 0.16±0.08 0.24±0.10 <0.001 0.15(0.09~0.18) 0.22(0.15~0.28) 0.004
    IgG(g/L) 18.1±6.4 16.3±3.8 0.082 19.0±7.1 16.2±4.0 0.015 18.5±6.3 17.3±5.7 0.403
    IgA(g/L) 3.1(2.3~3.8) 2.9(1.9~3.7) 0.348 3.2(2.1~3.9) 3.0(2.1~3.6) 0.246 4.1(2.6~6.3) 3.0(2.1~3.6) 0.006
    IgM(g/L) 2.9(1.8~4.8) 2.8(1.7~5.7) 0.597 2.6(1.4~4.8) 3.0(2.0~5.1) 0.155 2.3(1.6~4.8) 3.0(1.8~4.8) 0.358
    LSM(kPa) 14.2(8.2~21.6) 8.9(6.5~12.6) 0.002 15.4(9.0~24.6) 8.9(6.6~14.0) <0.001 22.7(15.3~42.0) 9.3(6.8~14.6) <0.001
    AAR 1.2(0.9~1.9) 0.9(0.7~1.3) 0.017 1.4(0.9~2.1) 1.0(0.7~1.4) 0.004 1.8(1.2~2.5) 1.0(0.8~1.5) <0.001
    APRI 1.1(0.5~1.8) 0.7(0.4~1.1) 0.058 1.1(0.5~1.9) 0.8(0.4~1.1) 0.054 1.4(0.6~2.6) 0.8(0.4~1.3) 0.023
    FIB-4 2.8(1.7~5.4) 1.7(1.1~3.1) 0.012 3.0(1.7~5.9) 1.9(1.2~3.5) 0.023 6.1(1.8~9.1) 2.2(1.4~3.6) 0.002
    肝纤维化分期[例(%)] <0.001 <0.001 <0.001
    S0 2(2.6) 3(9.4) 1(1.9) 4(7.1) 1(4.5) 4(4.7)
    S1 21(27.6) 20(62.5) 14(26.9) 27(48.2) 4(18.2) 37(43.0)
    S2 17(22.4) 6(18.8) 6(11.5) 17(30.4) 0(0.0) 23(26.7)
    S3 22(28.9) 3(9.4) 17(32.7) 8(14.3) 4(18.2) 21(24.4)
    S4 14(18.4) 0(0.0) 14(26.9) 0(0.0) 13(59.1) 1(1.2)
    下载: 导出CSV

    表  4  不同肝纤维化分期指标的单因素分析

    Table  4.   Univariate analysis of different liver fibrosis staging indicators

    指标 ≥S2 ≥S3 S4
    OR(95%CI P OR(95%CI P OR(95%CI P
    年龄(岁) 0.987(0.377~2.585) 0.978 1.003(0.965~1.041) 0.895 1.013(0.958~1.071) 0.653
    性别 1.010(0.973~1.048) 0.606 0.859(0.314~2.351) 0.768 0.658(0.136~3.192) 0.603
    自身抗体阳性 1.372(0.264~7.129) 0.707 0.545(0.105~2.843) 0.472 0.73(0.079~6.755) 0.782
    BMI(kg/m2 1.002(0.889~1.130) 0.973 1.002(0.886~1.134) 0.971 0.974(0.813~1.166) 0.771
    PLT(×109/L) 0.993(0.988~0.997) 0.003 0.991(0.985~0.996) 0.001 0.987(0.978~0.996) 0.003
    ALT(U/L) 0.999(0.997~1.002) 0.644 0.999(0.996~1.002) 0.492 0.986(0.970~1.003) 0.114
    AST(U/L) 1.001(0.997~1.004) 0.754 1.000(0.997~1.003) 0.805 1.000(0.996~1.004) 0.821
    GGT(U/L) 1.000(0.999~1.001) 0.656 1.000(0.998~1.001) 0.460 0.998(0.996~1.001) 0.234
    ALP(U/L) 1.000(0.998~1.001) 0.964 1.000(0.998~1.002) 0.923 1.001(0.999~1.003) 0.476
    CHE(U/L) 1.000(1.000~1.000) 0.045 1.000(0.999~1.000) <0.001 0.999(0.999~1.000) <0.001
    Alb(g/L) 0.944(0.883~1.009) 0.090 0.893(0.830~0.961) 0.003 0.728(0.623~0.850) <0.001
    TBil(μmol/L) 1.009(0.993~1.026) 0.259 1.020(1.002~1.039) 0.033 1.010(0.996~1.023) 0.153
    DBil(μmol/L) 1.007(0.989~1.025) 0.465 1.018(0.997~1.04) 0.090 1.009(0.992~1.026) 0.321
    IBil(μmol/L) 1.042(0.991~1.095) 0.105 1.066(1.012~1.122) 0.015 1.047(1.004~1.092) 0.032
    C3(g/L) 0.048(0.011~0.210) <0.001 0.006(0.001~0.052) <0.001 0.000(0.000~0.007) <0.001
    C4(g/L) 0.212(0.004~10.707) 0.438 0.034(0.001~2.234) 0.113 0.001(0.000~0.508) 0.031
    IgG(g/L) 1.035(0.965~1.109) 0.335 1.047(0.977~1.122) 0.191 1.047(0.960~1.142) 0.302
    IgA(g/L) 1.127(0.881~1.442) 0.342 1.268(0.989~1.625) 0.061 1.727(1.251~2.385) 0.001
    IgM(g/L) 1.093(0.898~1.331) 0.376 1.007(0.826~1.228) 0.945 0.798(0.573~1.113) 0.183
    LSM(kPa) 1.147(1.064~1.236) <0.001 1.299(1.168~1.445) <0.001 1.108(1.055~1.163) <0.001
    AAR 2.155(1.196~3.885) 0.011 3.024(1.658~5.517) <0.001 3.145(1.688~5.858) <0.001
    APRI 1.021(0.904~1.153) 0.739 1.072(0.947~1.212) 0.273 1.111(0.980~1.259) 0.099
    FIB-4 1.234(1.031~1.478) 0.022 1.333(1.115~1.594) 0.002 1.541(1.225~1.938) <0.001
    下载: 导出CSV

    表  5  不同肝纤维化分期调节混杂因素后指标的多因素分析

    Table  5.   Multi-factor analysis of indicators after adjustment of confounding factors for different liver fibrosis stages

    指标 ≥S2 ≥S3 S4
    OR(95%CI P OR(95%CI P OR(95%CI P
    模型1
    C3(g/L) 0.116(0.020~0.684) 0.017 0.013(0.001~0.309) 0.007 0.001(0.000~0.159) 0.009
    LSM(kPa) 1.102(1.009~1.204) 0.031 1.277(1.115~1.464) <0.001 1.057(0.984~1.135) 0.129
    模型2
    C3(g/L) 0.108(0.018~0.633) 0.014 0.010(0.000~0.244) 0.005 0.000(0.000~0.118) 0.007
    LSM(kPa) 1.103(1.009~1.205) 0.031 1.288(1.121~1.479) <0.001 1.033(0.955~1.117) 0.421
    模型3
    C3(g/L) 0.091(0.016~0.528) 0.008 0.005(0.000~0.145) 0.002 0.001(0.000~0.179) 0.011
    LSM(kPa) 1.134(1.029~1.251) 0.012 1.383(1.164~1.643) <0.001 1.051(0.978~1.128) 0.175
    模型4
    C3(g/L) 0.082(0.014~0.487) 0.006 0.003(0.000~0.103) 0.001 0.001(0.000~0.168) 0.010
    LSM(kPa) 1.134(1.030~1.248) 0.010 1.381(1.169~1.631) <0.001 1.028(0.953~1.108) 0.481
    注:除了最终模型所示的变量外,以下也包括在初始模型中:模型1 PLT、CHE和AAR,模型2 PLT、CHE、FIB-4,模型3 PLT、Alb和AAR,模型4 PLT、Alb和FIB-4。
    下载: 导出CSV

    表  6  C3、LSM及C3联合LSM对不同肝纤维化分期的诊断性能

    Table  6.   Diagnostic performance of C3, LSM and C3 combined with LSM for different liver fibrosis stages

    指标 C3 LSM C3联合LSM
    ≥S2 ≥S3 S4 ≥S2 ≥S3 S4 ≥S2 ≥S3 S4
    AUC 0.731 0.832 0.968 0.764 0.911 0.910 0.811 0.941 0.976
    P <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
    95%CI 0.637~0.812 0.748~0.897 0.915~0.992 0.672~0.840 0.840~0.957 0.839~0.956 0.725~0.880 0.879~0.977 0.926~0.996
    约登指数 0.393 0.531 0.915 0.504 0.756 0.745 0.542 0.782 0.915
    敏感度(%) 87.10 82.05 100.00 61.29 87.18 100.00 62.90 89.74 100.00
    特异度(%) 52.17 71.01 91.49 89.13 88.41 74.47 91.30 88.41 91.49
    阳性预测值(%) 71.1 61.5 63.6 88.4 81.0 36.8 90.7 81.4 63.6
    阴性预测值(%) 75.0 87.5 100.0 63.1 92.4 100.0 64.6 93.8 100.0
    阳性似然比 1.82 2.83 11.75 5.64 7.52 3.92 7.23 7.74 11.75
    阴性似然比 0.25 0.25 0.00 0.43 0.15 0.00 0.41 0.12 0.00
    下载: 导出CSV
  • [1] COLAPIETRO F, BERTAZZONI A, LLEO A. Contemporary epidemiology of primary biliary cholangitis[J]. Clin Liver Dis, 2022, 26( 4): 555- 570. DOI: 10.1016/j.cld.2022.06.001.
    [2] Chinese Society of Hepatology, Chinese Society of Gastroenterology, Chinese Society of Infectious Diseases. Consensus on the diagnosis and treatment of primary biliary cirrhosis(also known as primary biliary cholangitis)(2015)[J]. J Clin Hepatol, 2015, 31( 12): 1980- 1988. DOI: 10.3969/j.issn.1001-5256.2015.12.004.

    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. DOI: 10.3969/j.issn.1001-5256.2015.12.004.
    [3] Chinese Medical Association, Branch Hepatology. Guidelines for the diagnosis and treatment of primary biliary cholangitis(2021)[J]. J Clin Hepatol, 2022, 38( 1): 35- 41. DOI: 10.3969/j.issn.1001-5256.2022.01.007.

    中华医学会肝病学分会. 原发性胆汁性胆管炎的诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38( 1): 35- 41. DOI: 10.3969/j.issn.1001-5256.2022.01.007.
    [4] Chinese Society of Hepatology, Chinese Society of Gastroenterology, Chinese Society of Infectious Diseases. Consensus on the diagnosis and treatment of liver fibrosis(2019)[J]. J Clin Hepatol, 2019, 35( 10): 2163- 2172. DOI: 10.3969/j.issn.1001-5256.2019.10.007.

    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. 肝纤维化诊断及治疗共识(2019年)[J]. 临床肝胆病杂志, 2019, 35( 10): 2163- 2172. DOI: 10.3969/j.issn.1001-5256.2019.10.007.
    [5] TRIVEDI PJ, HIRSCHFIELD GM. Recent advances in clinical practice: Epidemiology of autoimmune liver diseases[J]. Gut, 2021, 70( 10): 1989- 2003. DOI: 10.1136/gutjnl-2020-322362.
    [6] HOHENESTER S, OUDE-ELFERINK RPJ, BEUERS U. Primary biliary cirrhosis[J]. Semin Immunopathol, 2009, 31( 3): 283- 307. DOI: 10.1007/s00281-009-0164-5.
    [7] YANG YL, ZHAO RC, ZHANG FC. Potential mesenchymal stem cell therapeutics for treating primary biliary cholangitis: Advances, challenges, and perspectives[J]. Front Cell Dev Biol, 2022, 10: 933565. DOI: 10.3389/fcell.2022.933565.
    [8] BUGDACI MS, ALKIM C, KARACA C, et al. Could complement C4 be an alternative to biopsy for chronic hepatitis B histopathologic findings?[J]. J Clin Gastroenterol, 2011, 45( 5): 449- 455. DOI: 10.1097/MCG.0b013e31820f7ee5.
    [9] LI Q, LU Q, ZHU MQ, et al. Lower level of complement component C3 and C3a in the plasma means poor outcome in the patients with hepatitis B virus related acute-on-chronic liver failure[J]. BMC Gastroenterol, 2020, 20( 1): 106. DOI: 10.1186/s12876-020-01258-3.
    [10] CHEN C, YUAN Z, LI WX, et al. Complement C3 facilitates stratification of stages of chronic hepatitis B and signifies development of acute-on-chronic liver failure in acute decompensated cirrhosis[J]. Adv Ther, 2023, 40( 3): 1171- 1186. DOI: 10.1007/s12325-022-02416-7.
    [11] RICKLIN D, HAJISHENGALLIS G, YANG K, et al. Complement: A key system for immune surveillance and homeostasis[J]. Nat Immunol, 2010, 11( 9): 785- 797. DOI: 10.1038/ni.1923.
    [12] TROUW LA, DAHA MR. Role of complement in innate immunity and host defense[J]. Immunol Lett, 2011, 138( 1): 35- 37. DOI: 10.1016/j.imlet.2011.02.014.
    [13] SAHU A, LAMBRIS JD. Structure and biology of complement protein C3, a connecting link between innate and acquired immunity[J]. Immunol Rev, 2001, 180: 35- 48. DOI: 10.1034/j.1600-065x.2001.1800103.x.
    [14] LUBBERS R, van ESSEN MF, van KOOTEN C, et al. Production of complement components by cells of the immune system[J]. Clin Exp Immunol, 2017, 188( 2): 183- 194. DOI: 10.1111/cei.12952.
    [15] SELMI C, BOWLUS CL, GERSHWIN ME, et al. Primary biliary cirrhosis[J]. Lancet, 2011, 377( 9777): 1600- 1609. DOI: 10.1016/S0140-6736(10)61965-4.
    [16] SCHLESINGER M, BENBASSAT C, SHOENFELD Y. Complement profile in primary biliary cirrhosis[J]. Immunol Res, 1992, 11( 2): 98- 103. DOI: 10.1007/BF02918614.
    [17] BARAK V, SELMI C, SCHLESINGER M, et al. Serum inflammatory cytokines, complement components, and soluble interleukin 2 receptor in primary biliary cirrhosis[J]. J Autoimmun, 2009, 33( 3-4): 178- 182. DOI: 10.1016/j.jaut.2009.09.010.
    [18] BIEWENGA M, FARINA SARASQUETA A, TUSHUIZEN ME, et al. The role of complement activation in autoimmune liver disease[J]. Autoimmun Rev, 2020, 19( 6): 102534. DOI: 10.1016/j.autrev.2020.102534.
    [19] HOMANN C, VARMING K, HØGÅSEN K, et al. Acquired C3 deficiency in patients with alcoholic cirrhosis predisposes to infection and increased mortality[J]. Gut, 1997, 40( 4): 544- 549. DOI: 10.1136/gut.40.4.544.
    [20] GARRED P, LYON H, CHRISTOFFERSEN P, et al. Deposition of C3, the terminal complement complex and vitronectin in primary biliary cirrhosis and primary sclerosing cholangitis[J]. Liver, 1993, 13( 6): 305- 310. DOI: 10.1111/j.1600-0676.1993.tb00650.x.
    [21] YUAN H, LI YW, LI J, et al. Clinical feature of patients with primary biliary cholangitis and primary biliary cirrhosis[J]. J Pract Hepatol, 2022, 25( 3): 403- 406. DOI: 10.3969/j.issn.1672-5069.2022.03.025.

    袁慧, 李毓雯, 李军, 等. 原发性胆汁性胆管炎与肝硬化患者临床指标差异分析[J]. 实用肝脏病杂志, 2022, 25( 3): 403- 406. DOI: 10.3969/j.issn.1672-5069.2022.03.025.
  • 加载中
图(2) / 表(6)
计量
  • 文章访问数:  129
  • HTML全文浏览量:  62
  • PDF下载量:  21
  • 被引次数: 0
出版历程
  • 收稿日期:  2023-02-25
  • 录用日期:  2023-03-14
  • 出版日期:  2023-11-28
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回