Peters Marion G, Di Bisceglie Adrian M, Kowdley Kris V, Flye Nancy L, Luketic Velimir A, Munoz Santiago J, Garcia-Tsao Guadalupe, Boyer Thomas D, Lake John R, Bonacini Maurizio, Combes Burton
University of California at San Francisco, San Francisco, CA 94143-0538, USA.
Hepatology. 2007 Sep;46(3):769-75. doi: 10.1002/hep.21759.
Primary biliary cirrhosis (PBC) is an uncommon chronic cholestatic liver disease that primarily afflicts young and middle-aged Caucasian women; there are limited data on the clinical presentation and disease severity among non-Caucasian patients with this disease. The goal of this study was to examine differences in the severity of liver disease between Caucasian and non-Caucasian patients with PBC screened for enrollment in a large national multicenter clinical trial. Demographic features, symptoms, physical findings, and laboratory tests obtained during screening were examined in 535 patients with PBC with respect to ethnicity, gender, and antimitochondrial antibody (AMA) status; 73 of 535 (13.6%) were non-Caucasian (21 were African American, and 42 were Hispanic). Non-Caucasians were more likely than Caucasians to be ineligible for participation in the clinical trial (46.5% versus 25.1%, P = 0.0001), primarily because of greater disease severity. African Americans and Hispanics were also more likely to have a lower activity level, more severe pruritus, and more advanced disease. However, the mean age, male-to-female ratio, and seroprevalence of AMA positivity were similar between the 2 groups.
Liver disease severity at clinical presentation is higher among non-Caucasians than Caucasians with PBC, and this cannot be explained by demographic or serologic features alone. Possible mechanisms underlying this health discrepancy are not clear, but increased awareness of PBC as a cause of chronic cholestatic liver disease is critical in evaluating non-Caucasian patients in the United States.
原发性胆汁性肝硬化（PBC）是一种罕见的慢性胆汁淤积性肝病，主要影响年轻和中年的白种女性；关于非白种患者的临床表现和疾病严重程度的数据有限。本研究的目的是检查在一项大型全国多中心临床试验中筛选入组的白种和非白种PBC患者之间肝病严重程度的差异。在535例PBC患者中，就种族、性别和抗线粒体抗体（AMA）状态检查了筛查期间获得的人口统计学特征、症状、体格检查结果和实验室检查；535例中有73例（13.6%）为非白种人（21例为非裔美国人，42例为西班牙裔）。非白种人比白种人更有可能不符合参与临床试验的条件（46.5%对25.1%，P = 0.0001），主要是因为疾病严重程度更高。非裔美国人和西班牙裔也更有可能活动水平较低、瘙痒更严重且疾病更晚期。然而，两组之间的平均年龄、男女比例和AMA阳性血清流行率相似。
非白种PBC患者临床表现时的肝病严重程度高于白种患者，这不能仅用人口统计学或血清学特征来解释。这种健康差异的潜在机制尚不清楚，但提高对PBC作为慢性胆汁淤积性肝病病因的认识对于评估美国的非白种患者至关重要。
