Haseeb Abdul, Siddiqui Ali, Taylor Linda J, Cox Kristen, Adler Douglas G
*University of Utah School of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Salt Lake City, UT †Jefferson University Hospitals, Division of Gastroenterology and Hepatology, Philadelphia, PA.
J Clin Gastroenterol. 2016 May-Jun;50(5):431-5. doi: 10.1097/MCG.0000000000000502.
Predicting the clinical course of primary sclerosing cholangitis (PSC) is difficult. There are currently a paucity of studies evaluating serum chemistries as predictors of conventional clinical endpoints. The purpose of this study was to prognosticate key clinical endpoints in patients with PSC who had elevated serum liver chemistries at the time of their initial presentation.
We performed a retrospective cohort study of PSC patients at our institution. The aim of our study was to determine the association between elevated liver chemistries at initial presentation-bilirubin, alanine transaminase, aspartate transaminase, or alkaline phosphatase-with a primary outcome of either cholangiocarcinoma, liver transplantation, death, or composite of the 3. The secondary endpoints examined were development of severe biliary ductal disease and need for biliary stent placement.
Eighty-one PSC patients (61 males and 20 females) were included in this study. By univariate analysis, there was a significant association between initial bilirubin elevation >2x the upper limit of normal (ULN) and death (P<0.009). Multivariate regression analysis revealed that an elevated initial serum total bilirubin >2xULN (P<0.017) significantly predicted the composite endpoint. By univariate analysis of pre-endoscopic retrograde cholangiopancreatography labs, serum bilirubin level elevation >2xULN showed an association with severity of biliary ductal disease (P<0.0001). A logistic regression of outcome variables also proved that >2xULN serum bilirubin levels predicted the ductal disease severity (P<0.0001).
An initial elevation of serum total bilirubin >2xULN in PSC patients correlates positively with the development of cholangiocarcinoma, subsequent liver transplantation, and death. Elevated bilirubin also correlates positively with the severity of cholangiographic findings.
预测原发性硬化性胆管炎（PSC）的临床病程具有挑战性。目前，评估血清化学指标作为传统临床终点预测指标的研究较少。本研究旨在对初次就诊时血清肝酶升高的PSC患者的关键临床终点进行预后评估。
我们对本机构的PSC患者进行了一项回顾性队列研究。我们研究的目的是确定初次就诊时肝酶升高（胆红素、丙氨酸转氨酶、天冬氨酸转氨酶或碱性磷酸酶）与胆管癌、肝移植、死亡或这三者的综合结果这一主要结局之间的关联。所检查的次要终点为严重胆管疾病的发生以及胆管支架置入的必要性。
本研究纳入了81例PSC患者（61例男性和20例女性）。单因素分析显示，初始胆红素升高>正常上限（ULN）的2倍与死亡之间存在显著关联（P<0.009）。多因素回归分析表明，初始血清总胆红素升高>2倍ULN（P<0.017）显著预测了综合终点。通过对内镜逆行胰胆管造影术前实验室检查结果进行单因素分析，血清胆红素水平升高>2倍ULN与胆管疾病的严重程度相关（P<0.0001）。对结局变量进行的逻辑回归分析也证实，血清胆红素水平>2倍ULN可预测胆管疾病的严重程度（P<0.0001）。
PSC患者初始血清总胆红素升高>2倍ULN与胆管癌的发生、随后的肝移植及死亡呈正相关。胆红素升高也与胆管造影结果的严重程度呈正相关。
