Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA; Department of Medicine, MetroWest Medical Center, Framingham, MA, USA.
Department of Gastroenterology & Hepatology, Section of Transplant Hepatology, The Johns Hopkins School of Medicine, Baltimore MD, USA.
J Clin Transl Hepatol. 2016 Mar 28;4(1):1-4. doi: 10.14218/JCTH.2015.00048. Epub 2016 Mar 15.
Background and Aim : Patients with primary sclerosing cholangitis (PSC) who develop cholangiocarcinoma (CCA) have a median survival of less than 6 months. In half of cases, PSC and CCA will be diagnosed either concurrently or within a year of one another. The aim of the present study is to demonstrate that the degree of biochemical liver dysfunction is associated with concomitant or impending CCA. Methods : We did a chart review of patients diagnosed with PSC and CCA up to 18 months from presentation ("CCA" group) as well as patients with PSC that underwent transplantation with no sign of CCA in their explanted liver ("nCCA" group). Along with demographic data and follow-up length, we recorded their presenting liver function tests, including alanine and aspartate aminotransferases (ALT, AST), total bilirubin (TBil), alkaline phosphatase (ALP), international normalization ratio (INR), and serum Ca 19-9 levels. Differences between mean values of the two groups were analyzed with a student's t-test. Results : Twenty-four patients were included. The "CCA" group consisted of eight patients, and the "non-CCA" group had 16 patients. There was no significant difference between the two groups in their presenting values of ALT, ALP, or serum Ca 19-9. However, the "CCA" group had significantly higher levels of AST, TBil, and INR. Conclusion : Patients with PSC and concurrent or impending CCA appear to exhibit significantly greater biochemical liver dysfunction than those who do not develop CCA. Therefore, newly-diagnosed PSC patients presenting with these findings may warrant more rigorous evaluation.
原发性硬化性胆管炎（PSC）患者并发胆管癌（CCA）的中位生存时间不足 6 个月。在半数病例中，PSC 和 CCA 要么同时诊断，要么在彼此诊断后的一年内被诊断。本研究旨在证明肝功能的生化指标异常程度与并发或即将发生的 CCA 相关。
我们对在发病后 18 个月内被诊断为 PSC 和 CCA 的患者（“CCA”组）以及在移植中未发现其供肝有 CCA 迹象的 PSC 患者（“nCCA”组）进行了图表回顾。除了人口统计学数据和随访时间外，我们还记录了他们的肝功能检查结果，包括丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBil）、碱性磷酸酶（ALP）、国际标准化比值（INR）和血清 CA19-9 水平。采用学生 t 检验分析两组间均值的差异。
共纳入 24 例患者。“CCA”组有 8 例，“非 CCA”组有 16 例。两组患者的 ALT、ALP 或血清 CA19-9 值在初诊时无显著差异。然而，“CCA”组的 AST、TBil 和 INR 值明显更高。
与未发生 CCA 的患者相比，同时或即将发生 CCA 的 PSC 患者的肝功能生化指标异常似乎更为显著。因此，新诊断的 PSC 患者出现这些发现可能需要更严格的评估。
