在原发性胆汁性胆管炎中国患者中，英国-PBC 和 GLOBE 评分系统的风险预测值：抗 gp210 的附加效应。
The risk predictive values of UK-PBC and GLOBE scoring system in Chinese patients with primary biliary cholangitis: the additional effect of anti-gp210.
机构信息
Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
Department of Gastroenterology and Hepatology, Nantong Institute of Liver Disease, Nantong Third People's Hospital, Nantong University, Jiangsu, China.
出版信息
Aliment Pharmacol Ther. 2017 Mar;45(5):733-743. doi: 10.1111/apt.13927. Epub 2017 Jan 13.
BACKGROUND
Adequate risk stratification is critical for the management of the patients with primary biliary cholangitis (PBC). The UK-PBC and GLOBE scoring systems for prognosis of PBC have been proposed recently, but have not been validated in Asian population.
AIM
To validate the UK-PBC and GLOBE scoring systems in Chinese patients for prognosis of PBC. To clarify the role of anti-gp210 as a biomarker, and to investigate whether anti-gp210 could affect the prognostic values of UK-PBC and GLOBE scoring systems.
METHODS
We retrospectively analysed 276 patients with PBC evaluated between September 2004 and May 2016, including 133 anti-gp210+ and 143 anti-gp210- patients.
RESULTS
The 5-year adverse outcome-free survivals of anti-gp210+ vs. anti-gp210- patients were 70% and 85%, respectively (P = 0.005). Cirrhosis (P = 0.001), albumin level ≤40 g/L (P = 0.011) and platelet count ≤153 × 10 (P < 0.001) had a superimposition effect on anti-gp210 antibody as a risk factor. Furthermore, long-term prognoses were evaluated using the UK-PBC and GLOBE scores. For UK-PBC scoring system, the area under receiver operating characteristic curve (AUROC) was 0.924 for all patients with PBC (n = 223), 0.940 for anti-gp210+ patients (n = 110) and 0.888 for anti-gp210- patients (n = 113). For GLOBE scoring system, the area under receiver operating characteristic curve was 0.901 for all patients with PBC (n = 223), 0.924 for anti-gp210+ patients (n = 110) and 0.848 for anti-gp210- patients (n = 113). UK-PBC score >0.0578 (P < 0.001, HR: 32.736, 95% CI: 11.368-94.267) and GLOBE score <0.850 (P < 0.001, HR: 18.763, 95% CI: 7.968-44.180) were associated with poorer outcomes in the whole cohort.
CONCLUSIONS
The UK-PBC and GLOBE scoring systems were good 5-year prognostic predictors in Chinese patients with PBC, especially in anti-gp210+ patients. As a biomarker, anti-gp210 antibody was associated with a more severe cholestatic manifestation and a worse long-term prognosis. The anti-gp210 antibody could be added to further optimise the UK-PBC and GLOBE scoring systems.
背景
原发性胆汁性胆管炎（PBC）患者的风险分层至关重要。最近提出了用于 PBC 预后的 UK-PBC 和 GLOBE 评分系统，但尚未在亚洲人群中得到验证。
目的
验证 UK-PBC 和 GLOBE 评分系统在中国 PBC 患者中的预后价值。阐明抗 gp210 作为生物标志物的作用，并探讨抗 gp210 是否会影响 UK-PBC 和 GLOBE 评分系统的预后价值。
方法
我们回顾性分析了 2004 年 9 月至 2016 年 5 月期间评估的 276 例 PBC 患者，包括 133 例抗 gp210+和 143 例抗 gp210-患者。
结果
抗 gp210+与抗 gp210-患者的 5 年不良结局无事件生存率分别为 70%和 85%（P=0.005）。肝硬化（P=0.001）、白蛋白水平≤40g/L（P=0.011）和血小板计数≤153×10（P＜0.001）对抗 gp210 抗体作为危险因素具有叠加效应。此外，使用 UK-PBC 和 GLOBE 评分评估长期预后。对于 UK-PBC 评分系统，所有 PBC 患者（n=223）、抗 gp210+患者（n=110）和抗 gp210-患者（n=113）的受试者工作特征曲线（ROC）下面积（AUROC）分别为 0.924、0.940 和 0.888。对于 GLOBE 评分系统，所有 PBC 患者（n=223）、抗 gp210+患者（n=110）和抗 gp210-患者（n=113）的 AUROC 分别为 0.901、0.924 和 0.848。UK-PBC 评分＞0.0578（P＜0.001，HR：32.736，95%CI：11.368-94.267）和 GLOBE 评分＜0.850（P＜0.001，HR：18.763，95%CI：7.968-44.180）与整个队列的不良结局相关。
结论
UK-PBC 和 GLOBE 评分系统是中国 PBC 患者 5 年预后的良好预测指标，尤其是在抗 gp210+患者中。作为一种生物标志物，抗 gp210 抗体与更严重的胆汁淤积表现和更差的长期预后相关。抗 gp210 抗体可添加到 UK-PBC 和 GLOBE 评分系统中以进一步优化。
Zotero 插件