Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
PLoS One. 2018 Apr 4;13(4):e0194839. doi: 10.1371/journal.pone.0194839. eCollection 2018.
Depression is prevalent in primary biliary cholangitis (PBC) patients. Our aims were to examine the effects of depression and antidepressants on hepatic outcomes of PBC patients.
We used the UK Health Improvement Network database to identify PBC patients between 1974 and 2007. Our primary outcome was one of three clinical events: decompensated cirrhosis, liver transplantation and death. We assessed depression and each class of antidepressant medication in adjusted multivariate Cox proportional hazards models to identify independent predictors of outcomes. In a sensitivity analysis, the study population was restricted to PBC patients using ursodeoxycholic acid (UDCA).
We identified 1,177 PBC patients during our study period. In our cohort, 86 patients (7.3%) had a depression diagnosis prior to PBC diagnosis, while 79 patients (6.7%) had a depression diagnosis after PBC diagnosis. Ten-year incidence of mortality, decompensated cirrhosis, and liver transplantation were 13.4%, 6.6%, and 2.0%, respectively. In our adjusted models, depression status was not a predictor of poor outcomes. After studying all classes of antidepressants, using the atypical antidepressant mirtazapine after PBC diagnosis was significantly protective (Adjusted HR 0.23: 95% CI 0.07-0.72) against poor liver outcomes (decompensation, liver transplant, mortality), which remained statistically significant in patients using UCDA (HR 0.21: 95% CI 0.05-0.83).
In our study, depression was not associated with poor clinical outcomes. However, using the antidepressant mirtazapine was associated with decreased mortality, decompensated cirrhosis and liver transplantation in PBC patients. These findings support further assessment of mirtazapine as a potential treatment for PBC patients.
抑郁症在原发性胆汁性胆管炎（PBC）患者中较为普遍。我们的目的是研究抑郁症和抗抑郁药对 PBC 患者肝脏结局的影响。
我们使用英国健康改善网络数据库，于 1974 年至 2007 年间识别出 PBC 患者。我们的主要结局为以下三种临床事件之一：失代偿性肝硬化、肝移植和死亡。我们使用调整后的多变量 Cox 比例风险模型评估抑郁症和每种抗抑郁药类别，以确定结局的独立预测因素。在敏感性分析中，研究人群限制为使用熊去氧胆酸（UDCA）的 PBC 患者。
在研究期间，我们共确定了 1177 名 PBC 患者。在我们的队列中，86 名患者（7.3%）在 PBC 诊断前有抑郁症诊断，而 79 名患者（6.7%）在 PBC 诊断后有抑郁症诊断。10 年死亡率、失代偿性肝硬化和肝移植的发生率分别为 13.4%、6.6%和 2.0%。在调整后的模型中，抑郁症状态不是不良结局的预测因素。研究所有类别的抗抑郁药后，与其他药物相比，在 PBC 诊断后使用非典型抗抑郁药米氮平显著降低不良肝脏结局（失代偿、肝移植、死亡）的风险（调整后的 HR 0.23：95%CI 0.07-0.72），在使用 UDCA 的患者中，这一结果仍具有统计学意义（HR 0.21：95%CI 0.05-0.83）。
在我们的研究中，抑郁症与不良临床结局无关。然而，在 PBC 患者中使用抗抑郁药米氮平与降低死亡率、失代偿性肝硬化和肝移植相关。这些发现支持进一步评估米氮平作为 PBC 患者潜在治疗方法的可能性。
