Qu Yundong, Wang Lei, Ye Qian, Zhang Yuan, Xiao Juan, Li Tao
Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan 250033, China.
Center of Evidence-based Medicine, Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan 250033, China.
J Coll Physicians Surg Pak. 2019 Nov;29(11):1101-1105. doi: 10.29271/jcpsp.2019.11.1101.
To explore the prognostic value of several widely used noninvasive fibrosis scores (NIFS) for the mortality due to liver-related events in Chinese primary biliary cholangitis (PBC) population.
An observational study.
Department of Infectious Diseases and Hepatology, the Second Hospital of Shandong University, Jinan, China, from August 2008 to July 2018.
Patients were diagnosed as PBC when they fulfilled at least two of the following criteria: presence of antimitochondrial antibodies (AMA), or other PBC-specific autoantibodies; and/or biochemical evidence of cholestasis; and/or histological evidence of liver biopsy. Patients were excluded if they were just started UDCA administration within last year, followed up for less than a year, diagnosed as overlap syndrome, or suffered from other coexisting hepatic diseases. Clinical data were recorded and scores of 11 generally accepted NIFS were calculated. Cox proportional hazards model was performed to explore independent predictors of liver-related mortality.
Sixty-five PBC patients were included in the current cohort. Five patients died due to liver-related events during a median of 35-month follow-up. The 5-year cumulative survival rate was 88.4%. Non-survival patients were characterised with lower platelet count (p=0.049), lower level of albumin (p=0.018), higher fibrosis index (p<0.001) and higher Doha score (p=0.006). Multivariate Cox regression analysis identified fibrosis index (HR 17.449, 95% CI 1.410-215.989, p=0.026) and Doha score (HR 1.782, 95% CI 1.146-2.771, p=0.010) as independent predictors for liver-related mortality of PBC patients.
Fibrosis index and Doha score could serve as valuable prognostic factors for liver-related mortality in Chinese PBC population.
探讨几种广泛应用的非侵入性纤维化评分（NIFS）对中国原发性胆汁性胆管炎（PBC）患者肝脏相关事件所致死亡率的预后价值。
一项观察性研究。
2008年8月至2018年7月，中国济南山东大学第二医院传染病与肝病科。
当患者满足以下至少两条标准时诊断为PBC：存在抗线粒体抗体（AMA）或其他PBC特异性自身抗体；和/或胆汁淤积的生化证据；和/或肝活检的组织学证据。如果患者在过去一年内刚开始使用熊去氧胆酸（UDCA）治疗、随访时间少于一年、诊断为重叠综合征或患有其他并存的肝脏疾病，则将其排除。记录临床数据并计算11种普遍认可的NIFS评分。采用Cox比例风险模型探讨肝脏相关死亡率的独立预测因素。
本队列纳入了65例PBC患者。在中位35个月的随访期间，5例患者因肝脏相关事件死亡。5年累积生存率为88.4%。未存活患者的特征为血小板计数较低（p = 0.049）、白蛋白水平较低（p = 0.018）、纤维化指数较高（p < 0.001）和多哈评分较高（p = 0.006）。多变量Cox回归分析确定纤维化指数（HR 17.449，95%CI 1.410 - 215.989，p = 0.026）和多哈评分（HR 1.782，95%CI 1.146 - 2.771，p = 0.010）是PBC患者肝脏相关死亡率的独立预测因素。
纤维化指数和多哈评分可作为中国PBC患者肝脏相关死亡率的有价值的预后因素。
