Departments of Gastroenterology and Hepatology, Henry Ford Health System, and Wayne State University School of Medicine, Detroit, Michigan, USA.
Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
Am J Gastroenterol. 2020 Feb;115(2):262-270. doi: 10.14309/ajg.0000000000000512.
We used data from the Fibrotic Liver Disease Consortium to evaluate the impact of ursodeoxycholic acid (UDCA) treatment across race/ethnicity, gender, and clinical status among patients with primary biliary cholangitis.
Data were collected from "index date" (baseline) through December 31, 2016. Inverse Probability of Treatment Weighting was used to adjust for UDCA treatment selection bias. Cox regression, focusing on UDCA-by-risk factor interactions, was used to assess the association between treatment and mortality and liver transplant/death.
Among 4,238 patients with primary biliary cholangitis (13% men; 8% African American, 7% Asian American/American Indian/Pacific Island [ASINPI]; 21% Hispanic), 78% had ever received UDCA. The final multivariable model for mortality retained age, household income, comorbidity score, total bilirubin, albumin, alkaline phosphatase, and interactions of UDCA with race, gender, and aspartate aminotransferase/alanine aminotransferase ≥1.1. Among untreated patients, African Americans and ASINPIs had higher mortality than whites (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] 1.08-1.67 and aHR = 1.40, 95% CI 1.11-1.76, respectively). Among treated patients, this relationship was reversed (aHR = 0.67, 95% CI 0.51-0.86 and aHR = 0.88, 95% CI 0.67-1.16). Patterns were similar for liver transplant/death. UDCA reduced the risk of liver transplant/death in all patient groups and mortality across all groups except white women with aspartate aminotransferase/alanine aminotransferase ≥1.1. As compared to patients with low-normal bilirubin at baseline (≤0.4 mg/dL), those with high-normal (1.0 > 0.7) and mid-normal bilirubin (0.7 > 0.4) had significantly higher liver transplant/death and all-cause mortality.
African American and ASINPI patients who did not receive UDCA had significantly higher mortality than white patients. Among African Americans, treatment was associated with significantly lower mortality. Regardless of UDCA treatment, higher baseline bilirubin, even within the normal range, was associated with increased mortality and liver transplant/death compared with low-normal levels.
我们利用纤维性肝病联盟的数据，评估熊去氧胆酸（UDCA）治疗在原发性胆汁性胆管炎患者中的种族/民族、性别和临床状况的影响。
数据收集自“索引日期”（基线）至 2016 年 12 月 31 日。逆概率治疗加权法用于调整 UDCA 治疗选择偏倚。Cox 回归，侧重于 UDCA 与风险因素的相互作用，用于评估治疗与死亡率和肝移植/死亡之间的关系。
在 4238 名原发性胆汁性胆管炎患者中（13%为男性；8%为非裔美国人，7%为亚裔美国人/美国印第安人/太平洋岛民[ASINPI]；21%为西班牙裔），78%的患者曾接受 UDCA 治疗。死亡率的最终多变量模型保留了年龄、家庭收入、合并症评分、总胆红素、白蛋白、碱性磷酸酶以及 UDCA 与种族、性别和天门冬氨酸氨基转移酶/丙氨酸氨基转移酶≥1.1 的相互作用。在未接受治疗的患者中，非裔美国人和 ASINPI 患者的死亡率高于白人（校正后的危险比[aHR]为 1.34，95%置信区间[CI]为 1.08-1.67 和 aHR = 1.40，95% CI 为 1.11-1.76）。在接受治疗的患者中，这种关系发生了逆转（aHR = 0.67，95% CI 为 0.51-0.86 和 aHR = 0.88，95% CI 为 0.67-1.16）。肝移植/死亡的模式也类似。UDCA 降低了所有患者组的肝移植/死亡风险和除天门冬氨酸氨基转移酶/丙氨酸氨基转移酶≥1.1 的白人女性以外的所有组的死亡率。与基线时胆红素低正常（≤0.4mg/dL）的患者相比，胆红素高正常（1.0＞0.7）和中正常（0.7＞0.4）的患者的肝移植/死亡和全因死亡率明显更高。
未接受 UDCA 治疗的非裔美国人和 ASINPI 患者的死亡率明显高于白人患者。在非裔美国人中，治疗与死亡率显著降低相关。无论是否接受 UDCA 治疗，与低正常水平相比，基线胆红素较高，即使在正常范围内，也与死亡率和肝移植/死亡增加相关。
