熊去氧胆酸应答与代偿性肝硬化原发性胆汁性胆管炎患者死亡率降低相关。
Ursodeoxycholic Acid Response Is Associated With Reduced Mortality in Primary Biliary Cholangitis With Compensated Cirrhosis.
机构信息
Division of Hepatology, Bruce W Carter VA Medical Center, Miami, Florida, USA.
Department of Medicine, Jackson Memorial Hospital, Miami, Florida, USA.
出版信息
Am J Gastroenterol. 2021 Sep 1;116(9):1913-1923. doi: 10.14309/ajg.0000000000001280.
INTRODUCTION
Patients with cirrhosis and men have been under-represented in most studies examining the clinical benefit of response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC). The aim of this study was to study the association of UDCA response and liver-related death or transplantation, hepatic decompensation, and hepatocellular carcinoma (HCC) in patients with PBC cirrhosis.
METHODS
We conducted a retrospective cohort study of veterans, predominantly men, with PBC and compensated cirrhosis to assess the association of UDCA response with the development of all-cause and liver-related mortality or transplantation, hepatic decompensation, and HCC using competing risk time-updating Cox proportional hazards models.
RESULTS
We identified 501 subjects with PBC and compensated cirrhosis, including 287 UDCA responders (1,692.8 patient-years [PY] of follow-up) and 214 partial responders (838.9 PY of follow-up). The unadjusted rates of hepatic decompensation (3.8 vs 7.9 per 100 PY, P < 0.0001) and liver-related death or transplantation (3.7 vs 6.2 per 100 PY, P < 0.0001) were lower in UDCA responders compared with partial responders. UDCA response was associated with a lower risk of hepatic decompensation (subhazard ratio [sHR] 0.54, 95% confidence interval [CI] 0.31-0.95, P = 0.03), death from any cause or transplantation (adjusted hazard ratio 0.49, 95% CI 0.33-0.72, P = 0.0002), and liver-related death or transplantation (sHR 0.40, 95% CI 0.24-0.67, P = 0.0004), but not HCC (sHR 0.39, 95% CI 0.60-2.55, P = 0.32). In a sensitivity analysis, the presence of portal hypertension was associated with the highest UDCA-associated effect.
DISCUSSION
UDCA response is associated with a reduction in decompensation, all-cause, and liver-related death or transplantation in a cohort of predominantly male patients with cirrhosis, with the highest benefit in patients with portal hypertension.
简介
在大多数研究原发性胆汁性胆管炎（PBC）中，对熊去氧胆酸（UDCA）反应的临床获益进行研究时，肝硬化和男性患者的代表性不足。本研究的目的是研究 PBC 肝硬化患者中 UDCA 反应与肝相关死亡或移植、肝失代偿和肝细胞癌（HCC）的关系。
方法
我们对退伍军人进行了回顾性队列研究，这些退伍军人主要为男性，患有 PBC 和代偿性肝硬化，使用竞争风险时间更新 Cox 比例风险模型评估 UDCA 反应与全因和肝相关死亡或移植、肝失代偿和 HCC 的发生之间的关系。
结果
我们确定了 501 例患有 PBC 和代偿性肝硬化的患者，其中 287 例 UDCA 反应者（1692.8 患者年 [PY] 的随访）和 214 例部分反应者（838.9 PY 的随访）。与部分反应者相比，UDCA 反应者的肝失代偿（每 100 PY 3.8 与 7.9，P<0.0001）和肝相关死亡或移植（每 100 PY 3.7 与 6.2，P<0.0001）发生率较低。UDCA 反应与肝失代偿（亚危险比 [sHR] 0.54，95%置信区间 [CI] 0.31-0.95，P=0.03）、任何原因导致的死亡或移植（调整后的危险比 0.49，95%CI 0.33-0.72，P=0.0002）和肝相关死亡或移植（sHR 0.40，95%CI 0.24-0.67，P=0.0004）的风险降低相关，但与 HCC 无关（sHR 0.39，95%CI 0.60-2.55，P=0.32）。在敏感性分析中，门静脉高压的存在与 UDCA 相关性的最高获益相关。
讨论
在一组主要为男性肝硬化患者中，UDCA 反应与失代偿、全因和肝相关死亡或移植的减少相关，在有门静脉高压的患者中获益最大。
Zotero 插件