熊去氧胆酸可改善原发性硬化性胆管炎患者的长期预后。

Ursodeoxycholic acid is associated with improved long-term outcome in patients with primary sclerosing cholangitis.

机构信息

Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.

Department of General Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.

出版信息

J Gastroenterol. 2022 Nov;57(11):902-912. doi: 10.1007/s00535-022-01914-3. Epub 2022 Sep 6.

DOI:10.1007/s00535-022-01914-3

PMID:36068441

Abstract

BACKGROUND

It remains unclear whether ursodeoxycholic acid (UDCA) treatment improves long-term outcomes in patients with primary sclerosing cholangitis (PSC). In this study, we investigated whether UDCA treatment is associated with improved liver transplantation (LT)-free survival in a cohort of Japanese patients with PSC.Journal instruction requires a city and country for affiliations; however, these are missing in affiliation [6]. Please verify if the provided city and country are correct and amend if necessary.'Tokyo, Japan' is correct.

METHODS

We used retrospective data from the Japanese PSC registry that included 435 patients with PSC. In this study, we enrolled patients with a complete dataset at diagnosis, along with the diagnosis year, treatment protocol, follow-up period, and outcome data. The association between UDCA treatment and all-cause death or LT was analyzed using Cox regression and inverse probability of UDCA treatment weighting (IPTW)-adjusted Cox regression models adjusted for covariates.

RESULTS

Among 435 patients with PSC, 110 were excluded due to insufficient or missing data, and the remaining 325 patients (male, 187 (58%); mean age at diagnosis, 45.8 years) were enrolled. The mean follow-up period was 5.1 years, and 57 deaths and 24 LTs occurred during observation. UDCA was administered to 278 patients (86%). The Cox regression model demonstrated that UDCA treatment was associated with an improvement in LT-free survival [adjusted hazard ratio (aHR) 0.47, 95% confidence interval (CI) 0.28-0.78, p = 0.003]. In addition, the IPTW-adjusted model indicated a significant association between UDCA and LT-free survival (aHR 0.43, 95% CI 0.25-0.75, p = 0.020). Sensitivity analysis excluding patients treated with bezafibrate indicated a similarly significant association between UDCA treatment and LT-free survival.

CONCLUSION

In this Japanese PSC cohort, UDCA treatment was significantly associated with improved LT-free survival.

摘要

背景

熊去氧胆酸（UDCA）治疗是否能改善原发性硬化性胆管炎（PSC）患者的长期预后仍不清楚。本研究旨在调查 UDCA 治疗是否与日本 PSC 患者的肝移植（LT）无失败生存率的改善相关。期刊要求在隶属关系中提供城市和国家，但隶属关系[6]中缺失了这些信息。请核实提供的城市和国家是否正确，并在必要时进行修正。隶属关系中“Tokyo, Japan”是正确的。

方法

我们使用了日本 PSC 登记处的回顾性数据，该数据纳入了 435 例 PSC 患者。本研究纳入了在诊断时具有完整数据集以及诊断年份、治疗方案、随访期和结局数据的患者。使用 Cox 回归和逆概率处理加权（IPTW）调整 Cox 回归模型，对 UDCA 治疗与全因死亡或 LT 的关联进行分析，并调整了协变量。

结果

在 435 例 PSC 患者中，有 110 例因数据不足或缺失而被排除，其余 325 例（男性 187 例[58%]；诊断时的平均年龄为 45.8 岁）被纳入研究。平均随访时间为 5.1 年，观察期间有 57 例死亡和 24 例 LT。278 例（86%）患者接受了 UDCA 治疗。Cox 回归模型显示，UDCA 治疗与 LT 无失败生存率的改善相关[调整后的危险比（aHR）0.47，95%置信区间（CI）0.28-0.78，p=0.003]。此外，IPTW 调整模型表明 UDCA 与 LT 无失败生存率之间存在显著关联（aHR 0.43，95%CI 0.25-0.75，p=0.020）。排除接受苯扎贝特治疗的患者后进行敏感性分析，也表明 UDCA 治疗与 LT 无失败生存率之间存在显著关联。