Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University, Kunming, China.
School of Public Health Kunming Medical University, Kunming, China.
BMC Gastroenterol. 2023 Nov 17;23(1):400. doi: 10.1186/s12876-023-03031-8.
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by inflammation of the interlobular bile ducts. Ursodeoxycholic acid (UDCA) is the only FDA approved first-line therapy for PBC, but up to 40% of patients with PBC have an incomplete response to UDCA. Neutrophil-to-lymphocyte (NLR) has been used to predict prognosis in various liver diseases. There is limited evidence on the treatment response to UDCA in PBC patients. Our study aimed to evaluate the relationship between NRL and the response to UDCA treatment in PBC patients.
A total of 257 primary biliary cholangitis (PBC) patients treated with UDCA (13-15 mg/kg/d) were enrolled in this retrospective study. The response to treatment was evaluated based on alkaline phosphatase levels ≤1.67 times the upper limit of the normal value after 12 months of UDCA treatment. Multivariable logistic regression analysis was performed to investigate the association between NLR at baseline and the response to 12 months of UDCA treatment after adjusting for important confounding variables. The stability of the results was evaluated by unadjusted and adjusted models.
The results of multiple regression analysis showed that NLR at baseline was positively associated with the nonresponse to UDCA treatment after adjustments for potential confounders (age, sex, BMI, hypertension, arterial plaque, thyroid disease, jaundice, albumin, globulin, total bile acid, ALP, GGT, LDLC, total cholesterol, hemoglobin, and APTT) (OR = 1.370, 95% CI 1.066-1.761). These results reveal that NLR is an independent risk factor for UDCA treatment nonresponse.
Our results suggest that PBC patients with a high NLR had a worse response to UDCA therapy.
原发性胆汁性胆管炎（PBC）是一种慢性胆汁淤积性肝病，其特征为小叶间胆管炎症。熊去氧胆酸（UDCA）是唯一被 FDA 批准的 PBC 一线治疗药物，但高达 40%的 PBC 患者对 UDCA 治疗反应不完全。中性粒细胞与淋巴细胞比值（NLR）已被用于预测各种肝病的预后。关于 PBC 患者对 UDCA 治疗反应的 NLR 相关证据有限。本研究旨在评估 NLR 与 PBC 患者对 UDCA 治疗反应之间的关系。
本回顾性研究共纳入 257 例接受 UDCA（13-15mg/kg/d）治疗的原发性胆汁性胆管炎（PBC）患者。根据 UDCA 治疗 12 个月后碱性磷酸酶水平降至正常值上限的 1.67 倍以下，评估治疗反应。多变量逻辑回归分析用于研究基线 NLR 与 UDCA 治疗 12 个月后的反应之间的关系，调整了重要混杂变量。通过未调整和调整模型评估结果的稳定性。
多回归分析结果表明，调整潜在混杂因素（年龄、性别、BMI、高血压、动脉斑块、甲状腺疾病、黄疸、白蛋白、球蛋白、总胆汁酸、ALP、GGT、LDLC、总胆固醇、血红蛋白和 APTT）后，基线 NLR 与 UDCA 治疗无反应呈正相关（OR=1.370，95%CI 1.066-1.761）。这些结果表明，NLR 是 UDCA 治疗无反应的独立危险因素。
我们的结果表明，NLR 较高的 PBC 患者对 UDCA 治疗的反应较差。
