Chang Ming-Ling, Cheng Jur-Shan, Le Puo-Hsien, Chen Wei-Ting, Ku Hsin-Ping, Chien Rong-Nan
Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fu Hsing Street, Kuei Shan, Taoyuan 333423, Taiwan.
Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Therap Adv Gastroenterol. 2024 Mar 28;17:17562848241241227. doi: 10.1177/17562848241241227. eCollection 2024.
How antimitochondrial antibody (AMA)-positive patients evolve to have primary biliary cholangitis (PBC) in viral hepatitis-endemic areas is unknown.
We aimed to investigate this evolution in Taiwan.
DESIGN/METHODS: A 16-year medical center-based cohort study of 2,095,628 subjects was conducted in Taiwan, an Asian country endemic to viral hepatitis. AMA-positive subjects were those with positive AMA with alkaline phosphatase (ALP) ⩽1.5 times the upper limit of normal (ULN), and PBC was defined as positive AMA with ALP >1.5 × ULN.
AMA-positive subjects had a lower average age- and sex-adjusted prevalence than PBC patients (4.68/10 11.61/10, = 0.0002), but their incidence was comparable (0.99/10 1.12/10, = 0.36). The former group had a borderline significantly lower mean age (56.59 years 58.10 years, = 0.06) and a lower female-to-male ratio (2.85:1 5.44:1, < 0.0001). Both AMA-positive subjects (prevalence change: 20.0%, < 0.01; incidence change: -9.2%, < 0.01) and PBC patients (prevalence change: 14.6%, < 0.01; incidence change: -4.7%, 0.01) prevalence rate increased but the incidence rate decreased. Among the 423 AMA-positive subjects, 77 (18.2%) developed PBC, for a mean duration of 1.757 years. Compared with AMA-positive subjects, PBC patients had similar concurrent chronic hepatitis B (CHB) rates (2.7% 4.3%, = 0.197) but lower chronic hepatitis C (CHC) rates (3.69% 15.60%, < 0.01).
PBC was more prevalent than AMA-positive subjects, and PBC patients had a higher female-to-male ratio than AMA-positive subjects, of whom 18.2% developed PBC (mean lag: 1.757 years). Upward trends in prevalence rates and downward trends in incidence rates were noted for both AMA-positive subjects and PBC. CHB was rare, CHC was more prevalent among PBC patients than the general population, and CHC was less prevalent among PBC than among AMA-positive subjects.
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