原发性胆汁性胆管炎且肝脏硬度显著的低风险个体：预后与治疗
Low-risk individuals with primary biliary cholangitis and significant liver stiffness: prognosis and treatment.
作者信息
Ding Dawei, Hu Yinan, Jia Gui, Wang Boling, Zheng Linhua, Deng Juan, Sun Ruiqing, Wang Xiufang, Guo Guanya, Cui Lina, Shang Yulong, Han Ying
机构信息
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Air Force Military Medical University, Xi'an, 710032, Shaanxi, China.
出版信息
Hepatol Int. 2024 Dec 11. doi: 10.1007/s12072-024-10743-w.
BACKGROUND
Some patients treated with ursodeoxycholic acid (UDCA) or combined fenofibrate had well-controlled biochemical parameters but high liver stiffness, and the prognosis as well as therapeutic options for these patients may be an area worthy of further exploration.
AIMS
To explore the prognosis and treatment of patients with low-risk and high liver stiffness.
METHODS
A retrospective study included 424 cases of UDCA monotherapy and 102 cases of combined fenofibrate treatment.
RESULTS
The combination of liver stiffness measurement (LSM) and the GLOBE score improved prognostic prediction for patients with UDCA monotherapy (area under the receiver operating characteristic curve [AUC] of 0.868 (0.811-0.925) for the fitted model and 0.834 (0.767-0.900) for the GLOBE score, p = 0.006). Further analyses revealed that LSM had an additive prognostic effect mainly in low-risk patients defined by GLOBE < 0.5 (AUC, 0.777 [0.724-0.825] vs 0.642 [0.583-0.699], p = 0.001). For patients in the low-risk group, the prognosis was worse when LSM > 11 kPa (7/53 [13%] vs 2/227 [1%], p = 0.001). The prognosis was consistent between patients in the "low-risk and LSM > 11 kPa" group and the medium-risk group defined by 0.5 < GLOBE < 1.8 (7/53 [13%] vs 22/121 [18%], p = 0.418). In low-risk patients treated with combined fenofibrate therapy, the prognosis was worse when LSM > 11 kPa (3/21 [14%] vs 0/47 [0%], p = 0.022). The prognosis was consistent between patients in the "low-risk and LSM > 11 kPa" and the medium-risk groups (3/21 [14%] vs 6/27 [22%], p = 0.353). Antifibrotic drugs failed to reduce the incidence of the primary outcome (5/45 [11%] vs 5/27 [19%], p = 0.598), and delayed the progression of LSM in patients with low-risk and LSM > 11 kPa at 36 months of follow-up (changes in LSM, - 3.31 [- 5.04 to - 1.52] vs - 1.74 [- 2.83 to 1.5], p = 0.046).
CONCLUSIONS
Patients with GLOBE-defined low-risk and LSM > 11 kPa had a poor prognosis, and antifibrotic therapy may slow the progression of liver stiffness in these patients.
背景
一些接受熊去氧胆酸（UDCA）或联合非诺贝特治疗的患者生化指标得到良好控制，但肝脏硬度较高，这些患者的预后以及治疗选择可能是值得进一步探索的领域。
目的
探讨低风险且肝脏硬度高的患者的预后及治疗情况。
方法
一项回顾性研究纳入了424例UDCA单药治疗病例和102例联合非诺贝特治疗病例。
结果
肝脏硬度测量（LSM）与GLOBE评分相结合改善了UDCA单药治疗患者的预后预测（拟合模型的受试者工作特征曲线下面积[AUC]为0.868[0.811 - 0.925]，GLOBE评分为0.834[0.767 - 0.900]，p = 0.006）。进一步分析显示，LSM主要在GLOBE < 0.5定义的低风险患者中具有附加预后效应（AUC，0.777[0.724 - 0.825]对0.642[0.583 - 0.699]，p = 0.001）。对于低风险组患者，当LSM > 11 kPa时预后更差（7/53[13%]对2/227[1%]，p = 0.001）。“低风险且LSM > 11 kPa”组患者与0.5 < GLOBE < 1.8定义的中风险组患者的预后一致（7/53[13%]对22/121[18%]，p = 0.418）。在接受联合非诺贝特治疗的低风险患者中，当LSM > 11 kPa时预后更差（3/21[14%]对0/47[0%]，p = 0.022）。“低风险且LSM > 11 kPa”组与中风险组患者的预后一致（3/21[14%]对6/27[22%]，p = 0.353）。抗纤维化药物未能降低主要结局的发生率（5/45[11%]对5/27[19%]，p = 0.598），并在随访36个月时延缓了低风险且LSM > 11 kPa患者的LSM进展（LSM变化，-3.31[-5.04至-1.52]对-1.74[-2.83至1.5]，p = 0.046）。
结论
GLOBE定义的低风险且LSM > 11 kPa的患者预后较差，抗纤维化治疗可能会减缓这些患者肝脏硬度的进展。
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