Fujinaga Yukihisa, Namisaki Tadashi, Tsuji Yuki, Shibamoto Akihiko, Kubo Takahiro, Koizumi Aritoshi, Matsuda Takuya, Inoue Takashi, Iwai Satoshi, Tomooka Fumimasa, Tanaka Misako, Takaya Hiroaki, Noguchi Ryuichi, Nishimura Norihisa, Sato Shinya, Kitagawa Koh, Kaji Kosuke, Akahane Takemi, Mitoro Akira, Asada Kiyoshi, Yoshiji Hitoshi
Department of Gastroenterology, Nara Medical University, Nara, Japan.
Department of Evidence-Based Medicine, Nara Medical University, Nara, Japan.
Hepatol Res. 2025 Jul;55(7):968-976. doi: 10.1111/hepr.14192. Epub 2025 Apr 7.
This study aimed to determine the predictive ability of the histological stage (HS) compared with biochemical response to ursodeoxycholic acid (UDCA) (BR) on developing complications in patients with primary biliary cholangitis (PBC).
Overall, 226 patients with asymptomatic PBC treated with UDCA were enrolled. Pathological staging was conducted based on the Scheuer and Nakanuma classifications, which were graded for liver fibrosis (fibrosis) and bile duct loss (BDL). BR was evaluated according to the Nara criteria, Paris II criteria, and Barcelona criteria. PBC complications included pruritus, esophageal varices, ascites, and jaundice.
The cumulative complication rates (CCRs) of the four patient groups (early disease/responder [group A], early disease/non-responder [group B], advanced disease/responder [group C], and advanced disease/non-responder [group D]) were estimated by combining the HS according to the Scheuer and Nakanuma classifications and BR based on three UDCA response criteria. The CCRs for the Scheuer classification/Paris II criteria, Scheuer classification/Barcelona criteria, Nakanuma classification/Nara criteria, Nakanuma classification/Paris II criteria, Nakanuma classification/Barcelona criteria, fibrosis/Barcelona criteria, and BDL/Paris II criteria were significantly higher in group C than in group A. The CCRs for the Scheuer classification/Nara criteria, Scheuer classification/Barcelona criteria, Nakanuma classification/Nara criteria, Nakanuma classification/Barcelona criteria, fibrosis/Nara criteria, fibrosis/Paris II criteria, and fibrosis/Barcelona criteria were significantly higher in group D than in group B. An advanced Nakanuma stage was independently associated with developing complications in patients with PBC.
The CCR increases with HS progression regardless of BR. HS is linked to a higher risk of developing complications than BR in patients with PBC.
本研究旨在确定与原发性胆汁性胆管炎（PBC）患者对熊去氧胆酸（UDCA）的生化反应（BR）相比，组织学分期（HS）对PBC患者发生并发症的预测能力。
总共纳入了226例接受UDCA治疗的无症状PBC患者。根据Scheuer和中沼分类法进行病理分期，对肝纤维化（纤维化）和胆管丢失（BDL）进行分级。根据奈良标准、巴黎II标准和巴塞罗那标准评估BR。PBC并发症包括瘙痒、食管静脉曲张、腹水和黄疸。
通过结合根据Scheuer和中沼分类法的HS以及基于三种UDCA反应标准的BR，估计了四组患者（早期疾病/反应者 [A组]、早期疾病/无反应者 [B组]、晚期疾病/反应者 [C组] 和晚期疾病/无反应者 [D组]）的累积并发症发生率（CCR）。Scheuer分类法/巴黎II标准、Scheuer分类法/巴塞罗那标准、中沼分类法/奈良标准、中沼分类法/巴黎II标准、中沼分类法/巴塞罗那标准、纤维化/巴塞罗那标准和BDL/巴黎II标准的CCR在C组中显著高于A组。Scheuer分类法/奈良标准、Scheuer分类法/巴塞罗那标准、中沼分类法/奈良标准、中沼分类法/巴塞罗那标准、纤维化/奈良标准、纤维化/巴黎II标准和纤维化/巴塞罗那标准的CCR在D组中显著高于B组。中沼晚期分期与PBC患者发生并发症独立相关。
无论BR如何，CCR均随HS进展而增加。在PBC患者中，HS比BR与发生并发症的风险更高相关。
