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[中性粒细胞/淋巴细胞比值对原发性胆汁性胆管炎预后的预测价值]

[Predictive value of neutrophil/lymphocyte ratio in the prognosis of primary biliary cholangitis].

作者信息

Zhu H L, Zheng M Y, Li W B, Huang Y Q, Zhang L L, Yang W T, Zhou M, Yang J H

机构信息

Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China.

Department of General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650101, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2025 Jul 20;33(7):652-659. doi: 10.3760/cma.j.cn501113-20240903-00470.

Abstract

To predict pre-treatment clinical parameters that are associated with poor response and prognosis to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC) and to use second-line treatment drugs in the early stages to delay the progression of the disease so that patients can benefit from early-stage treatment. Patients diagnosed with PBC at the Second Affiliated Hospital of Kunming Medical University from 2013 to 2022 were collected. Two hundred fifty-seven cases were screened in accordance with the inclusion and exclusion criteria. The response and prognosis conditions one year after treatment were followed up in outpatient and inpatient departments, as well as through telephone calls. Statistical analyses were performed using -tests, Mann-Whitney test, test, Fisher's exact test, and logistic regression analysis according to different data. A total of 257 PBC cases were included, with 223 females (86.80%) and 34 males (13.20%). Univariate and multivariate binary logistic regression analyses showed that baseline high albumin levels [odds ratio (): 0.882, 95% confidence interval (): 0.805~0.967, =0.008] were a protective factor for PBC patients' response to UDCA treatment after adjusting for different confounding factors, while baseline high alkaline phosphatase (: 1.012, 95%: 1.008~1.016, <0.001) and baseline high neutrophil/lymphocyte ratio (NLR) level (: 1.462, 95%:1.079~1.981, =0.014) were risk factors for a poor response to UDCA. Trend analysis showed that the baseline NLR quantile was positively correlated with the risk of poor response to UDCA (: 5.512, 95%: 1.040~29.216, =0.045) in patients with PBC. Cox proportional hazards regression analysis identified that age [hazard ratio (): 1.050, 95%: 1.019~1.082] and NLR value (:1.089, 95%:1.021~1.161) were independent influencing risk factors for all-cause mortality in PBC patients (<0.05). Baseline high albumin levels are protective factors against a poor biochemical response to UDCA, while baseline high alkaline phosphatase levels and high NLR are risk factors for a poor biochemical response to UDCA in patients with PBC. Additionally, baseline high NLR values are positively correlated with poor biochemical response to UDCA treatment.

摘要

预测原发性胆汁性胆管炎(PBC)患者对熊去氧胆酸(UDCA)反应不佳及预后不良的治疗前临床参数,并在疾病早期使用二线治疗药物延缓疾病进展,使患者从早期治疗中获益。收集了2013年至2022年在昆明医科大学第二附属医院诊断为PBC的患者。根据纳入和排除标准筛选出257例病例。通过门诊、住院部以及电话随访治疗后一年的反应和预后情况。根据不同数据进行t检验、Mann-Whitney检验、χ²检验、Fisher精确检验和逻辑回归分析。共纳入257例PBC病例,其中女性223例(86.80%),男性34例(13.20%)。单因素和多因素二元逻辑回归分析显示,在调整不同混杂因素后,基线高白蛋白水平[比值比(OR):0.882,95%置信区间(CI):0.805~0.967,P = 0.008]是PBC患者对UDCA治疗反应的保护因素,而基线高碱性磷酸酶(OR:1.012,95%CI:1.008~1.016,P < 0.001)和基线高中性粒细胞/淋巴细胞比值(NLR)水平(OR:1.462,95%CI:1.079~1.981,P = 0.014)是对UDCA反应不佳的危险因素。趋势分析显示,PBC患者基线NLR分位数与对UDCA反应不佳风险呈正相关(OR:5.512,95%CI:1.040~29.216,P = 0.045)。Cox比例风险回归分析确定年龄[风险比(HR):1.050,95%CI:1.019~1.082]和NLR值(HR:1.089,95%CI:1.021~1.161)是PBC患者全因死亡的独立影响危险因素(P < 0.05)。基线高白蛋白水平是UDCA生化反应不佳的保护因素,而基线高碱性磷酸酶水平和高NLR是PBC患者对UDCA生化反应不佳的危险因素。此外,基线高NLR值与UDCA治疗的生化反应不佳呈正相关。

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