熊去氧胆酸治疗1个月后的碱性磷酸酶水平和基线红细胞分布宽度对原发性胆汁性胆管炎治疗应答的预测价值.docx

自身免疫性肝病DOI:10.12449/JCH240310熊去氧胆酸治疗1个月后的碱性磷酸酶水平和基线红细胞分布宽度对原发性胆汁性胆管炎治疗应答的预测价值王楠'胡蓉1,卞石惠、仲威2,张飞"谭友文,1江苏大学附属人民医院老年科,江苏镇江2120022江苏大学附属医院心血管科，江苏镇江2120023江苏大学附属第三人民医院肝病科,江苏镇江212004画言储：弓三11S,316959714(OReID:0009-0007358-886X),tyw915(ORQD:0000-0002-5464-1407)摘要：目的研究基线红细胞分布宽度(RDW)和熊去氧胆酸(UDCA)治疗1个月后的ALP水平预测原发性胆汁性胆管炎(PBC)患者对UDCA治疗的应答情况。方法回顾性分析2015年1月2022年7月于江苏大学附属第三人民医院肝病中心确诊的127例PBC患者资料，收集基线指标、治疗1个月后以及1年后随访数据根据巴黎-I标准将患者分为应答良好组和应答欠佳组，分析2组患者临床及实验室特征，以及与UDCA应答之间的相关性，利用Logistic回归法分析与UDCA治疗应答相关的独立危险因素。利用ROC曲线下面积(AUC)确定相关指标的最佳临界值，根据界值将患者再次分组，分析两组间基线指标、应答情况的差异.符合正态分布的计量资料两组间比较采用成组f检验；非正态分布的计量资料两组间比较采用Mann-WhitneyU检验.计数资料组间雌测J采用2检验。结果UDCA应答欠佳组患者基线TBilAST/ALT.ALP.RDW、RDW-CV以及UDCA治疗1个月后的ALP水平明显高于应答良好组(Z值分别为-4.792、-3.697、-2.399、-4.102、-3.220、-4.236,P值均0.05);应答欠佳组患者基线Alb、Hb.淋巴细胞数、红细胞比容及BMI水平明显低于应答良好组(Z值分别为-3.592、-3.603,-2.602,-3.829,-2.432,产值均0.05);应答欠佳组患者魁前白蛋白、白球比、翱曜白A、游离三碘甲状腺原氨酸水平明显低于应答良好组(嵋分别为4.530、3.402、3.485、3.639,产值均0.001).应答良好组患者存在肝硬化、合并胆囊结石胆囊炎以及贫血占匕阚氐，两组间差异均有统计学意义”值分别为20.815、3.892、12.283,产值均005)。与RDW(OR=I.157f95%Cl:1.0281.301,P=O.015)交第1个月醐ALP水平(。月=LoI2,95%C:LoO51.020,P=O.002),其AUC分别版.713、0.720.基线RDW2正常(±阻UDCAJ台疗1个月后ALP2.2倍正常值上限组患者UDC岫答率更低(42.6%vs8.2%,/=20.813,P0.OOI)。结论期RDWN正常值上限同时UDCA治疗1个月后ALPN2.2倍正常值上限的患者对UDCA的生化应答率更低。关键词：原发性胆汁性胆管炎；熊去氧胆酸；危险因素；生化学应答基金项目：国家自然科学基金(82000261);中国公共卫生项目(GWLM202002)；江苏大学医教协同创新基金重点项目(JDY2023020)ValueofalkalinephosphataselevelafterursodeoxycholicacidtreatmentforonemonthandbaselineredbloodcelldistributionwidthinpredictingthetreatmentresponseofprimarybiliarycholangitisWANGNan',HURong',BIANShihui',ZHONGWef,ZHANGPengfef,TANYouwerP.(1.DepartmentOfGeriatrics,ThePeople'sHospitalofJiangsuUniversity,Zhenjiang,Jiangsu212002,China;2.DepartmentofCardiology,AffiliatedHospitalofJiangsuUniversity,Zhenjiang,Jiangsu212002,China;3.DepartmentOfHepatoIogy,TheThirdPeople'sHospitalOfJiangsuUniversity,Zhenjiang,Jiangsu212004,China)Correspondingauthors:ZHANGPengfei,316959714(ORCID:0009-0007-4358-886X);TANYouwen,tyw915(ORCID：0000-0002-5464-1407)Abstract:ObjectiveToinvestigatethevalueofbaselineredcelldistributionwidth(RDW)andalkalinephosphatase(ALP)levelafterUrSOdeOXyChOIiCadd(UDCA)treatmentforonemonthinpredictingtheresponsetoUDCAtreatmentinpatientswithprimarybiliarycholangitis(PBC).MethodsAretrospectiveanalysiswasperfornedforthedataof127patientswithPBCwhowerediagnosedinDepartmentofHepatology,TheThirdPeople'sHospitalofJiangsuUniversity,fromJanuary2015toJuly2022,withdatacollectedatbaseline,afteronemonthoftreatment,andafterOneyearoffollowp.BasedontheParis-Icriteria,thepatientsweredividedintogoodresponsegroupandpoorresponsegroupfandthetwgroupswereanalyzedintermsOfdiniCalandlaboratoryfeaturesandtheirassociationwithresponsetoUDCA.TbeLogisticregressimethodwasusedtoinvestigatetheindependentriskfactorsforresponsetoUDCAtreatmentTheareaundertheROCOJnZe(AUC)wasusedtodetaminetheoptimalcut-offvaluesofrelatedindicators;thepatientsweredividedintotwogroupsbasedonsuchvalues,andthetwogroupswerecomparedintermsofbaselineindicatorsandresponse.Theindependent-samplesttestwasusedforcomparisofnormallydistributedctinuousdatabetweentwogroups,andtheManrvWhitneyL/testwasusedforcomparisofnon-nomallydistributedcontinuousdatabeeentwogroups;thechi-squaretestwasusedforcomparisonofcategoricaldatabetweentwogroups.ResultsComparedwiththegoodresponsegroup,theprresponsegrouphadsignificantlyhigherlevelsoftotalbilirubin,aspartateaminotransferase/alanineaminotransferase,ALP,RDW,andRDW-CVatbaselineandasignificantlyhigherlevelofALPafteronemonthofUDCAtreatment(Z=-4.792,-3.697,-2399,-4.102,-3220,and-4236,allP<0,05).Comparedwithtegoodresponsegroup,thepoorresponsegrphadsignificantlylowerlevelsofalbumin,hemoglobin,Iymphcxytes,hematocrit,andbodymassindexatbaseline(Z=-3.592,-3.603,-2.602,-3,829,-2.432,allP<0.05),aswellassignificantlylowerlevelsofprealbumin,albumin/globulinratio,apolipoproteinA,andfreetriiodothyronineatbaseline(M.530,3.402,3.485,and3.639,allP<0.001).Comparedwiththeprresponsegroup,thegoodresponsegrouphadasignificantlylowerproportionofpatientswithlivercirrhosis,gallstones/cholecystitis,oranemia(/=20.815,3.892,and12283,all尸<0.05).BaselineRDW(oddsratioOR=1157,95%confidenceintervalCl:1.0281301,P=0015)andALPlevelafteremonthOftreatment(CV?=1012,95%C:10051.020,P=0.002)wereindependentriskfactorsforresponsetoUDCA,withanAUCof0.713and0.720,respectively.ThepatientswithbaselineRDWupperlimitofnormal(ULN)andALP>22×ULNafteronemonthofUDCAtreatmenthadalowerUDCAresponserate(42.6%vs8.2%,/=20.813,P<0.001).CondusionPatientswithbaselineRDW>ULNandALP22×ULNafterOnemonthofUDCAtreatmenttendtohavealowbiochemicalresponseratetoUDCA.Keywords:PrimaryBiliaryGnolangitis;UrsodxycholicAdd;RiskFactors;BiochemicalResponseResearchfunding:NationalNaturalScienceFoundationofChina(82CXX)261);ChinaPublicHealthProgram(GWLM202002);KeyProjectofMedicalEducationCollaborativeInnovationFundOfJiangsuUniversity(JDY2023020)原发性胆汁性胆管炎(PBC)是一种自身免疫介导的以慢性非化脓性胆管炎和肝内小叶间胆管破坏为主要病理表现的肝内胆汁淤积性疾病