Risk factors of decompensated liver cirrhosis in primary biliary cirrhosis

doi:10.3969/j.issn.1673-8640.2018.05.006

Abstract

Abstract:

Objective To investigate the risk factors of decompensated liver cirrhosis in patients with primary biliary cirrhosis（PBC）,and to provide an evidence-based medicine reference for clinical diagnosis and treatment. Methods The clinical data of 115 PBC patients,including 72 compensated patients and 43 decompensated patients,were collected retrospectively. The correlations of decompensated liver cirrhosis with biochemical indices [albumin（Alb）,globulin（Glb）,total bilirubin （TB）,alkaline phosphatase （ALP）,gamma-glutamyltransferase（GGT）,total bile acid（TBA）,alanine aminotransferase（ALT） and aspartate aminotransferase（AST）],coagulation index [prothrombin time（PT）],immunological indices（IgM,IgG,IgA and γ-Glb）,autoantibodies [anti-soluble acidic nuclear protein 100（sp100） antibody,anti-nuclear pore glycoprotein 210（gp210） antibody and anti-centromere antibody] and Mayo risk score were analyzed. Multivariate Logistic regression analysis was used to identify independent risk factors for predicting decompensation in PBC patients. Results Compared with compensated patients,the decompensated patients had higher levels of TB,TBA,PT,γ-Glb,IgA,IgG and Mayo risk score,but they had lower levels of Alb and GGT （P<0.05）. There was no statistical significance for the levels of Glb,ALP,ALT,AST and IgM and the positive rates of anti-sp100 antibody,anti-gp210 antibody and anti-centromere antibody between the 2 groups（P>0.05）. Multivariate Logistic regression analysis showed that Alb<34.5 g/L [odds ratio （OR）=4.458,95% confidence interval （CI） 1.019-19.501],IgA>3.09 g/L（OR=15.41,95%CI 2.868-82.786）,Mayo risk score >5.04 （OR=15.7,95%CI 2.653-92.907）were independent risk factors for predicting decompensation. The areas under receiver operating characteristic（ROC）curves of Alb,IgA and Mayo risk score were 0.881,0.700 and 0.860,respectively. The area under ROC curve of the combined determination of Alb,IgA and Mayo risk score was 0.912. Conclusions Alb<34.5 g/L,IgA >3.09 g/L and Mayo risk score >5.04 and the probability of Alb,IgA and Mayo risk score combined determination >0.45 play roles for predicting decompensation in patients with PBC.

Key words: Primary biliary cirrhosis, Decompensation, Risk factor, Clinical study

CLC Number:

R446.1

LI Jinghua, ZHAO Wei, TONG Jingjing, ZHANG Tie, CAO Yongtong. Risk factors of decompensated liver cirrhosis in primary biliary cirrhosis[J]. Laboratory Medicine, 2018, 33(5): 399-403.

Figures/Tables 4

References 19

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组别	例数	Alb（g/L）	Glb（g/L）	TB（μmol/L）	ALP（U/L）	GGT（U/L）
代偿期组	72	37（35~40）	31（29~37）	15.8（11.7~30.0）	250（140~437）	233（103~510）
失代偿期组	43	31（25~33）	34（31~37）	29.9（16.6~85.2）	208（142~353）	110（55~221）
统计值		-6.753	-1.426	-3.223	-0.947	-3.182
P值		<0.001	0.154	0.001	0.344	0.001
组别	TBA（μmol/L）	ALT（U/L）	AST（U/L）	PT（s）	γ-Glb（%）	IgA（g/L）
代偿期组	24（11~46）	61（32~112）	60（36~108）	10.9（10.2~11.5）	21.5±5.2	2.2±0.8
失代偿期组	49（15~107）	56（25~89）	88（52~115）	12.6（11.4~15.3）	27.6±6.4	3.6±2.0
统计值	-2.745	-1.278	-1.714	-5.628	-5.165	-4.023
P值	0.006	0.201	0.087	<0.001	<0.001	<0.001
组别	IgG（g/L）	IgM（g/L）	Mayo评分	抗sp100抗体阳性例数	抗gp210抗体阳性例数	抗着丝点抗体阳性例数
代偿期组	14.3（11.5~19.2）	3.3（2.0~5.0）	4.5（4.1~5.3）	11	31	15
失代偿期组	18.1（14.4~22.4）	3.7（2.1~4.8）	6.2（5.5~7.7）	8	13	14
统计值	-2.748	-0.216	-6.286	0.216	1.874	2.039
P值	0.006	0.829	<0.001	0.796	0.234	0.182

组别	例数	Alb（g/L）	Glb（g/L）	TB（μmol/L）	ALP（U/L）	GGT（U/L）
代偿期组	72	37（35~40）	31（29~37）	15.8（11.7~30.0）	250（140~437）	233（103~510）
失代偿期组	43	31（25~33）	34（31~37）	29.9（16.6~85.2）	208（142~353）	110（55~221）
统计值		-6.753	-1.426	-3.223	-0.947	-3.182
P值		<0.001	0.154	0.001	0.344	0.001
组别	TBA（μmol/L）	ALT（U/L）	AST（U/L）	PT（s）	γ-Glb（%）	IgA（g/L）
代偿期组	24（11~46）	61（32~112）	60（36~108）	10.9（10.2~11.5）	21.5±5.2	2.2±0.8
失代偿期组	49（15~107）	56（25~89）	88（52~115）	12.6（11.4~15.3）	27.6±6.4	3.6±2.0
统计值	-2.745	-1.278	-1.714	-5.628	-5.165	-4.023
P值	0.006	0.201	0.087	<0.001	<0.001	<0.001
组别	IgG（g/L）	IgM（g/L）	Mayo评分	抗sp100抗体阳性例数	抗gp210抗体阳性例数	抗着丝点抗体阳性例数
代偿期组	14.3（11.5~19.2）	3.3（2.0~5.0）	4.5（4.1~5.3）	11	31	15
失代偿期组	18.1（14.4~22.4）	3.7（2.1~4.8）	6.2（5.5~7.7）	8	13	14
统计值	-2.748	-0.216	-6.286	0.216	1.874	2.039
P值	0.006	0.829	<0.001	0.796	0.234	0.182

预测指标	回归系数	标准误	Wald值	赋值说明	P值	OR值	95%CI
Alb	1.495	0.753	3.942	0为Alb≥34.5 g/L,1为Alb<34.5 g/L	0.047	4.458	1.019~19.501
IgA	2.735	0.858	10.166	0为IgA≤3.09 g/L,1为IgA>3.09 g/L	0.001	15.410	2.868~82.786
Mayo评分	2.754	0.907	9.215	0为Mayo≤5.04 g/L,1为Mayo>5.04 g/L	0.002	15.700	2.653~92.907

预测指标	回归系数	标准误	Wald值	赋值说明	P值	OR值	95%CI
Alb	1.495	0.753	3.942	0为Alb≥34.5 g/L,1为Alb<34.5 g/L	0.047	4.458	1.019~19.501
IgA	2.735	0.858	10.166	0为IgA≤3.09 g/L,1为IgA>3.09 g/L	0.001	15.410	2.868~82.786
Mayo评分	2.754	0.907	9.215	0为Mayo≤5.04 g/L,1为Mayo>5.04 g/L	0.002	15.700	2.653~92.907

指标	敏感性	特异性	阳性预测值	阴性预测值	准确度
Alb<34.5 g/L	83.7	79.2	70.5	89.1	80.9
IgA>3.09 g/L	53.7	87.0	71.0	75.9	75.5
Mayo评分>5.04	90.5	73.6	66.7	93.0	79.8
Alb+IgA+Mayo评分联合预测概率>0.45	87.5	85.5	77.8	92.2	86.2