慢性乙型肝炎合并原发性胆汁性胆管炎患者的临床病理特征及转归分析

摘要/Abstract

摘要： 目的分析慢性乙型肝炎(CHB)合并原发性胆汁性胆管炎(PBC)患者的临床病理特征及其转归。方法收集2017年2月—2022年12月期间我院诊治并进行肝活检的PBC患者105例,其中合并CHB患者16例。PBC、CHB诊断符合要求。比较合并CHB、未合并CHB组一般情况、实验室检查、血清抗体、免疫球蛋白和补体水平变化,分析两组穿刺病理特征,治疗随访1年,比较两组应答情况。结果 PBC合并CHB患者腹水、肝硬化分别为7例(43.7%)、13例(81.2%),显著高于未合并CHB[17例(19.1%)、46例(51.7%),P<0.05]。合并CHB组PLT、ALP、GGT、TG、INR分别为93(81,157)×10⁹/L、180(124,309)U/L、146(64,311)U/L、1.2(1.0,1.6)mmol/L、1.3(1.2,1.5),与未合并CHB组[137(78,215)×10⁹/L、132(75,178)U/L、101(51,170)U/L、0.9(0.7,1.1)mmol/L、1.0(0.8,1.2)]比较,差异具有统计学意义(P<0.05)。合并CHB组ANA、抗gp210抗体阳性率为15例(93.7%)、7例(43.7%),高于未合并CHB组[62例(69.7%)、15例(16.8%),P<0.05]。合并CHB组血清IgG、IgA、IgM水平为17.9(13.9,21.2)g/L、3.6(2.6,5.2)g/L、2.5(1.2,3.5)g/L,显著高于未合并CHB组[16.4(12.7,20.0)g/L、3.2(2.3,4.5)g/L、2.2(1.7,2.9)g/L,P<0.05]。105例PBC患者病理特征包括界面性肝炎66例(62.8%)、桥接坏死27例(25.7%)、汇管区炎性细胞浸润92例(87.6%)、肝内淤胆19例(18.1%)、胆管损伤12例(11.4%)及玫瑰花结形成9例(8.6%)。经过1年的治疗,合并CHC、未合并CHC组应答11例(68.7%)、67例(75.3%)。结论 PBC患者合并CHB时病情易出现免疫功能失调,例如免疫球蛋白升高和补体水平下降,临床实践中通过观察上述免疫功能相关指标的变化能够指导PBC病情及预后判断。

关键词: 慢性乙型肝炎, 原发性胆汁性胆管炎, 临床病理特征, 转归

Abstract: Objective To analyze the clinicopathological features and perform regression in analysis in patients with chronic hepatitis B (CHB) and concurrent primary biliary cholangitis(PBC). Methods Between February 2017 and December 2022, we collected data from 105 patients diagnosed with PBC who underwent liver biopsy at our hospital, including those with concurrent CHB. The diagnoses of PBC and CHB were confirmed according to established criteria. We compared demographic data, laboratory tests, serum antibody levels, immunoglobulin, and complement levels between the CHB-combined and non-CHB-combined groups. Additionally, we analyzed the pathological characteristics of liver biopsies from both groups. Patients were followed for one year to assess treatment responses, which were then compared between the two groups. Results Among patients with PBC, 7 cases (43.7%) presented with ascites and 13 cases (81.2%) had cirrhosis, significantly higher than those without concurrent CHB, where 17 cases (19.1%) had ascites and 46 cases (51.7%) had cirrhosis( P<0.05). In the CHB group, PLT, ALP, GGT, TG and INR were recorded as follows: 93 (81, 157) × 10⁹/L, 180 (124, 309) U/L, 146 (64, 311) U/L, 1.2 (1.0, 1.6) mmol/L, 1.3(1.2, 1.5), respectively. These values were significantly different from the non- CHB group, which showed PLT at 137 (78, 215) × 10⁹/L, ALP at 132 (75, 178) U/L, GGT at101 (51, 170) U/L, TG at 0.9 (0.7, 1.1) mmol/L, and INR at 1.0 (0.8, 1.1)(P<0.05). The positive rates of ANA and anti-gp210 antibodies in patients with CHB were 15 cases (93.7%) and 7 cases (43.7%), respectively, which were higher than in patients without CHB, where the rates were 62 cases (69.7%) and 15 cases (16.8%)(P<0.05). Serum immunoglobulin levels in the CHB group were significantly elevated, with IgG at 17.9(13.9, 21.2) g/L, IgA at 3.6(2.6, 5.2) g/L, and IgM at 2.5(1.2, 3.5) g/L, comparednto the non-CHB group, which had IgG at 16.4 (12.7, 20.0) g/L, IgA at 3.2 (2.3, 4.5) g/L, and IgM at 2.2 (1.7, 2.9) g/L(P<0.05). Pathological features observed in the 105 PBC patients included interfacial hepatitis in 66 cases(62.8%), bridging necrosis in 27 cases (25.7%), inflammatory cell infiltration in the portal area in 92 cases(87.6%), intrahepatic cholestasis in 19 cases(18.1%), bile duct injury in 12 cases(11.4%), rosette formation in 9 cases (8.6%). After one year of treatment, the response rates were 11 cases (68.7%) in the CHB group and 67 cases (75.3%) in the non-CHB group. Conclusion Patients with PBC complicated by CHB are at increased risk of immune dysfunction, characterized by elevated immunoglobulin levels and decreased complement levels. Monitoring changes in these immune function-related indicators can aid in assessing the condition and prognosis of PBC in clinical practice.

Key words: Chronic hepatitis B, Primary biliary cholangitis, Clinicopathological features, Regression

徐顺兵, 李俊兰, 温彪. 慢性乙型肝炎合并原发性胆汁性胆管炎患者的临床病理特征及转归分析[J]. 肝脏, 2024, 29(11): 1392-1395.

XU Shun-bing, LI Jun-lan, WEN Biao. Clinicopathological characteristics and regression analysis of patients with chronic hepatitis B and concurrent primary biliary cholangitis[J]. Chinese Hepatolgy, 2024, 29(11): 1392-1395.

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