Clinical Characteristics Of Primary Biliary Cholangitis And Value Of Non-invasive Serological Indicators In Diagnosis Of Cirrhosis

Objective: To investigate the clinical features of primary biliary cholangitis(PBC)and the value of non-invasive serological indicators in the diagnosis of PBC cirrhosis.Methods: The clinical data of the first confirmed PBC patients in the outpatient and inpatient departments of our hospital from January 2014 to December 2020 were retrospectively analyzed.The PBC patients were divided into cirrhosis group and noncirrhosis group according to the diagnostic criteria of cirrhosis.By comparing the general data,liver function,immunoglobulin,complement levels and five non-invasive serological indicators of the two groups.Analyze the clinical characteristics of the two groups and the diagnostic value of non-invasive serological indicators for PBC cirrhosis.Results: Among 74 PBC patients,16 were males(22.97%),58 were female(77.03 %);Average age 55.99±11.85 years;33 patients with cirrhosis(44.59%),41 patients with non-cirrhosis(55.41%).Common clinical symptoms and signs: jaundice in 31 cases(41.89%),abdominal distension in 15 cases(20.27%),fatigue in 13 cases(17.57%),anorexia in 14 cases(18.92%),splenomegaly in 30 cases(40.54%),ascites in18cases(24.32%).60 cases(81.08%)with other diseases,5 cases of autoimmune hepatitis,Sjogren’s syndrome in 11 cases(14.86%),rheumatoid arthritis in 1 case(1.35%),hypertension in 7 cases(9.46%),Cerebral infarction in 5 cases(6.76%),Type2 diabetes mellitus in 9 cases(12.16%).70 cases(94.59%)with abnormal liver function,42 cases(56.76%)of ALT increased,54 cases(72.97%)of AST 5 increased,45cases(60.81%)of ALP increased,64 cases(86.49%)of GGT increased and 47 cases(63.51%)of TBil increased.Autoimmune related antibodies: AMA and(or)AMAM2 were positive in 66 cases(89.19%).ANA positive patients in 48 cases(64.86%),SP100 positive in 16 cases(21.62%),GP210 positive in 15 cases(20.27%),SSA antibody positive in 22 cases(29.73%),SSB antibody positive in 9 cases(12.16%).Comparison of biochemical indexes,immunoglobulin,complement levels and five non-invasive serum indicators in cirrhotic and non-cirrhotic groups,There were significant differences in age,ALT、AST、GGT、TG and complement C3、C4 between cirrhosis group and non-hepatic cirrhosis group(P<0.05),and significant increase in RPR、FIB-4、AAR value between cirrhosis group and non-hepatic cirrhosis group(P<0.05).The AUC values for RPR、AAR and FIB-4 predicted PBC cirrhosis were0.72、0.68 and 0.67.Age combined with RPR values predicted PBC cirrhosis with the AUC of 0.74.Conclusion: PBC often occurs in middle-aged and elderly women,common clinical symptoms are jaundice and abdominal distension.Sjogren’s syndrome is PBC most common complication of extrahepatic autoimmune disease.ALT、AST、ALP and GGT can be increased in PBC patients,with the most significant increase in GGT.AMA and AMA-M2 are specific indicators of PBC diagnosis.PBC patients can detect a variety of anti-nuclear antibodies,the highest detection rate of anti-SSA antibodies.The diagnostic value of RPR in PBC cirrhosis was better than that of APRI、GPR、AAR and FIB-4.The combination of RPR and age can improve the diagnostic value of PBC cirrhosis.