Early Response Of Hepatobiliary Biochemical Indexes After Short-term Ursodeoxycholic Acid Treatment For The Patients With Primary Biliary Cholangitis

Objective:To explore the early response of hepatobiliary biochemical indexes after short-term ursodeoxycholic acid treatment for the patients with primary biliary cholangitis.Methods:PBC inpatients newly diagnosed in the Second Clinical College of Shanxi Medical University from March 2013 to September 2019 were collected.According to the Child-Pugh(C-P)score,the patients with newly diagnosed PBC were divided into groups A,B and C.the early biochemical response was defined as the improvement of hepatobiliary biochemical indexes while daily dose of 13-15 mg/kg UDCA was administrated for 3-4 weeks.These indexes included ALP,GGT,AST,TBA and TBIL,and they were pairwise compared before and after treatment.The baseline ALP,GGT and AST indexes whose decline was less than20% or 40% were carried out as diagnosis with ROC curve analysis.The baseline TBIL and treatment-increased TBA synchronously with the decline of ALP,GGT and AST level which was less than 20% on after treatment were carried out as diagnosis with ROC curve analysis.Results:1.The levels of ALT,AST,ALP,GGT and TBIL of groups A and B after treatment were lower than before(P<0.05).And there was no significant difference in the group C(P>0.05).By contrast,TBA levels after treatment in group A,B and C were significantly higher than before(P<0.05).2.ROC curve analysis of the baseline ALP,GGT and AST indexes whose decline was less than 20% showed that their cut-off value of indexes were respectively 211.00,285.85 and86.68U/L in group A,their true positive rate(TPR)vs.true negative rate(TNR)were respectively 1.000 vs.0.583,0.750 vs.0.917 and 0.818 vs.0.846.And then the cut-off value of above in group B were respectively 505.00,353.10 and 179.15U/L,their TPR vs.TNR were respectively 0.909 vs.0.727,0.800 vs.0.833 and 0.800 vs.0.917.But no statistical significance was found in ROC curve analysis of above indexes of group C.3.ROC curve analysis of the treatment-increased TBA level synchronously with the less than 20% in the decline of ALP,AST and GGT showed their cut-off value were respectively38.75 and 35.95μmol/L in group A and B,their TPR vs.TNR were respectively 0.818 vs.1.000 and 0.917 vs.0.667.There were not statistically significance in ROC curve analysis of TBA in group C.4.As for baseline ALP,GGT and AST whose level were treatment-decreased and less than40%,ROC curve analysis was not found their statistical significance of above indexes.5.The baseline TBIL level synchronously with the less than 20% in the decline of ALP,AST and GGT were analyzed by ROC curve,but no statistical significance was found in group A,B and C.Conclusion:1.After the patients with PBC were initially treated with UDCA for 3-4 weeks,the early biochemical response of decline by 20% is difficult while ALP,GGT and AST level are more than 211.00,285.85 and 86.68U/L respectively in grade A by C-P score.So are the indexes of grade B by C-P score while ALP,GGT and AST level are more than 505.00,353.10 and179.15U/L.While these indexes are lower than above level,it is easy of the decline by 20%that are considered as the early response.2.While the treatment-increased TBA level in grade A and B by C-P score are respectively more than 38.75 and 35.95μmol/L,the early response of the decline by 20% is possible in ALT,AST and GGT level.3.It is not yet possible to make a prediction that the early response of ALP,GGT and AST indicators will decrease by 40% of the baseline value.4.It is not yet possible to see the early response of TBIL that decreased 20% in synchronization with the indicators of ALP,GGT and AST.5.The judgment of the significant early response value of TBIL index fails to achieve in grade A,Bor C.