Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis
Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis
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DOI：
10.1002/hep.21472
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发表时间：
2007-01-01
期刊：
影响因子：
13.5
通讯作者：
Ishibashi, Hiromi
中科院分区：
文献类型：
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作者：
Nakamura, Minoru;Kondo, Hisayoshi;Ishibashi, Hiromi
抗核抗体（ANA）在原发性胆汁性肝硬化（PBC）的长期预后中的预测作用仍然难以捉摸。根据276例经活检证实的确诊PBC患者的数据，采用逐步考克斯比例风险回归和非条件逐步logistic回归模型评估PBC进展与ANA的相关性，这些患者已在日本国立医院组织肝病研究组（NHOSLJ）注册。当肝功能衰竭/肝移植（LT）死亡被定义为终点时，（风险比（HR）= 6.742，95%置信区间（CI）：2.408，18.877），晚期在首次肝活检时，Scheuer分期3、4（HR = 4.285，95% CI：1.682，10 -913）和男性（HR = 3.266，95% CI：1.321，8.075）是显著的危险因素。当临床进展至肝衰竭/LT死亡时（即，肝衰竭型进展）或发展为食管静脉曲张或肝细胞癌而不发展为黄疸（总胆红素< 1.5 mg/dL）（即，门脉高压型进展）定义为早期终点（Scheuer分期1，2）PBC患者，抗gp 210抗体阳性是肝衰竭类型进展的重要危险因素[比值比（OR）= 33-777，95% CI：5.930，636-745]，而阳性抗着丝粒抗体是门静脉高压型进展的重要危险因素（OR = 4.202，95%CI：1.307，14-763）。组织学上，抗gp 210抗体阳性与更严重的界面肝炎和小叶炎症最显着相关，而抗着丝粒抗体阳性与更严重的导管反应最显着相关。结论：提示PBC有两种不同的进展类型，即肝衰竭型和门脉高压型进展，分别以抗gp 210抗体阳性和抗着丝粒抗体阳性为代表。
The predictive role of antinuclear antibodies (ANAs) remains elusive in the long-term outcome of primary biliary cirrhosis (PBC). The progression of PBC was evaluated in association with ANAs using stepwise Cox proportional hazard regression and an unconditional stepwise logistic regression model based on the data of 276 biopsy-proven, definite PBC patients who have been registered to the National Hospital Organization Study Group for Liver Disease in Japan (NHOSLJ). When death of hepatic failure/liver transplantation (LT) was defined as an end-point, positive anti-gp210 antibodies (Hazard ratio (HR) = 6.742, 95% confidence interval (CI): 2.408, 18.877), the late stage (Scheuer's stage 3, 4) (HR = 4.285, 95% CI:1.682,10-913) and male sex (HR = 3.266, 95% CI: 1.321,8.075) were significant risk factors at the time of initial liver biopsy. When clinical progression to death of hepatic failure/LT (i.e., hepatic failure type progression) or to the development of esophageal varices or hepatocellular carcinoma without developing jaundice (Total bilirubin < 1.5 mg/dL) (i.e., portal hypertension type progression) was defined as an end-point in the early stage (Scheuer's stage 1, 2) PBC patients, positive anti-gp210 antibodies was a significant risk factor for hepatic failure type progression [odds ratio (OR) = 33-777, 95% CI: 5.930, 636-745], whereas positive anti-centromere antibodies was a significant risk factor for portal hypertension type progression (OR = 4.202, 95% Cl: 1.307, 14-763). Histologically, positive anti-gp210 antibodies was most significantly associated with more severe interface hepatitis and lobular inflammation, whereas positive anticentromere antibodies was most significantly associated with more severe ductular reaction. Conclusion: These results indicate 2 different progression types in PBC, hepatic failure type and portal hypertension type progression, which may be represented by positive-anti-gp210 and positive-anticentromere antibodies, respectively.