Do Antinuclear Antibodies in Primary Biliary Cirrhosis Patients Identify Increased Risk for Liver Failure?
Do Antinuclear Antibodies in Primary Biliary Cirrhosis Patients Identify Increased Risk for Liver Failure?
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DOI：
10.1016/s1542-3565(04)00465-3
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发表时间：
2004-12-01
影响因子：
12.6
通讯作者：
Bloch, Donald B.
中科院分区：
文献类型：
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作者：
Yang, Wei-Hong;Yu, Jiang Hong;Bloch, Donald B.
背景与目的：原发性胆汁性肝硬化（PBC）是一种临床病程多变的慢性胆汁淤积性肝病。鉴定与肝功能衰竭风险增加相关的血清学标志物将有助于PBC患者的管理。本研究的目的是鉴定抗核抗体（ANA）标记物，可用于预测PBC的预后。方法：采用间接免疫荧光法对492例PBC患者进行ANAs鉴定。使用chi(2)和Kaplan-Meier分析来检验ANAs与肝衰竭之间的关系。结果：与ana阴性患者相比，ana阳性PBC患者发生肝功能衰竭的比例更高（41%对25%，P = 0.005）。抗着丝粒抗体的存在与肝功能衰竭相关（抗着丝粒抗体阳性vs阴性，58% vs 33%, P = 0.001）。与ana阴性患者相比，ana阳性患者发生肝功能衰竭的时间更短（log rank评分5.8,P = 0.02）。8.9年后（无肝功能衰竭患者的中位随访时间），68%的ana阳性患者和81%的ana阴性患者无肝功能衰竭。抗着丝粒抗体也与肝衰竭时间缩短相关（log rank评分8.4,P = 0.004）。8.9年后，52%的抗着丝粒抗体阳性和74%的抗着丝粒抗体阴性患者无肝衰竭。结论：总的来说，ANAs，尤其是抗着丝粒抗体，与PBC患者的肝功能衰竭有关。有ANAs的PBC患者可能是实验性治疗的候选者，以延长诊断和肝衰竭之间的时间间隔。ana阴性的患者，临床表现相对良性，可能应该单独用熊去氧胆酸治疗。
Background & Aims: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease with a variable clinical course. Identification of serologic markers associated with increased risk of liver failure would assist in management of PBC patients. The objective of this study was to identify antinuclear antibody (ANA) markers that may be used to predict PBC outcome. Methods: Indirect immunofluorescence was used to identify ANAs in 492 PBC patients. chi(2) and Kaplan-Meier analyses were used to examine the association between ANAs and liver failure. Results: A greater percentage of ANA-positive, compared to ANA-negative, PBC patients developed liver failure (41% vs 25%, P = .005). The presence of anti-centromere antibodies was associated with liver failure (anti-centromere antibody positive vs negative, 58% vs 33%, P = .001). The time to liver failure was shorter in ANA-positive, compared with ANA-negative, patients (log rank score 5.8, P = .02). After 8.9 years (the median follow-up for patients without liver failure), 68% of ANA-positive and 81% of ANA-negative patients were free of liver failure. Anti-centromere antibodies were also associated with a shorter time to liver failure (log rank score 8.4, P = .004). After 8.9 years, 52% of anti-centromere antibody positive and 74% of anti-centromere antibody negative patients were without liver failure. Conclusions: ANAs in general, and anti-centromere antibodies in particular, are associated with liver failure in PBC. PBC patients with ANAs may be candidates for treatment with experimental therapies to prolong the interval between diagnosis and liver failure. ANA-negative patients, who appear to have a relatively benign clinical course, should perhaps be treated with ursodeoxycholic acid alone.