Esophagogastric varices as a prognostic factor for the determination of clinical stage in patients with primary biliary cirrhosis
Esophagogastric varices as a prognostic factor for the determination of clinical stage in patients with primary biliary cirrhosis
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食管胃静脉曲张作为原发性胆汁性肝硬化患者临床分期确定的预后因素
DOI：
10.1007/s00535-003-1196-6
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发表时间：
2003
影响因子：
6.3
通讯作者：
M. Onji
中科院分区：
文献类型：
--
作者：
E. Takeshita;T. Kumagi;H. Matsui;M. Abe;S. Furukawa;Y. Ikeda;B. Matsuura;K. Michitaka;N. Horiike;M. Onji
原发性胆汁性肝硬化（PBC）通常分为无症状PBC（a-PBC）和有症状PBC（s-PBC）。虽然a-PBC与s-PBC患者的比例一直在增加，但目前尚不清楚PBC的分期标准是否是最佳的。我们从食管胃静脉曲张（EGV）的角度研究了PBC患者的临床分期。我们根据实验室资料、组织学分期、症状和EGV的存在来研究PBC的临床特征。结果（1）a-PBC患者存在EGV，a-PBC与s-PBC患者EGV分级无差异; (2)有EGV的a-PBC患者肝损害较无EGV的a-PBC患者严重，预后较无EGV的a-PBC患者差。(3)3年内从a-PBC进展为s-PBC的11例患者中有3例发生EGV。(4)3例a-PBC伴EGV患者中有1例在3年随访时进展为s-PBC。结论EGV是评价PBC的重要指标之一。因此，我们想提出，具有EGV的a-PBC患者应该被包括在目前定义的s-PBC类别中，或者创建包括EGV作为预后因素的PBC的新预后类别。
BackgroundPrimary biliary cirrhosis (PBC) is usually classified as either asymptomatic PBC (a-PBC) or symptomatic PBC (s-PBC). Although the proportion of a-PBC versus s-PBC patients has been consistently increasing, it is not clear whether the present criteria for the staging of PBC are optimal or not. We investigated the clinical stage of PBC patients from the standpoint of esophagogastric varices (EGV).MethodsOne hundred and nine PBC patients were enrolled in this retrospective study. We investigated the clinical features of PBC based on laboratory data, histological stage, symptoms, and existence of EGV. In addition, the clinical course and prognosis in patients who were periodically followed up were also studied.Results(1) EGV was detected in a-PBC patients, and there was no difference in the grade of EGV between a-PBC and s-PBC patients. (2) a-PBC patients with EGV had more liver damage than those without EGV, and a-PBC patients with EGV had a poorer prognosis than those without EGV. (3) Three of 11 patients who progressed from a-PBC to s-PBC within 3 years had EGV. (4) One of 3 a-PBC patients with EGV had progressed to s-PBC at 3-year follow-up.ConclusionsThese results indicate that EGV is one of the most important factors for evaluating PBC. Therefore, we would like to propose that a-PBC patients with EGV should either be included in the presently defined s-PBC class, or that new prognostic classes of PBC be created that include EGV as a prognostic factor.