Eur J Gastroenterol Hepatol:在原发性胆汁性胆管炎患者中,吸烟与晚期肝纤维化相关

2018-08-31 MedSci MedSci原创

在PBC患者中,吸烟,无论是主动还是被动均与晚期纤维化有关。在患有晚期肝纤维化的吸烟者中,死亡率升高。

研究背景:原发性胆汁性胆管炎(PBC)的结果受到遗传因素和环境因素的影响。目的:本研究的目的是研究吸烟对肝脏组织学和死亡率的影响。

研究患者和方法:在171例患有PBC(163例妇女)的克瑞坦患者中,记录了吸烟和饮酒习惯(基于标准)。148例患者进行了肝穿。采用logistic回归分析,计算优势比。

研究结果:吸烟与每日饮酒超过20克[调整的优势比 (AOR)=2.20, 95% CI: 1.029-4.099]、重度肝脂肪变性(AOR=5.31, 95% CI: 2.019-9.919)和3-4期肝纤维化相关(AOR=1.21,95%CI:1.015-3.031)。对性别、年龄、体重指数和酒精消耗进行调整后,多变量分析表明,重度吸烟,多年的被动吸烟,以及严重的坏死性炎症等是晚期纤维化的独立因素。每隔一年,吸烟强度就会增加,患晚期纤维化的可能性要高出3.2倍(95%CI:2.018-6.294)。在患有晚期肝纤维化的吸烟者中,死亡率增加。

研究结论:在PBC患者中,吸烟,无论是主动还是被动均与晚期纤维化有关。在患有晚期肝纤维化的吸烟者中,死亡率升高。

原始出处

Mantaka A, Koulentaki M, Samonakis D, et al. Association of smoking with liver fibrosis and mortality in primary biliary cholangitis. Eur J Gastroenterol Hepatol, 2018, Aug 13. doi: 10.1097/MEG.0000000000001234.

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579202, encodeId=20c715e92026f, content=<a href='/topic/show?id=372b834e673' target=_blank style='color:#2F92EE;'>#胆汁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83476, encryptionId=372b834e673, topicName=胆汁)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a0616505872, createdName=108807375_62823132, createdTime=Sun Sep 02 10:54:00 CST 2018, time=2018-09-02, status=1, ipAttribution=)]
  5. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579202, encodeId=20c715e92026f, content=<a href='/topic/show?id=372b834e673' target=_blank style='color:#2F92EE;'>#胆汁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83476, encryptionId=372b834e673, topicName=胆汁)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a0616505872, createdName=108807375_62823132, createdTime=Sun Sep 02 10:54:00 CST 2018, time=2018-09-02, status=1, ipAttribution=)]
  6. 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href='/topic/show?id=8f633e1073d' target=_blank style='color:#2F92EE;'>#原发性胆汁性胆管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37107, encryptionId=8f633e1073d, topicName=原发性胆汁性胆管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec53439, createdName=zhty5337, createdTime=Sun Sep 02 10:54:00 CST 2018, time=2018-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427216, encodeId=47f8142e216be, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Sun Sep 02 10:54:00 CST 2018, time=2018-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579202, encodeId=20c715e92026f, content=<a href='/topic/show?id=372b834e673' target=_blank style='color:#2F92EE;'>#胆汁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83476, encryptionId=372b834e673, topicName=胆汁)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a0616505872, createdName=108807375_62823132, createdTime=Sun Sep 02 10:54:00 CST 2018, time=2018-09-02, status=1, ipAttribution=)]
    2019-02-08 许安
  7. 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    2018-09-02 gwc384
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由此可见,在对熊去氧胆酸单独治疗反应不明显的原发性胆汁性胆管炎患者中,将熊去氧胆酸与苯扎贝特联合治疗导致完全生化反应的发生率显着高于安慰剂和单纯的熊去氧胆酸治疗的发生率。

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原发性胆汁性胆管炎(PBC,旧称原发性胆汁性肝硬化)是一种自身免疫性肝病,病理表现为免疫介导的胆道上皮细胞损伤、胆汁淤积和进行性纤维化,最终会进展至胆汁性肝硬化。发病机制可能与遗传和环境因素有关。PBC 常见于50 岁以上的女性。男性、发病年龄较小(<45 岁)和疾病终末期是预后不良的指标。越来越多的患者通过胆汁淤积相关的肝脏血清学指标联合抗线粒体抗体(AMA)诊断PBC,多数患者在诊断时尚未发展

《2017年欧洲肝病学会临床实践指南:原发性胆汁性胆管炎的诊断和管理》摘译

原发性胆汁性胆管炎(PBC)是一种以胆汁淤积为特点的慢性自身免疫性肝病,如果不治疗将会发展为胆汁性肝硬化。通常根据胆汁淤积的表现及血清抗线粒体抗体(AMA)阳性作出诊断。患者具有不同的临床表现及病程,为保证对患者个性化治疗,需进行风险分层。治疗的目的是减缓疾病进程、防止发展至终末阶段和改善症状。目前减缓疾病进展的药物包括已许可的治疗方案[熊去氧胆酸(UDCA)和奥贝胆酸(OCA)]和超适应证用药的