Hepatology:原发性硬化性胆管炎患者的预后相关的因素分析

2019-04-20 不详 MedSci原创

可预测原发性硬化性胆管炎(PSC)患者需要肝移植或死亡的因素一直是临床医生想要探索的热点,因此,本项研究就此进行了相关研究并开发和验证了一种用于实际临床环境的PSC风险评分模型。

背景及目的
可预测原发性硬化性胆管炎(PSC)患者需要肝移植或死亡的因素一直是临床医生想要探索的热点,因此,本项研究就此进行了相关研究并开发和验证了一种用于实际临床环境的PSC风险评分模型。

方法:
研究人员从英国PSC研究队列中招募了1001名合格患者,通过Cox比例风险模型分析评估了他们与2年和10年与结果相关的临床变量,并以此为短期和长期结果预测生成风险评分模型,验证其在两个独立队列中的使用准确性。

结果:
本项研究显示共计451名患者(36%)在7904人年的累积随访期间接受移植或出现死亡。在出现不良预后的患者中血清碱性磷酸酶至少提高了2.4倍(P <0.0001),存在肝外胆管疾病(HR = 1.45; P = 0.01)也会增加不良预后的风险。研究人员开发了两种基于年龄,胆红素,碱性磷酸酶,白蛋白,血小板,肝外胆管疾病和静脉曲张出血的风险评分系统,对于预测2年和10年的结果具有良好的辨别力(C-Index= 0.81& 0.80)。UK-PSC风险评分均在我们的外部队列中得到充分验证,并且优于梅奥诊所和天冬氨酸氨基转移酶与血小板比率指数(APRI)评分(C-Index=0.75和0.63)。虽然先前验证的人类白细胞抗原(HLA)-DR * 03:01风险等位基因的杂合性预测不良结果的风险增加(HR = 1.33; P= 0.001),其添加并未提高UK-PSC风险评分的预测准确性。

结论:
本项研究表明血清碱性磷酸酶的升高以及肝外胆管疾病是PSC患者发生不良预后的主要影响因素,同时,建立了一种可以有效预测PSC患者预后的评分模型。

原始出处:

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    2019-04-22 gwc384
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