原发性胆汁性胆管炎合并甲状腺疾病患者临床特征分析

目的:探究原发性胆汁性胆管炎(PBC)合并甲状腺疾病(TD)患者的临床特征,以及两者之间的联系。方法:回顾性分析青岛大学附属医院2005—2017年确诊为PBC的患者,根据是否合并TD将患者分组,对2组患者的一般情况和临床特征进行组间比较。采用独立样本t检验、非参数检验、χ^2检验或Fisher确切概率法进行分析。结果:资料完整的148例PBC患者中45例(30.4%)合并TD。合并TD的PBC患者出现SS的比例更高(33.3%比17.5%,χ^2=4.545,P=0.033),其血清抗SP100抗体和抗SSB抗体的阳性率较未合并TD患者高,2组间差异有统计学意义(20.0%比5.8%,χ^2=5.440,P=0.020;20.0%比2.9%,χ^2=10.087,P=0.001)。未合并TD的PBC患者腹胀和黄疸发生率较高(29.1%比11.1%,χ^2=5.629,P=0.018;23.3%比8.9%,χ^2=4.241,P=0.039),总胆红素(TBIL)、直接胆红素(DBil)和ALP更易高于正常值,2组间差异有统计学意义(40.8%比17.8%,χ^2=7.405,P=0.007;43.7%比17.8%,χ^2=9.147,P=0.002;69.9%比51.1%,χ^2=4.811,P=0.028),肝纤维化和门静脉高压常见,2组间差异有统计学意义(40.8%比22.2%,χ^2=4.731,P=0.030;25.2%比8.9%,χ^2=5.183,P=0.023)。结论:TD不影响PBC的自然病程。PBC合并TD患者较少出现肝纤维化、门脉高压和胆汁淤积,但易合并SS,应加强多科室的联合诊断和治疗。

Clinical characteristics of primary biliary cholangitis with thyroid disease

Objective To investigate the clinical features of primary biliary cholangitis(PBC)with thyroid disease(TD)and the association between TD and PBC.Methods From 2005 to 2017,clinical data of PBC patients from the affiliated hospital of Qingdao university were retrospectively analyzed.All PBC patients were divided into 2 groups according to whether they have TD.The general conditionsand clinical manife-stations in the two groups were analyzed.T-test,nonparametric test,Chi-square test and Fisher's exact test-swere applied to compare datain subgroups.Results A total of 148 PBC patients were involved in to our study,of which 45 cases(30.4%)had TD.PBC patients with TD showed a higher incidence of Sj?gren's synd-rome(SS)(33.3%vs 17.5%,χ^2=4.545,P=0.033).Moreover,there was a higher positive rate of anti-SP100 and anti-SSB antibody in PBC patients with TD(20.0%vs 5.8%,χ^2=5.440,P=0.020;20.0%vs 2.9%,χ^2=10.087,P=0.001)compared with patients without.PBC patients without TD presented a higher incidence of abdominal distension and jaundice(29.1%vs 11.1%,χ^2=5.629,P=0.018;23.3%vs 8.9%,χ^2=4.241,P=0.039)compared to patients with TD.The ratio of patients with elevated total bilirubin(TBiL),direct bilirubin(DBiL),or increased alkaline phosphatase(ALP)was higher in PBC without TD group(40.8%vs 17.8%,χ^2=7.405,P=0.007;43.7%vs 17.8%,χ^2=9.147,P=0.002;69.9%vs 51.1%,χ^2=4.811,P=0.028).Correspondingly,PBC patients without TD was associated with a higher probability of cirrhosis and portal hypertension(40.8%vs 22.2%,χ^2=4.731,P=0.030;25.2%vs 8.9%,χ^2=5.183,P=0.023).Conclusion TD has no effect on the natural history of PBC.PBC patients with TD are associated with a lower probability of liver fibrosis,portal hypertension and cholestasis symptoms but a higher incidence of SS when compared with PBC patients without TD.Multi-disciplinary approach should be implemented to the mag-nagement of PBC.