透明质酸等指标对原发性胆汁性胆管炎患者肝纤维化的预测价值OA

Objective The aim of this study was to investigate the predictive value of hyaluronic acid relative upper limit of normal,prothrombin time,immunoglobulin G,and other serological indicators for advanced liver fibrosis in patients with primary bili-ary cholangitis(PBC)with interface hepatitis.Methods A total of 174 patients with histopathologically confirmed primary biliary chol-angitis(PBC)complicated by interface hepatitis were enrolled from the Affiliated Wuxi Fifth Hospital of Jiangnan University between January 2017 and January 2023.According to the Scheuer scoring system,the patients were divided into significant liver fibrosis group(92 cases)and advanced liver fibrosis group(82 cases).Hyaluronic acid,laminin,procollagen type Ⅲ,collagen type Ⅳ,prothrom-bin time,immunoglobulin G,immunoglobulin M,glutamyl transferase,alkaline phosphatase,and other indicators were collected.The relative upper limit of normal of some indicators was calculated using the normal upper limit.Differences in serological indicators between groups were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of significant liver fibrosis developing to advanced liver fibrosis in PBC patients with interface hepatitis.The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of serum HA rULN,PT,and IgG levels for the development of significant liver fibro-sis to advanced liver fibrosis in PBC patients with interface hepatitis.Results The levels of HA rULN,LN rULN,PCⅢ rULN,Ⅳ-C rULN,PT,AST,and IgG were lower in the significant fibrosis group than in the advanced fibrosis group,respectively.(Z/P=-7.331/<0.001、-4.568/<0.001、-4.738/<0.001、-5.451/<0.001、-6.216/<0.001、-1.981/<0.048,t/P=-5.299/<0.001).The results of multifactorial logistic regression analysis showed that elevated serum levels of HA rULN,PT,and IgG were independent risk factors(P<0.01)for significant fibrosis to advanced liver fibrosis in PBC patients with interface hepatitis,respectively.[OR(95%CI)=3.436(1.691～6.980)];[OR(95%CI)=2.719(1.538～4.805)];[OR(95%CI)=1.191(1.064～1.333)].The area under the curve(AUC)for serum HA rULN,PT,IgG levels and the combination of the three for diagnosis of PBC patients with interface hepatitis who progressed from significant liver fibrosis to advanced liver fibrosis were 0.822,0.773,0.711,and 0.883,respectively.The combined diagnosis was greater than that of HA rULN alone(Z=-2.505,P=0.012),the combined diagnosis was greater than that of PT alone(Z=-3.490,P<0.001),and the combined diagnosis was greater than that of IgG alone(Z=-4.759,P<0.001).Conclusion The combined use of HA rULN,PT,and IgG is valuable in diagnosing the development of significant liver fibrosis stage to advanced stage in PBC patients with interface hepatitis.