ABSTRACT
ObjectiveTo investigate the value of baseline red cell distribution width （RDW） and alkaline phosphatase （ALP） level after ursodeoxycholic acid （UDCA） treatment for one month in predicting the response to UDCA treatment in patients with primary biliary cholangitis （PBC）. MethodsA retrospective analysis was performed for the data of 127 patients with PBC who were diagnosed in Department of Hepatology， The Third People’s Hospital of Jiangsu University， from January 2015 to July 2022， with data collected at baseline， after one month of treatment， and after one year of follow-up. Based on the Paris-I criteria， the patients were divided into good response group and poor response group， and the two groups were analyzed in terms of clinical and laboratory features and their association with response to UDCA. The Logistic regression method was used to investigate the independent risk factors for response to UDCA treatment. The area under the ROC curve （AUC） was used to determine the optimal cut-off values of related indicators； the patients were divided into two groups based on such values， and the two groups were compared in terms of baseline indicators and response. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the good response group， the poor response group had significantly higher levels of total bilirubin， aspartate aminotransferase/alanine aminotransferase， ALP， RDW， and RDW-CV at baseline and a significantly higher level of ALP after one month of UDCA treatment （Z=-4.792， -3.697， -2.399， -4.102， -3.220， and -4.236， all P<0.05）. Compared with the good response group， the poor response group had significantly lower levels of albumin， hemoglobin， lymphocytes， hematocrit， and body mass index at baseline （Z=-3.592， -3.603， -2.602， -3.829， -2.432， all P<0.05）， as well as significantly lower levels of prealbumin， albumin/globulin ratio， apolipoprotein A， and free triiodothyronine at baseline （t=4.530， 3.402， 3.485， and 3.639， all P<0.001）. Compared with the poor response group， the good response group had a significantly lower proportion of patients with liver cirrhosis， gallstones/cholecystitis， or anemia （χ2=20.815， 3.892， and 12.283， all P<0.05）. Baseline RDW （odds ratio ［OR］=1.157， 95% confidence interval ［CI］： 1.028 — 1.301， P=0.015） and ALP level after one month of treatment （OR=1.012， 95%CI： 1.005 — 1.020， P=0.002） were independent risk factors for response to UDCA， with an AUC of 0.713 and 0.720， respectively. The patients with baseline RDW≥upper limit of normal （ULN） and ALP≥2.2×ULN after one month of UDCA treatment had a lower UDCA response rate （42.6% vs 8.2%， χ2=20.813， P<0.001）. ConclusionPatients with baseline RDW≥ULN and ALP≥2.2×ULN after one month of UDCA treatment tend to have a low biochemical response rate to UDCA.
ABSTRACT
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease, and may progress to cirrhosis and associated with complications of end-stage liver disease. The immunological characteristic of PBC is the presence of anti-mitochondrial autoantibodies (AMAs), and some anti-nuclear antibodies (ANAs) have high specificity for the diagnosis of PBC. In recent years, it has been found that anti-gp210, anti-sp100 and anti-centromere antibodies are correlated with the severity of PBC, treatment response to ursodeoxycholic acid (UDCA) and poor prognosis. However, correlation between AMAs and disease progression of PBC is still in controversial. This article reviewed the progress in research on the influence of autoantibodies on biochemical response and prognosis of PBC.
ABSTRACT
Primary biliary cholangitis (PBC) is an immune-mediated chronic and progressive intrahepatic cholestasis disease. Treatment with ursodeoxycholic acid (UDCA) can significantly improve the prognosis of patients with PBC, but some patients still have poor response to UDCA, which is the main risk factor for disease progression. Several evaluation models and scoring systems based on biochemical response have been applied to screen out patients with poor response in clinical practice. Integrated traditional Chinese and Western medicine therapy for PBC has certain advantages in improving the symptoms, liver biochemistry, fibrosis indices, and biochemical response rate of PBC patients and thus holds promise for clinical application; however, further improvement is needed for experimental design and efficacy evaluation.
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Objective@#To examine the effects of ursodeoxycholic acid combined with Traditional Chinese Medicine on biochemical response in patients with primary biliary cholangitis.@*Methods@#According to the method of receiving treatment, 197 patients with primary biliary cholangitis were divided into Traditional Chinese Medicine plus Western medicine group (93 cases, 47.2%) and Western medicine group (104 cases, 52.8%). From the baseline date, the combined group was treated with ursodeoxycholic acid plus traditional Chinese medicine decoction or Chinese patent medicine for at least one month and the Western medicine group simply took ursodeoxycholic acid . Additionally, Traditional Chinese medicine decoction prescriptions were mainly Xiaoyaosan and Yinchenhao. Chinese patent medicine were restricted to Biejia Ruangan tablets, Fuzheng Huayu capsules, Jiuweigantai capsules and Yinzhihuang capsules, which were used to treat liver fibrosis and cholestasis. The primary efficacy endpoint was defined as ALP level < 1.67 × ULN and ≥ 15% decrease in ALP with baseline level and TBIL≤ULN after 12 months of treatment.@*Results@#The overall biochemical response rate of patients was 35.0% (69/197). The response rate of TCM+ Western medicine group was 43.0% (40/93), and that of Western medicine group was 27.9% (29/104). The difference between the two groups was statistically significant (χ2 = 4.936, P < 0.05). Further analysis showed that the Chinese and Western medicine group was superior to the Western medicine group alone in reducing γ-glutamyltransferase (GGT) and TBiL [the median decline were GGT: 160.1 U/L and 111.3 U/L (Z = -2.474, P < 0.05), TBiL: 5.2 umol/l and 3.1 umol/l (Z = -2.125, P < 0.05)].@*Conclusion@#UDCA combined with TCM therapy can remarkably improve the biochemical response rate in patients with PBC and distinctly decrease the TBIL and GGT levels than UDCA monotherapy.
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Objective:To evaluate the biochemical and structural changes of apatinib in patients with progressive radioactive iodine-re-fractory differentiated thyroid cancer (RAIR-DTC). Methods:The participants (n=10) were followed up since March 2016. Treatment ef-fect was evaluated in using both biochemical [thyroglobulin (Tg) and thyroglobulin antibody (Tg-Ab)] and structural responses (target lesions, TL). Adverse events were also recorded over time. Results:The median follow-up was 7.9 months. The Tg level declined rapid-ly within 6 weeks after apatinib treatment, and the average decline ranged from 60%to 90%, indicating the immediate biochemical re-sponse of apatinib in progressive RAIR-DTC. The Tg level tended to stabilize thereafter. However, the Tg level rebounded by 4%–135%when withdrawal was performed for 3–14 days. The number of TLs decreased rapidly within 8 weeks, and the average decreased ranged from 40%to 60%, indicating the presence of rapid structural responses. Thereafter, the number of TLs continued to stabilize. TLs, in contrast to Tg, were not significantly affected by drug withdrawal. The rate of change in Tg (Tgvn) was positively correlated with the rate of change in TL (TLvn) [TLvn=0.17×Tgvn+0.50 (r=0.56, P<0.05)]. The apatinib dose was adjusted due to adverse events, which could be relieved after 3 to 14 days of withdrawal. Apatinib can effectively control the disease even at a reduced dose of 250 mg/d. Conclusion:Apatinib treatment showed a fast and sustainable biochemical and structural responses. Tg could be regarded as an objec-tive indicator. Tgvn is positively correlated with TLvn, and the response of Tg is more sensitive than that of TLs.
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BACKGROUND/AIMS: The authors examined whether the response to interferon (IFN) therapy can affect the development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. METHODS: Out of 353 biopsy-proven CHB patients, 229 (65%) were treated with IFN-alpha for 6 to 12 months. They were followed for a median period of 75 months (range, 6-120). In patients treated with IFN, biochemical and virologic responses were evaluated at the end of treatment (EOT). The cumulative incidence rates of HCC were calculated and analyzed in relation to baseline characteristics as well as biochemical and virologic responses to IFN therapy. RESULTS: The overall cumulative incidence of HCC was 0%, 0.8%, 3.7% and 5.5% at 3, 5, 7 and 8 years, respectively. Age, serum AFP levels and the stage of fibrosis were significantly associated with the occurrence of HCC. As a whole, IFN therapy did not affect the occurrence of HCC. Among the patients treated with IFN, biochemical responders had low HCC incidence rates compared with non-responders (p=0.018). However, the HCC incidence rates of virologic responders were not different from non-responders (p=0.203). CONCLUSIONS: Biochemical rather than virologic response to IFN therapy may be more closely associated with decrease of HCC incidence in CHB patients.