Early response of hepatobiliary biochemical indexes after short-term ursodeoxycholic acid treatment in patients with primary biliary cholangitis / 中华风湿病学杂志

ABSTRACT

Objective:To explore the early response of hepatobiliary biochemical indexes after short-term ursodeoxycholic acid treatment in patients with primary biliary cholangitis (PBC).Methods:According to the Child-Pugh (C-P) score, the patients with newly diagnosed PBC were divided into groups A, B and C. The early biochemical response was defined as the improvement of hepatobiliary biochemical indexes while daily dose of 13-15 mg/kg ursodeoxycholic acid(UDCA) was administrated for 3-4 weeks. Rank sum test was used to compare the alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), total bile acid (TBA) and total bilirubin (TBil) before and after treatment between groups. Chi-square test was used to analyze the differences in numerical data between groups. ROC curve was also used for data an-alysis.Results:The levels of AST, ALP, GGT and TBil of groups A and B after treatment were lower than those of before treatment ( P<0.05). And there was no significant difference in group C ( P>0.05). On the contrast, TBA levels after treatment in group A, B and C were significantly higher than those of before ( P<0.05). ROC curve analysis of the baseline ALP, GGT and AST indexes that declineed less than 20% showed that their cut-off value of indexes were 211.00, 285.85 and 86.68 U/L respectively in group A. And then the cut-off value of above parameters in group B was 505.00, 353.10 and 179.15 U/L respectively. But no statistical significant difference was found in ROC curve analysis of above indexes of group C. The baseline TBil level declined synchronously with the decline of ALP, AST and GGT less than 20% were analyzed by ROC curve, but no statistical significant difference was found in group A, B and C. ROC curve analysis of the treatment showed that increased of TBA level was synchronously to the decline of ALP, AST and GGT less than 20% showed that cut-off value were 38.75 and 35.95 μmol/L respectively in group A and B. There was no statistically significant difference in ROC curve analysis of TBA in group C. As for baseline ALP, GGT and AST their level were decreased with treatment, and less than 40%, ROC curve analysis did not find statistical significant difference in above indexes. Conclusion:After 3-4 weeks of UDCA treatment, the cut off values of ALP, GGT and AST in Grade A or B of C-P are met, and the biochemical response could be reduced by 20% or more, among which the accuracy of ALP is higher. The TBA level of C-P in grade A or B PBC patients after UDCA treatment increases, and when the Cut-off value is met, it suggests that ALP, GGT and AST indexes may decrease by 20% or more. Total bilirubin does not show response to treatment.