Evolutionary relationship between antimitochondrial antibody positivity and primary biliary cholangitis in Taiwan: a 16-year hospital cohort study.

IF 3.4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Therapeutic Advances in Gastroenterology Pub Date : 2024-03-28 eCollection Date: 2024-01-01 DOI:10.1177/17562848241241227

Ming-Ling Chang, Jur-Shan Cheng, Puo-Hsien Le, Wei-Ting Chen, Hsin-Ping Ku, Rong-Nan Chien

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Abstract

Background: How antimitochondrial antibody (AMA)-positive patients evolve to have primary biliary cholangitis (PBC) in viral hepatitis-endemic areas is unknown.

Objectives: We aimed to investigate this evolution in Taiwan.

Design/methods: A 16-year medical center-based cohort study of 2,095,628 subjects was conducted in Taiwan, an Asian country endemic to viral hepatitis. AMA-positive subjects were those with positive AMA with alkaline phosphatase (ALP) ⩽1.5 times the upper limit of normal (ULN), and PBC was defined as positive AMA with ALP >1.5 × ULN.

Results: AMA-positive subjects had a lower average age- and sex-adjusted prevalence than PBC patients (4.68/10⁵ versus 11.61/10⁵, p = 0.0002), but their incidence was comparable (0.99/10⁵ versus 1.12/10⁵, p = 0.36). The former group had a borderline significantly lower mean age (56.59 years versus 58.10 years, p = 0.06) and a lower female-to-male ratio (2.85:1 versus 5.44:1, p < 0.0001). Both AMA-positive subjects (prevalence change: 20.0%, p < 0.01; incidence change: -9.2%, p < 0.01) and PBC patients (prevalence change: 14.6%, p < 0.01; incidence change: -4.7%, p < 0.01) prevalence rate increased but the incidence rate decreased. Among the 423 AMA-positive subjects, 77 (18.2%) developed PBC, for a mean duration of 1.757 years. Compared with AMA-positive subjects, PBC patients had similar concurrent chronic hepatitis B (CHB) rates (2.7% versus 4.3%, p = 0.197) but lower chronic hepatitis C (CHC) rates (3.69% versus 15.60%, p < 0.01).

Conclusion: PBC was more prevalent than AMA-positive subjects, and PBC patients had a higher female-to-male ratio than AMA-positive subjects, of whom 18.2% developed PBC (mean lag: 1.757 years). Upward trends in prevalence rates and downward trends in incidence rates were noted for both AMA-positive subjects and PBC. CHB was rare, CHC was more prevalent among PBC patients than the general population, and CHC was less prevalent among PBC than among AMA-positive subjects.

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台湾抗线粒体抗体阳性与原发性胆汁性胆管炎的演变关系：一项为期 16 年的医院队列研究。

背景：在病毒性肝炎流行地区，抗线粒体抗体（AMA）阳性患者是如何演变为原发性胆汁性胆管炎的？在病毒性肝炎流行地区，抗线粒体抗体（AMA）阳性患者如何演变为原发性胆汁性胆管炎（PBC）尚不清楚：设计/方法：一项为期 16 年、以医疗中心为基础的队列研究：我们在病毒性肝炎流行的亚洲国家台湾开展了一项为期 16 年、以医疗中心为基础的队列研究，共纳入 2,095,628 名受试者。AMA阳性受试者是指AMA阳性且碱性磷酸酶（ALP）⩽1.5倍于正常值上限（ULN）的受试者，PBC是指AMA阳性且ALP >1.5 × ULN的受试者：经年龄和性别调整后，AMA 阳性受试者的平均患病率低于 PBC 患者（4.68/105 对 11.61/105，p = 0.0002），但两者的发病率相当（0.99/105 对 1.12/105，p = 0.36）。前者的平均年龄略低（56.59 岁对 58.10 岁，p = 0.06），男女比例较低（2.85:1 对 5.44:1，p p p p 0.01），患病率有所上升，但发病率有所下降。在 423 名 AMA 阳性受试者中，有 77 人（18.2%）发展为 PBC，平均病程为 1.757 年。与 AMA 阳性受试者相比，PBC 患者的慢性乙型肝炎（CHB）并发率相似（2.7% 对 4.3%，P = 0.197），但慢性丙型肝炎（CHC）并发率较低（3.69% 对 15.60%，P 结论：PBC 的发病率高于 AMA 阳性受试者：PBC的发病率高于AMA阳性受试者，PBC患者的男女比例高于AMA阳性受试者，其中18.2%的患者发展为PBC（平均滞后时间：1.757年）。AMA阳性受试者和PBC的患病率呈上升趋势，发病率呈下降趋势。CHB很少见，CHC在PBC患者中的发病率高于普通人群，而CHC在PBC患者中的发病率低于AMA阳性受试者。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.