Article Text
Abstract
BACKGROUND In some patients with primary biliary cirrhosis, ursodeoxycholic acid causes full biochemical normalisation of laboratory data; in others, indexes improve but do not become normal.
AIMS To characterise complete and incomplete responders.
METHODS Seventy patients with primary biliary cirrhosis were treated with ursodeoxycholic acid 10–15 mg/kg/day and followed up for 6–13 years.
RESULTS In 23 patients (33%) with mainly stage I or II disease, cholestasis indexes and aminotransferases normalised within 1–5 years, except for antimitochondrial antibodies. Histological findings improved. Indexes were not normalised in 47 patients (67%) although the improvement of their biochemical functions parallelled the trend in the first group. In these incomplete responders histological findings improved to a lesser extent. The only difference between the two groups before treatment was higher levels of alkaline phosphatase and γ glutamyl transpeptidase in the incomplete responders. At onset of treatment the discriminant value separating responders from incomplete responders was 660 U/l for alkaline phosphatase and 131 U/l for γ glutamyl transpeptidase. One year later it was 239 and 27 U/l (overall predictive value for responders 92%, for incomplete responders 81%). There were no differences between the two groups concerning immune status, antimitochondrial antibody subtypes, liver histology, or any other data. HLA-B39, DRB1*08, DQB1*04 dominated in both groups.
CONCLUSIONS In patients with mainly early stages of primary biliary cirrhosis, higher values of alkaline phosphatase and γ glutamyl transpeptidase are the only biochemical indexes which allow discrimination between patients who will completely or incompletely respond to ursodeoxycholic acid treatment.
- primary biliary cirrhosis
- prognostic indexes
- full response to ursodeoxycholic acid
- incomplete responders
- anti-p53 autoantibodies
- HLA typing
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Footnotes
- Abbreviations used in this paper:
- AFT
- α1 fetoprotein
- ALT
- alanine aminotransferase
- AMA
- antimitochondrial antibodies
- ANA
- antinuclear antibodies
- AP
- alkaline phosphatase
- AST
- aspartate aminotransferase
- AT III
- antithrombin III
- CA 19-9
- carbohydrate antigen 19-9
- CHE
- cholinesterase
- GGT
- γ glutamyl transpeptidase
- GLDH
- glutamate dehydrogenase
- HBsAg
- hepatitis B surface antigen
- HCV
- hepatitis C virus
- PBC
- primary biliary cirrhosis
- SMA
- smooth muscle antibodies
- UDCA
- ursodeoxycholic acid