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原发性胆汁性胆管炎预后模型的演进与应用
DOI: 10.12449/JCH250730
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：万玲玲负责收集、查阅、整理文献及论文书写；梁丽娜负责文献查阅指导及修改论文；卢书明负责设计、指导及论文审阅并最后定稿。
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摘要: 原发性胆汁性胆管炎（PBC）是一种自身免疫性疾病，好发于中年女性。PBC早期临床症状不明显，最终可发展至肝硬化并出现各种并发症。熊去氧胆酸是治疗PBC最有效的药物，但仍有40%的PBC患者对熊去氧胆酸应答不敏感，导致病情缓慢进展。准确评估PBC患者病情及预后有助于治疗方案的优化。本文就PBC预后模型的研究进展进行综述，以期为临床治疗提供参考。Abstract: Primary biliary cholangitis （PBC） is an autoimmune liver disease often observed in middle-aged women. The early clinical symptoms of PBC are not obvious， and it can progress to liver cirrhosis and lead to various complications. Ursodeoxycholic acid （UDCA） is the most effective drug for the treatment of PBC， but about 40% of the patients are still insensitive to UDCA， which can lead to slow progression of the disease. Accurate assessment of disease conditions and patient prognosis can help to optimize treatment regimens. This article reviews the research advances in prognostic models for PBC， in order to provide a reference for clinical treatment.
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Key words:
- Primary Biliary Cholangitis /
- Prognosis /
- Model
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表 1 PBC预后模型/评分系统
Table 1. Primary biliary cholangitis prognostic models and scoring systems
预后模型/评分系统 模型组成/评分定义 Yale模型 0.037×1.037×年龄+0.74×2.1×肝肿大（否=0，是=1）-1.34×0.26×门静脉纤维化（否=0，是=1）+0.82×2.26×［胆
红素≥5 mg/dL（否=0，是=1）］-0.73×0.48×［胆红素<1.5 mg/dL（否=0，是=1）］简化版Mayo模型 0.871×lnTBil（mg/dL）-2.53×lnAlb（mg/dL）+0.039×年龄+2.38×ln凝血酶原时间（s）+0.859×水肿积分1） European模型 0.04×（年龄-55）+1.39×腹水（否=0，是=1）+0.65×静脉曲张破裂出血（否=0，是=1）-0.085×［Alb（g/L）-34.3］+
2.53×［log胆红素（µmol/L）-1.53］Rochester标准 ALP<2×ULN和Mayo模型<4.5分 巴塞罗那标准 ALP水平下降>40%或降至正常（UDCA治疗1年） ParisⅠ标准 ALP≤3×ULN，AST≤2×ULN，胆红素正常（UDCA治疗1年） 鹿特丹标准 胆红素和/或Alb降至正常（UDCA治疗1年） 爱媛标准 GGT水平下降≥70%或降至正常（UDCA治疗6个月） 多伦多标准 ALP<1.67×ULN（UDCA治疗2年） Paris Ⅱ标准 ALP≤1.5×ULN，AST≤1.5×ULN，胆红素正常（UDCA治疗1年） APRI指数 APRI≤0.54（UDCA治疗前或治疗1年） ALBI评分 -0.085×Alb（g/L）+0.66×log胆红素（µmol/L） GLOBE评分 0.044 378×年龄+0.939 82×ln（胆红素×ULN）+0.335 648×ln（ALP×ULN）-2.266 708×（Alb× LLN）-0.002 581×
血小板计数（109/L）+1.216 8652）UK-PBC评分 1-基线幸存者功能ˆexp｛0.028 785 43×（治疗1年时ALP×ULN-1.722 136 304）-0.042 287 3×［（治疗1年时ALT
或AST×ULN/10）-1-8.675 729 006］+1.419 9×［ln（治疗1年时胆红素×ULN/10）+2.709 607 778］-1.960 303×（基
线Alb×LLN-1.176 730 01）-0.416 195 4×（基线血小板×LLN-1.873 564 875）｝3）注：1）水肿积分（0，无水肿；0.5，利尿剂可控制的水肿；1，利尿剂不能控制的水肿）；2）年龄为开始UCDA治疗时，胆红素、ALP、Alb及血小板计数为治疗1年后；ULN，正常值上限，LLN，正常值下限；3）基线幸存者功能即0.982（在5年时）、0.941（在10年时）、0.893（在15年时）。
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