Hepatology research : the official journal of the Japan Society of Hepatology · 2025
Fibrosis stage is an independent predictor of liver-related complications in primary biliary cholangitis.
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Fujinaga Yukihisa, Namisaki Tadashi, Tsuji Yuki, Shibamoto Akihiko, Kubo Takahiro, Koizumi Aritoshi, Matsuda Takuya, Inoue Takashi, Iwai Satoshi, Tomooka Fumimasa, Tanaka Misako, Takaya Hiroaki, Noguchi Ryuichi, Nishimura Norihisa, Sato Shinya, Kitagawa Koh, Kaji Kosuke, Akahane Takemi, Mitoro Akira, Asada Kiyoshi, Yoshiji Hitoshi
Аннотация
AIM: This study aimed to determine the predictive ability of the histological stage (HS) compared with biochemical response to ursodeoxycholic acid (UDCA) (BR) on developing complications in patients with primary biliary cholangitis (PBC).
METHODS: Overall, 226 patients with asymptomatic PBC treated with UDCA were enrolled. Pathological staging was conducted based on the Scheuer and Nakanuma classifications, which were graded for liver fibrosis (fibrosis) and bile duct loss (BDL). BR was evaluated according to the Nara criteria, Paris II criteria, and Barcelona criteria. PBC complications included pruritus, esophageal varices, ascites, and jaundice.
RESULTS: The cumulative complication rates (CCRs) of the four patient groups (early disease/responder [group A], early disease/non-responder [group B], advanced disease/responder [group C], and advanced disease/non-responder [group D]) were estimated by combining the HS according to the Scheuer and Nakanuma classifications and BR based on three UDCA response criteria. The CCRs for the Scheuer classification/Paris II criteria, Scheuer classification/Barcelona criteria, Nakanuma classification/Nara criteria, Nakanuma classification/Paris II criteria, Nakanuma classification/Barcelona criteria, fibrosis/Barcelona criteria, and BDL/Paris II criteria were significantly higher in group C than in group A. The CCRs for the Scheuer classification/Nara criteria, Scheuer classification/Barcelona criteria, Nakanuma classification/Nara criteria, Nakanuma classification/Barcelona criteria, fibrosis/Nara criteria, fibrosis/Paris II criteria, and fibrosis/Barcelona criteria were significantly higher in group D than in group B. An advanced Nakanuma stage was independently associated with developing complications in patients with PBC.
CONCLUSIONS: The CCR increases with HS progression regardless of BR. HS is linked to a higher risk of developing complications than BR in patients with PBC.
METHODS: Overall, 226 patients with asymptomatic PBC treated with UDCA were enrolled. Pathological staging was conducted based on the Scheuer and Nakanuma classifications, which were graded for liver fibrosis (fibrosis) and bile duct loss (BDL). BR was evaluated according to the Nara criteria, Paris II criteria, and Barcelona criteria. PBC complications included pruritus, esophageal varices, ascites, and jaundice.
RESULTS: The cumulative complication rates (CCRs) of the four patient groups (early disease/responder [group A], early disease/non-responder [group B], advanced disease/responder [group C], and advanced disease/non-responder [group D]) were estimated by combining the HS according to the Scheuer and Nakanuma classifications and BR based on three UDCA response criteria. The CCRs for the Scheuer classification/Paris II criteria, Scheuer classification/Barcelona criteria, Nakanuma classification/Nara criteria, Nakanuma classification/Paris II criteria, Nakanuma classification/Barcelona criteria, fibrosis/Barcelona criteria, and BDL/Paris II criteria were significantly higher in group C than in group A. The CCRs for the Scheuer classification/Nara criteria, Scheuer classification/Barcelona criteria, Nakanuma classification/Nara criteria, Nakanuma classification/Barcelona criteria, fibrosis/Nara criteria, fibrosis/Paris II criteria, and fibrosis/Barcelona criteria were significantly higher in group D than in group B. An advanced Nakanuma stage was independently associated with developing complications in patients with PBC.
CONCLUSIONS: The CCR increases with HS progression regardless of BR. HS is linked to a higher risk of developing complications than BR in patients with PBC.