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      Early Prognostic Utility of Gp210 Antibody-Positive Rate in Primary Biliary Cholangitis: A Meta-Analysis

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          Abstract

          Background

          The prevalence of primary biliary cholangitis (PBC), which is an autoimmune liver disease, has increased over time. PBC often leads to severe consequences, such as liver failure and death. Stratification tools using biochemical liver tests are needed to assess and predict the progression of this disease at the time of PBC diagnosis.

          Methods

          We searched PubMed, Cochrane Library, Web of Science, and Embase for studies focused on the relationship between positive rates of Gp210 antibodies and poor prognosis of PBC. The primary end point was the number of PBC patients with poor outcome in the Gp210 antibody (+) and Gp210 antibody (−) groups. The secondary end point was the basic serum level of alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin (TBIL), and IgM in the two groups. The age and number of female patients were also measured.

          Results

          A total of 5 studies, comprising 737 patients, were included in this analysis. A positive rate of Gp210 antibodies was positively correlated with poor outcomes and with many types of progression in PBC, especially liver failure. Mortality was also higher in the Gp210 antibody (+) group. Furthermore, the serum levels of ALP and IgM were associated with the positive rate of Gp210 antibodies, while the serum levels of ALT and TBIL were not. The age and number of female patients were also not associated with the positive rate of Gp210 antibodies.

          Conclusion

          PBC-specific Gp120 antibodies are optimal predictors of PBC prognosis at the time of diagnosis. Some other liver function indicators, such as ALP and IgM, can be used as predictors to complement Gp210 antibodies to establish a stratification tool to predict the prognosis of PBC at the time of diagnosis.

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          Most cited references29

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          EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis

          Primary biliary cholangitis (PBC) is a chronic inflammatory autoimmune cholestatic liver disease, which when untreated will culminate in end-stage biliary cirrhosis. Diagnosis is usually based on the presence of serum liver tests indicative of a cholestatic hepatitis in association with circulating antimitochondrial antibodies. Patient presentation and course can be diverse and risk stratification is important to ensure all patients receive a personalised approach to their care. The goals of treatment and management are the prevention of end-stage liver disease, and the amelioration of associated symptoms. Pharmacologic approaches in practice, to reduce the impact of the progressive nature of disease, currently include licensed therapies (ursodeoxycholic acid and obeticholic acid) and off-label therapies (fibric acid derivatives, budesonide). These clinical practice guidelines summarise the evidence for the importance of a structured, life-long and individualised, approach to the care of patients with PBC, providing a framework to help clinicians diagnose and effectively manage patients.
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            Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases

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              Primary biliary cirrhosis.

              Primary biliary cirrhosis is a chronic cholestatic liver disease characterised by destruction of small intrahepatic bile ducts, leading to fibrosis and potential cirrhosis through resulting complications. The serological hallmark of primary biliary cirrhosis is the antimitochondrial antibody, a highly disease-specific antibody identified in about 95% of patients with primary biliary cirrhosis. These patients usually have fatigue and pruritus, both of which occur independently of disease severity. The typical course of primary biliary cirrhosis has changed substantially with the introduöction of ursodeoxycholic acid (UDCA). Several randomised placebo-controlled studies have shown that UDCA improves transplant-free survival in primary biliary cirrhosis. However, about 40% of patients do not have a biochemical response to UDCA and would benefit from new therapies. Liver transplantation is a life-saving surgery with excellent outcomes for those with decompensated cirrhosis. Meanwhile, research on nuclear receptor hormones has led to the development of exciting new potential treatments. This Seminar will review the current understanding of the epidemiology, pathogenesis, and natural history of primary biliary cirrhosis, discuss management of the disease and its sequelae, and introduce research on new therapeutic options.
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                Author and article information

                Contributors
                Journal
                Dis Markers
                Dis. Markers
                DM
                Disease Markers
                Hindawi
                0278-0240
                1875-8630
                2019
                13 October 2019
                : 2019
                : 9121207
                Affiliations
                1Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, China
                2Department of Immunologic Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
                3Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
                4Department of Infectious Diseases, Taihe Hospital, Shiyan, Hubei, China
                Author notes

                Academic Editor: Anja Hviid Simonsen

                Author information
                https://orcid.org/0000-0002-0037-1114
                https://orcid.org/0000-0001-8956-6649
                https://orcid.org/0000-0002-3532-4318
                https://orcid.org/0000-0002-8950-1340
                https://orcid.org/0000-0001-9613-1731
                https://orcid.org/0000-0002-2188-9692
                Article
                10.1155/2019/9121207
                6815635
                31737133
                0fd58491-d678-4799-91c5-7a4c636a712d
                Copyright © 2019 Chunyang Huang et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 May 2019
                : 15 July 2019
                : 12 August 2019
                Funding
                Funded by: National Science and Technology Key Project on “Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Prevention and Treatment”
                Award ID: 2017ZX10302201-004-002
                Award ID: 2017ZX10202203-006-001
                Award ID: 2017ZX10201201-002-002
                Award ID: 2017ZX10201201-001-001
                Award ID: 2017ZX10203201-005
                Award ID: 2012ZX10002004-006
                Funded by: Beijing Municipal Administration of Hospitals
                Award ID: ZYLX201711
                Award ID: PX2019062
                Award ID: DFL20151601
                Funded by: Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support
                Award ID: ZYLX201806
                Funded by: National Key R&D Program of China
                Award ID: 2017YFA0103000
                Categories
                Review Article

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