Improvement of serum alkaline phosphatase to <1.5 upper limit of normal predicts better outcome and reduced risk of cholangiocarcinoma in primary sclerosing cholangitis

被引：145
作者：
Al Mamari, Said [1 ]
Djordjevic, Jelena [1 ]
Halliday, John S. [1 ]
Chapman, Roger W. [1 ]
机构：
[1] Oxford Univ Hosp, Transit Gastroenterol Unit, Oxford OX3 9DU, England
来源：
JOURNAL OF HEPATOLOGY | 2013年 / 58卷 / 02期
关键词：
Serum alkaline phosphatase; Primary sclerosing cholangitis; Cholangiocarcinoma; DOSE URSODEOXYCHOLIC ACID; NATURAL-HISTORY MODEL; LIVER-TRANSPLANTATION; MULTICENTER; SURVIVAL; PROGNOSIS; THERAPY;
D O I：
10.1016/j.jhep.2012.10.013
中图分类号：
R57 [消化系及腹部疾病];
学科分类号：
摘要：
Background 82 Aims: Normalization of serum alkaline phosphatase (SAP) was recently shown to correlate with better prognosis in Primary Sclerosing Cholangitis (PSC). We aimed at evaluating the impact of SAP improvement to below 1.5 the upper limit of normal (ULN) on the prognosis of this cholestatic liver disease. Methods: Oxford PSC database was screened for cases diagnosed between 1980 and 2004. Cases which met the inclusion criteria were retrospectively examined for clinical parameters, laboratory values, and clinical end points (liver decompensation, liver transplantation, and liver-related deaths including cholangiocarcinoma). Cases were followed-up to 31/12/2010. Results: 139 patients were included, (87 males). Improvement of SAP to below 1.5 ULN was achieved by 55 (40%) patients in a median time of 2 years, compared to 84 (60%) who did not. 3/55 (6%) patients with SAP improvement reached an end point compared to 32/84 (38%) patients with no SAP improvement (p <0.0001). 13/84 (15%) patients with no SAP improvement developed cholangiocarcinoma compared to no cholangiocarcinoma in the group with SAP improvement (p = 0.002). The end point free survival was significantly longer in patients with SAP improvement (p <0.0001). The significance of SAP improvement as a predictor of prognosis persisted after controlling for other clinical and laboratory variables. Improvement of SAP to below 1.5 ULN was comparable to complete normalization of SAP in terms of prognosis. Conclusions: Improvement in SAP to below 1.5 ULN is associated with better outcome and reduced risk of CCA in PSC. This was comparable to the achievement of complete normalization of SAP. (C) 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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页码：329 / 334
页数：6
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