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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Male Sex Is Associated With Higher Rates of Liver-Related Mortality in Primary Biliary Cholangitis and Cirrhosis
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Male Sex Is Associated With Higher Rates of Liver-Related Mortality in Primary Biliary Cholangitis and Cirrhosis

机译：男性与原发性胆汁性胆管炎和肝硬化的肝脏相关死亡率较高相关

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BACKGROUND AND AIMS: The impact of sex on the postcirrhosis progression of primary biliary cholangitis (PBC) has not been well defined. Prior studies have suggested that men have worse outcomes but present at more advanced stages of fibrosis than women. This observation, however, has been limited by small numbers of men and even fewer patients with cirrhosis. APPROACH AND RESULTS: We investigated the association of sex with the development of all-cause and liver-related mortality or transplantation, decompensation, and hepatocellular carcinoma (HCC), using competing-risk time-updating Cox proportional hazards models in a large cohort of predominantly male patients with PBC cirrhosis assembled from the Veterans Health Administration. In a cohort of 532 participants (418 male) with PBC-related cirrhosis with a total follow-up of 3,231.6 person-years (PY) from diagnosis of compensated cirrhosis, male participants had a higher unadjusted rates of death or transplantation (8.5 vs. 3.8 per 100 PY; P < 0.0001), liver-related death or transplantation (5.5 vs. 2.7 per 100 PY; P < 0.0001), decompensation (5.5 vs. 4.0 per 100 PY; P = 0.002), and I ICC (0.9 vs. 0.3 per 100 PY; P < 0.0001). After adjusting for confounders, male sex was associated with a higher risk of death or transplantation (adjusted hazard ratio, 1.80; 95 CI, 1.01-3.19; P = 0.046), and liver-related death or transplantation (subhazard ratio, 2.17; 95 CI, 1.15-4.08; P = 0.02). A sensitivity analysis that defined ursodeoxycholic acid response as normalization of alkaline phosphatase and total bilirubin revealed similar findings. CONCLUSIONS: In patients with PBC and well-compensated cirrhosis, male sex is associated with a higher risk of both death and liver-related death or transplantation.
机译：背景和目的：性别对原发性胆汁性胆管炎 （PBC） 肝硬化后进展的影响尚未明确定义。先前的研究表明，与女性相比，男性的预后更差，但处于更晚期的纤维化阶段。然而，这一观察结果受到少数男性和更少肝硬化患者的限制。方法和结果： 我们调查了性别与全因和肝脏相关死亡率或移植、失代偿和肝细胞癌 （HCC） 发展的关联，使用竞争风险时间更新的 Cox 比例风险模型，在退伍军人健康管理局收集的以男性为主的 PBC 肝硬化患者中。在532名患有PBC相关肝硬化的受试者（418名男性）的队列中，从诊断为代偿性肝硬化开始的总随访时间为3,231.6人年（PY），男性受试者的未调整死亡率或移植率更高（8.5 vs. 3.8/100 PY;P < 0.0001）、肝脏相关死亡或移植（5.5 vs. 2.7/100 PY;P < 0.0001）、失代偿（5.5 vs. 4.0/100 PY;P = 0.002） 和 I ICC（0.9 vs. 0.3/100 PY;P < 0.0001）。调整混杂因素后，男性与较高的死亡或移植风险相关（校正风险比，1.80;95% CI，1.01-3.19;P = 0.046）和肝脏相关死亡或移植（亚风险比，2.17;95% CI，1.15-4.08;P = 0.02）。一项敏感性分析将熊去氧胆酸反应定义为碱性磷酸酶和总胆红素的正常化，揭示了类似的发现。结论：在PBC和代偿性肝硬化患者中，男性与较高的死亡风险和肝脏相关死亡或移植风险相关。

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