[Impact of anti-gp210 and anti-centromere antibody dual positivity on clinical prognosis in patients with primary biliary cholangitis: risk analysis and establishment of response criteria].

Abstract

Objective: To explore the impact and establish biochemical response criteria for optimized risk stratification for anti-glycoprotein (gp) 210 and anti-centromeric antibodies (ACA) dual positivity on the prognosis of patients with primary biliary cholangitis (PBC). Methods: A retrospective cohort study was conducted, including 1 286 PBC patients who visited the Department of Gastroenterology, First Affiliated Hospital of Air Force Medical University, from June 2006 to March 2025. Patients were grouped according to their serum autoantibody status. Clinical data such as baseline demographic characteristics, laboratory indicators, and histological staging were collected. The endpoint events were complications of cirrhosis (ascites, hepatic encephalopathy, variceal bleeding, etc.), hepatocellular carcinoma, liver transplantation, or death. Statistical analysis was performed using SPSS 26.0 software. Survival curves were plotted using the Kaplan-Meier method. The log-rank test was used to compare differences between groups. ROC curves were plotted to compare the predictive performance of different biochemical response criteria. Continuous data were compared using the independent samples t-test or the Mann-Whitney U rank-sum test between the groups. Categorical data were compared using the χ² test or Fisher's exact test between the groups. Results: Patients with dual positivity for anti-gp210 antibody and ACA had significantly shorter event-free survival (P<0.05). Early-stage patients with dual positivity had a significantly higher incidence of adverse events than other groups (46.05%, P<0.05), along with lower serum albumin (ALB) and platelet count (PLT) levels (P<0.05). The area under the curve (AUC) was 0.873 (95%CI: 0.771-0.975) for the biochemical response criteria based on ALB ≥1×lower limit of normal (LLN) and PLT ≥1×LLN after one year of ursodeoxycholic acid (UDCA) treatment. The incidence rate of adverse events in biochemical respondents was 4.3%, which was superior to other biochemical response criteria in predicting adverse events in early-stage dual-positive patients (P<0.05). However, there was no statistically significant difference in the incidence of endpoint events among the different biochemical response criteria groups in late dual-positive patients (P>0.05). Conclusion: PBC patients with dual positivity for anti-gp210 antibody and ACA have a poorer prognosis and exhibit a high risk of decompensation in the early stages of disease. Biochemical response criteria based on ALB and PLT can accurately identify high-risk patients with dual positivity at an early stage, providing an objective basis for implementing early intensive intervention strategies for high-risk patients in clinical practice.