Abstract
To highlight the clinical characteristics of primary biliary cholangitis on the basis of gender in terms of the extent of liver injury and extra-liver autoimmune expressions. The retrospective study was conducted at the Tri-Service General Hospital, Taiwan, and comprised data of patients aged >20 years diagnosed with primary biliary cholangitis between January 2000 and December 2018. Patients in the control group were randomly selected from the health examination centre. Liver injury manifestations and susceptibilities were analysed along gender lines. The gene expression microarray data from the National Centre for Biotechnology Information Gene Expression Omnibus database was also used to explore the relationship between autoimmune-induced inflammation and androgen response expression. Statistical analysis was done using Graph-Pad Prism 7.0. Of the 75 cases, 63(84%) were females with a mean age of 64.6±1.78 years, and 12(16%%) were males with a mean age of 46.6±5.6 years. Of the 66 controls, 55(83.3%) were females with a mean age of 51.67 years, and 11(16.6%) were males with a mean age of 45.9 years. There were no significant differences in terms of liver profiles related to gender in the control group (p>0.05). Among the cases, male patients showed fewer extrahepatic autoimmune disorders and more severe liver injuries before or after ursodeoxycholic acid treatment (p<0.05). There was a positive correlation between androgen receptor response and the extent of systemic inflammation (p<0.05). Conclusion: The association between androgen receptor responses and inflammation was linked to gender-related hepatic injuries, which may explain why liver inflammation in male patients is generally more severe compared to the female patients. The association between androgen receptor responses and inflammation was linked to gender-related hepatic injuries, which may explain why liver inflammation in male patients is generally more severe compared to the female patients.
Highlights
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease that progressively destroys small biliary ducts
The association between androgen receptor responses and inflammation was linked to gender-related hepatic injuries, which may explain why liver inflammation in male patients is generally more severe compared to the female patients
PBC patients showed a higher percentage of cirrhosis than the controls, and female PBC patients had the highest incidence of hepatitis C virus (HCV) infection, while gender had no significant difference in the control group (p>0.05)
Summary
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease that progressively destroys small biliary ducts. Growing concerns regarding PBC incidence among males underscores the importance of early testing, especially with decreased prevalence of hepatitis B virus. Ursodeoxycholic acid (UDCA), which significantly delays the progression of periportal necroinflammatory lesions, is the only first-line drug approved for PBC treatment. Gender-related differences in disease activity or UDCA susceptibility have not been explored. Recent studies have determined that being female is a susceptibility factor for drug-induced liver toxicity, but a negative predictor of non-alcoholic fatty liver disease. Recent studies have determined that being female is a susceptibility factor for drug-induced liver toxicity, but a negative predictor of non-alcoholic fatty liver disease5,6 These conflicting results show the underlying pathophysiology related to gender. Lieo et al identified that being male is an independent predictor of all-cause mortality in PBC-related cholestatic liver disease cases, but did not determine the extent of liver damage. The current study was planned to determine whether gender is a potential risk factor for liver injury or a potential negative prognostic factor
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