{"id":2302,"date":"2019-12-31T19:32:10","date_gmt":"2019-12-31T18:32:10","guid":{"rendered":"https:\/\/angh.net\/abstracts\/prise-en-charge-de-la-cholangite-biliaire-primitive-dans-les-hopitaux-generaux-francais-etude-descript\/"},"modified":"2019-12-31T19:32:10","modified_gmt":"2019-12-31T18:32:10","slug":"prise-en-charge-de-la-cholangite-biliaire-primitive-dans-les-hopitaux-generaux-francais-etude-descript","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/prise-en-charge-de-la-cholangite-biliaire-primitive-dans-les-hopitaux-generaux-francais-etude-descript\/","title":{"rendered":"Prise en charge de la cholangite biliaire primitive dans les h\u00f4pitaux g\u00e9n\u00e9raux fran\u00e7ais. Etude DESCRIPT."},"content":{"rendered":"<p><strong>2019<\/strong><\/p>\n<p><em>Isabelle Rosa, Xavier Causse, Bertrand Hanslik, Jean-Pierre Arpurt, Jean Henrion, Christophe Renou, Armand Garioud, Olivier Chazouill\u00e8res, Christophe Corpechot, Alexandre Pariente pour les co-investigateurs des \u00e9tudes DESCRIPT 1 et 2.<\/em><\/p>\n<p><strong>H\u00e9patologie <\/strong>&#8211; \u00a02019-05-15 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Introduction: La prise en charge des malades atteints de cholangite biliaire primitive (CBP) est mal connue en France. L\u2019objet de ce travail est de comparer les caract\u00e9ristiques, la prise en charge, la r\u00e9ponse au traitement et l\u2019\u00e9volution des malades suivis \u00e0 l\u2019h\u00f4pital g\u00e9n\u00e9ral, et de ceux suivis \u00e0 l\u2019h\u00f4pital universitaire (HU) ou en pratique lib\u00e9rale (PL).<br \/>\nM\u00e9thodes:  Nous avons r\u00e9alis\u00e9 du 1er avril 2016 au 31 d\u00e9cembre 2017 une \u00e9tude r\u00e9trospective des malades atteints CBP et r\u00e9cemment vus \u00e0 l\u2019 h\u00f4pital g\u00e9n\u00e9ral (HG), universitaire (HU) ou en (PL), au cours de 2 p\u00e9riodes successives (01\/04\/16 pour l\u2019ensemble des centre, prolong\u00e9 \u00e0 2017 pour les h\u00f4pitaux g\u00e9n\u00e9raux).  Les donn\u00e9es collect\u00e9es \u00e9taient celles disponibles au moment du diagnostic et de la derni\u00e8re consultation. La r\u00e9ponse biochimique (RB) \u00e0 l\u2019acide ursod\u00e9soxycholique (AUDC) fut \u00e9valu\u00e9e \u00e0 l\u2019aide des scores de Paris I et Paris II combin\u00e9s, et le score GLOBE calcul\u00e9. Les caract\u00e9ristiques des malades, leur RB \u00e0 l\u2019 AUDC et leur \u00e9volution fut compar\u00e9e entre eux et entre les lieux de prise en charge. Les facteurs pr\u00e9dictifs ind\u00e9pendants de RB insuffisante \u00e0 l\u2019AUDC et de complications ont \u00e9t\u00e9 d\u00e9termin\u00e9s \u00e0 l\u2019aide de la r\u00e9gression logistique et du mod\u00e8le de Cox.<br \/>\nR\u00e9sultats : Parmi les 436 malades inclus, 176 provenaient des HG, 173 des HUs et 87 de PL. L\u2019\u00e2ge moyen (56 ans), la proportion de femmes (90%), de positivit\u00e9 des anticorps antimitochondriaux (93%), la m\u00e9diane des phosphatases alcalines (PAL) (2,3 x [LSN], IQR 2,0)), et de l\u2019albumin\u00e9mie (40 g\/L) \u00e9taient similaire \u00e0 ceux des malades des autres centres, mais la bilirubin\u00e9mie m\u00e9diane (12 \u00b5M, IQR 9,5 \u00b5M) \u00e9tait plus basse (p=0,01). Les taux de r\u00e9alisation de la biopsie h\u00e9patique (44%) \u00e9tait similaires, mais la r\u00e9alisation de l\u2019\u00e9lastographie (53%) sup\u00e9rieure (p=0,0005). Un quart des malades n\u2019avaient ni biopsie ni \u00e9lastom\u00e9trie. La proportion de malades aux stades pr\u00e9coces (64%) et de syndromes de chevauchement CBP-h\u00e9patite autoimmune (8%) \u00e9tait similaire, mais les malades sur la liste de transplantation plus rares (1%) qu\u2019\u00e0 l\u2019h\u00f4pital universitaire (8%) (p=0.001).<br \/>\nLa proportion de malades recevant de l\u2019 AUDC \u00e9tait la m\u00eame (95%), la dose m\u00e9diane initiale (13,6 mg\/kg\/j, IQR 4,5) \u00e9tait similaire ; elle n\u2019\u00e9tait optimale que chez 29% des malades (excessive chez 44%, insuffisante chez 27%. La dose finale d\u2019 AUDC (15,0 mg\/kg\/j, IQR 3,7) \u00e9tait similaire, optimale chez 31%, insuffisante chez 25%, sans diff\u00e9rence selon le lieu de prise en charge.<br \/>\nLe taux de RB \u00e0 l\u2019 AUDC (d\u00e9terminable chez 89% des malades) \u00e9tait de 66% (59% dans les HU, 54% en PL, p=0,17). Le score GLOBE moyen \u00e9tait similaire dans les 3 groupes. Avec un suivi moyen de 6 ans, le taux de complications h\u00e9patiques  \u00e9tait de 5,2%, contre (15,6%) \u00e0 l\u2019 HU et 5,8% en PL (p=0,0003).<br \/>\nEn r\u00e9gression logistique, les pr\u00e9dicteurs ind\u00e9pendants de RB \u00e9taient la bilirubin\u00e9mie et l\u2019 albumin\u00e9mie. Avec un mod\u00e8le de Cox, les pr\u00e9dicteurs ind\u00e9pendants de complications \u00e9taient le stade avanc\u00e9 au diagnostic et la r\u00e9ponse biochimique. Le centre de prise en charge n\u2019\u00e9tait un facteur pr\u00e9dictif ind\u00e9pendant ni de RB, ni de complication .<br \/>\nConclusion : Un nombre cons\u00e9quent de malades atteints de CBP est pris en charge dans les HG. Les malades sont sans doute un peu moins s\u00e9v\u00e8res que dans les HU. La qualit\u00e9 de la prise en charge et le taux de RB sont  similaires, et le type de centre n\u2019est un facteur pr\u00e9dictif ind\u00e9pendant ni de RB, ni de complication. L\u2019\u00e9valuation du stade initial, la dose d\u2019 AUDC et l\u2019\u00e9valuation de la RB peuvent \u2013doivent-\u00eatre am\u00e9lior\u00e9s.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2019 Isabelle Rosa, Xavier Causse, Bertrand Hanslik, Jean-Pierre Arpurt, Jean Henrion, Christophe Renou, Armand Garioud, Olivier Chazouill\u00e8res, Christophe Corpechot, Alexandre Pariente pour les co-investigateurs des \u00e9tudes DESCRIPT 1 et 2. H\u00e9patologie &#8211; \u00a02019-05-15 &#8211;\u00a0CO &#8211; ________________________________ Introduction: La prise en charge des malades atteints de cholangite biliaire primitive (CBP) est mal connue en France. L\u2019objet [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[30],"class_list":["post-2302","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-30"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Prise en charge de la cholangite biliaire primitive dans les h\u00f4pitaux g\u00e9n\u00e9raux fran\u00e7ais. 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