Unexplained elevation of serum alkaline phosphatase in middle-aged and elderly women – alert to the possibility of primary biliary cirrhosis Ma Xiong Wang Qixia Ma Xiong, Department of Gastroenterology, Shanghai Renji Hospital A 52-year-old Ms. Shi was found to have elevated serum alkaline phosphatase by chance during a physical examination at her workplace three years ago and has since been seen at several local hospitals. After a series of tests such as various viral hepatitis markers, no clear cause for her abnormal alkaline phosphatase could be found. At the suggestion of her family, Ms. Shi brought all her laboratory data for three years to a major hospital in Shanghai for further treatment. There, she was clearly diagnosed with “primary biliary cirrhosis”. After regular treatment, her condition was significantly controlled. Many people may wonder what kind of disease primary biliary cirrhosis is. Has everyone who has this disease developed cirrhosis? Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic liver disease of unknown etiology, characterized histologically by destruction of the interlobular and septal bile ducts. The disease usually affects middle-aged women and presents clinically with pruritus with or without jaundice. Routine application of hematologic screening tests can detect the disease before the onset of symptoms. The natural history of PBC is a slow progressive cholestatic process with liver damage, fibrosis, cirrhosis and its complications.PBC was first reported by Addison et al. in 1851. Since AMA was applied to the diagnosis of PBC, many patients with asymptomatic and pre-cirrhotic stages were screened. At this time, patients did not present with clinical, biochemical or histological features. Therefore, it has been suggested that the term “chronic non-suppurative destructive cholangitis” is more applicable to this condition than “primary biliary cirrhosis”. The typical symptoms of PBC are fatigue and itching. Skin scraping, jaundice, and enlargement of the liver and spleen are not characteristic signs but are more common. Jaundice usually appears late in the disease process, but can also be seen in 20% to 40% of patients in the early stages. 90% to 95% of patients are women, and the age of onset is usually 30 to 65 years. Other symptoms are right upper abdominal pain and anorexia. Pruritus may appear at any time during the course of the disease and may occasionally resolve as the disease progresses. In contrast, jaundice is usually persistent and is also the most important indicator of prognosis. other clinical manifestations of PBC include skin hyperpigmentation, xanthomas, and macular tumors. Patients with advanced disease may present with manifestations of cirrhotic complications such as ascites, bleeding from ruptured esophagogastric fundic varices, and hepatic encephalopathy. Steatorrhea is common due to lack of bile salts in the intestinal lumen, and steatorrhea may also be associated with pancreatic pancreatic enzyme deficiency or celiac disease that sometimes accompanies patients with PBC. Spontaneous fractures may occur due to severe osteoporosis in patients. The use of anti-mitochondrial antibodies (AMA) for the diagnostic process of PBC has made the diagnosis of PBC relatively easy. The diagnosis of PBC is usually preclinical when routine screening tests show only 2 to 3-fold elevation of ALP, and positive serum AMA is seen in 90% to 95% of cases. immunoglobulin type in PBC is characterized by elevated IgM. The three criteria for the diagnosis of PBC are biochemical abnormalities suggestive of biliary depression (e.g. ALP), positive AMA and diagnostic histological findings. In the treatment of PBC, ursodeoxycholic acid (Ursodeoxycholic acid, UDCA) (13-15 mg/Kg body weight) has been shown to significantly improve hepatic biochemical parameters in patients with PBC and has a significant benefit on the long-term survival of patients with PBC, and is the drug of choice for the treatment of PBC and is the only drug approved by the U.S. Food and Drug Administration (FDA). serum bilirubin, ALP, transaminases, cholesterol and IgM levels in PBC patients. The management of cholestatic complications (such as pruritus, osteoporosis and fat-soluble vitamin deficiency) should also be given high priority, as this aspect of treatment can improve the quality of life and even prolong the survival of patients in cases where the primary disease cannot be effectively removed. China is still a major hepatitis B country, but with the spread of medical knowledge, liver function abnormalities caused by hepatitis viruses are well known and certain precautions have been taken, such as universal vaccination against hepatitis B, management of blood products and use of antiviral drugs. However, recurrent liver function abnormalities due to non-viral hepatitis are confusing to many patients and clinicians. Patients with recurrent alkaline phosphatase elevation with significant pruritus and jaundice should consider the possibility of PBC after excluding viral hepatitis and common causes such as drug, alcohol and fatty liver disease. Early identification of the cause and appropriate treatment will help control the disease and improve the quality of life.