自身免疫性肝炎治疗应答速度与疾病进展的相关性

张红霞; 郭丽萍; 周璐; 王邦茂

doi:10.3969/j.issn.1001-5256.2018.04.025

自身免疫性肝炎治疗应答速度与疾病进展的相关性

DOI: 10.3969/j.issn.1001-5256.2018.04.025

天津医科大学总医院消化科

基金项目:

国家自然科学基金资助项目(81470834)；

详细信息

中图分类号: R575.1
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出版历程
- 出版日期: 2018-04-20

Association between the rapidity of response and progression to cirrhosis in patients with autoimmune hepatitis

Department of Gastroenterology, General Hospital of Tianjin Medical University

Research funding:

摘要

摘要:
目的评价自身免疫性肝炎（AIH）患者治疗应答速度与肝硬化进展的关系,分析影响应答速度的因素。方法回顾性分析2001年11月-2017年5月在天津医科大学总医院就诊的61例长期随访的AIH患者的临床资料,依据血清转氨酶应答速度（即转氨酶降至正常水平所需时间）分为<3个月组、36个月组、612个月组、1224个月组、>24个月组。比较各组的持续应答率及肝硬化进展率,并分析影响应答速度的因素。正态分布的计量资料2组比较采用两独立样本t检验,多组比较采用单因素方差分析。计数资料2组比较采用χ2检验,多组比较采用列联表卡方检验。结果转氨酶在3个月内降至正常的患者发生肝硬化的比例（20%）最低,肝功能持续2年未降至正常的2例患者全部进展为肝硬化,肝功能持续1年未降至正常的患者有一半以上（62.5%）进展为肝硬化。比较3个月内应答者与3个月内未应答者肝硬化的进展率（20%vs 48.15%）,发现早期应答较晚期应答者肝硬化进展的比例低,差异有统计学意义（χ2=5.067,P<0.05）。将3个月内应答组（20%）分别...
- 肝炎,自身免疫性 /
- 肝硬化 /
- 预后
Abstract:
Objective To evaluate the association between the rapidity of response and progression to cirrhosis in patients with autoimmune hepatitis (AIH) , and to analyze the influencing factors for the rapidity of response.Methods A retrospective analysis was performed on 61 AIH patients with long-term follow-up, who visited The General Hospital of Tianjin Medical University from November 2001 to May 2017.These patients were divided into five groups according to the time for transaminase to decrease to a normal level:< 3 months group, 3-6 months group, 6-12 months group, 12-24 months group, and > 24 months group.The chi-square test was used to compare the rate of progression to cirrhosis and sustained response rate between these groups.One-way analysis of variance and the two-independent-samples t test were used to analyze the influencing factors for the rapidity of response.The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups, and one-way analysis of variance was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between two groups, and the contingency table chi-square test was used for comparison between multiple groups.Results The < 3 months group had the lowest proportion of patients with progression to cirrhosis (20%) ; all of the two patients in the > 24 months group progressed to cirrhosis; and 62.5% of the patients in the 12-24 months group progressed to cirrhosis.The rate of progression to cirrhosis was significantly lower in the patients who showed response within 3 months than in those who showed no response within 3 months (20% vs 48.15%, χ2= 5.067, P < 0.05) .The rates of progression to cirrhosis for the < 3 months group, 3-6 months group, 6-12 months group, 12-24 months group, and > 24 months group were 20%, 41.7%, 20%, 62.5%, and 100%, respectively, and the < 3 months group had a significantly lower rate of progression to cirrhosis than the 12-24 months group and > 24 months group (χ2= 5.546 and 6.400, both P < 0.05) .The sustained response rate of the < 3 months group was significantly higher than that of the 12-24 months group and > 24 months group (χ2= 4.322, P < 0.05) .Conclusion For AIH patients, the rapidity of response is associated with progression to cirrhosis; a rapid response reduces the rate of progression to cirrhosis.Responding within 3 months may indicate a good outcome, while responding beyond 1 year may indicate a poor outcome.Initial alanine aminotransferase level, and therapeutic drugs may influence the rapidity of response.
- hepatitis, autoimmune /
- liver cirrhosis /
- prognosis

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参考文献(19)

[1]European Association for the Study of the Liver.EASL clinical practice guidelines:autoimmune hepatitis[J].J Hepatol, 2015, 63 (4) :971-1004.

[2]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and management of autoimmune hepatitis (2015) [J].J Clin Hepatol, 2016, 32 (1) :9-22. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会.自身免疫性肝炎诊断和治疗共识 (2015) [J].临床肝胆病杂志, 2016, 32 (1) :9-22.

[3]CZAJA AJ, MANNS MP.Advances in the diagnosis, pathogenesis, and management of autoimmune hepatitis[J].Gastroenterology, 2010, 139 (1) :58-72.

[4]CZAJA AJ.Rapidity of treatment response and outcome in type 1autoimmune hepatitis[J].J Hepatol, 2009, 51 (1) :161-167.

[5]WANG Q, QIU D, MA X.Early normalization of aminotransferase predicts complete biochemical remission in autoimmune hepatitis patients[J].Aliment Pharmacol Ther, 2011, 34 (1) :107-109.

[6]ALVAREZ F, BERG PA, BIANCHI FB, et al.International Autoimmune Hepatitis Group report:review of criteria for diagnosis of autoimmune hepatitis[J].J Hepatol, 1999, 31 (5) :929-938.

[7]LUTH S, HERKEL J, KANZLER S, et al.Serologic markers compared with liver biopsy for monitoring disease activity in autoimmune hepatitis[J].J Clin Gastroenterol, 2008, 42 (8) :926-930.

[8]CZAJA AJ.Advances in the current treatment of autoimmune hepatitis[J].Dig Dis Sci, 2012, 57 (8) :1996-2010.

[9]GLEESON D, HENEGHAN MA, British Society of Gastroenterology.British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis[J].Gut, 2011, 60 (12) :1611-1629.

[10]FRIEDMAN SL.Liver fibrosis—from bench to bedside[J].J Hepatol, 2003, 38 (Suppl 1) :s38-s53.

[11]LIEBER CS.Prevention and treatment of liver fibrosis based on pathogenesis[J].Alcohol Clin Exp Res, 1999, 23 (5) :944-949.

[12]PINZANI M, ROINBOUTS K.Liver fibrosis:from the bench to clinical targets[J].Dig Liver Dis, 2004, 36 (4) :231-242.

[13]TAKIGAWA T, MIYAZAKI H, KINOSHITA M, et al.Glucocorticoid receptor-dependent immunomodulatory effect of ursodeoxycholic acid on liver lymphocytes in mice[J].Am J Physiol Gastrointest Liver Physiol, 2013, 305 (6) :427-438.

[14]YASUHIRO M, YOSHIAKI I, HARUHIKO K, et al.Efficacy of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis[J].Hepatol Int, 2009, 3 (4) :556-562.

[15]LI YR, WANG WB, ZHANG LY, et al.The analysis of efficacy of glycyrrhizin therapy for autoimmune hepatitis[J].J Clin Hepatol, 2007, 23 (2) :117-118. (in Chinese) 李蕴铷, 王文冰, 张黎颖, 等.甘草酸类药物治疗自身免疫性肝炎疗效分析[J].临床肝胆病杂志, 2007, 23 (2) :117-118.

[16]Expert Committee on Clinical Application of Glycyrrhizin Preparation in the Treatment of Liver Diseases.Expert consensus on clinical application of glycyrrhizin preparation in the treatment of liver diseases[J].J Clin Hepatol, 2016, 32 (5) :844-852. (in Chinese) 甘草酸制剂肝病临床应用专家委员会.甘草酸制剂肝病临床应用专家共识[J].临床肝胆病杂志, 2016, 32 (5) :844-852.

[17]SELVARAJAH V, MONTANO-LOZA AJ, CZAJA AJ.Systematic review:managing suboptimal treatment responses in autoimmune hepatitis with conventional and nonstandard drugs[J].Aliment Pharmacol Ther, 2012, 36 (8) :691-707.

[18]LIU L, LI XD, XIAO MZ, et al.Correlation analysis of autoantibodies and biochemical indicators in patients with autoimmune hepatitis typeⅠ[J/CD].Chin J Liver Dis:Electronic Edition, 2016, 8 (2) :14-18. (in Chinese) 刘玲, 李晓东, 肖明中, 等.自身免疫性肝炎Ⅰ型患者自身抗体与血清生物化学指标的相关性分析[J/CD].中国肝脏病杂志:电子版, 2016, 8 (2) :14-18.

[19]QIU DK, MA X, SHENG L.Study on strengthening the response to the treatment of autoimmune hepatitis[J].Chin J Dig, 2013, 33 (1) :2-4.邱德凯, 马雄, 盛黎.加强对自身免疫性肝炎治疗应答的研究[J].中华消化杂志, 2013, 33 (1) :2-4.

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