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自身免疫性肝炎治疗应答速度与疾病进展的相关性
Association between the rapidity of response and progression to cirrhosis in patients with autoimmune hepatitis
文章发布日期:2018年03月07日  来源:  作者:张红霞,郭丽萍,周璐,等  点击次数:354次  下载次数:48次

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【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、3~6个月组、6~12个月组、12~24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%)分别与3~6个月应答(41.7%)、6~12个月应答(20%)、12~24个月应答(62.5%)以及>24个月应答组(100%)比较,发现3个月内应答组较12~24个月、>24个月应答组肝硬化的进展率低,差异均有统计学意义(χ2值分别为5546、6.400,P值均<0.05)。并且3个月内应答组较12~24个月应答组发生持续转氨酶应答的比例高,差异有统计学意义(χ2=4.322,P<0.05)。结论AIH患者的治疗应答速度与预后有关,早期应答者肝硬化的进展率较低,3个月内应答可能是提示预后较好的一个早期的时间标准,而1年以上仍未应答可能是提示预后较差的一个晚期的时间标准。初始ALT水平及治疗药物可能会影响应答速度。
【Abstract】:ObjectiveTo 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. MethodsA 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. ResultsThe <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). ConclusionFor 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.
【关键字】:肝炎, 自身免疫性; 肝硬化; 预后
【Key words】:hepatitis, autoimmune; liver cirrhosis; prognosis
【引证本文】:ZHANG HX, GUO LP, ZHOU L, et al. Association between the rapidity of response and progression to cirrhosis in patients with autoimmune hepatitis[J]. J Clin Hepatol, 2018, 34(4): 820-824. (in Chinese)
张红霞, 郭丽萍, 周璐, 等. 自身免疫性肝炎治疗应答速度与疾病进展的相关性[J]. 临床肝胆病杂志, 2018, 34(4): 820-824.

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