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

作　　者：张红霞[1] 郭丽萍[1] 周璐[1] 王邦茂[1] ZHANG Hongxia;GUO Liping;ZHOU Lu;et al.(Department of Gastroenterology, General Hospital of Tianjin Medical University, Tianjin 300052, Chin)

机构地区：[1]天津医科大学总医院消化科,天津300052

出　　处：《临床肝胆病杂志》2018年第4期820-824,共5页Journal of Clinical Hepatology

基　　金：国家自然科学基金资助项目(81470834)

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。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 grou

关 键 词：肝炎 自身免疫性 肝硬化 预后 

分 类 号：R575.1[医药卫生—消化系统]