肝脂肪变性对泼尼松与硫唑嘌呤联合治疗的自身免疫性肝炎患者治疗应答的影响  

Impact of hepatic steatosis on biochemical remission in patients with autoimmune hepatitis receiving standardized prednisone and azathioprine therapy

作　　者：管海燕 张慧[1] 张毅 王晓兰 吴婷婷 Guan Haiyan;Zhang Hui;Zhang Yi(Department of Pharmacy,Second Affiliated Hospital,Soochow University,Suzhou 215151,Jiangsu Province,China)

机构地区：[1]苏州大学附属第二医院药学部,江苏省苏州市215151 [2]苏州大学附属第二医院内分泌科,江苏省苏州市215151

出　　处：《实用肝脏病杂志》2025年第2期214-217,共4页Journal of Practical Hepatology

基　　金：江苏省自然科学基金资助项目(编号:BK20221525)。

摘　　要：目的探讨肝脏脂肪变性对泼尼松与硫唑嘌呤联合治疗的自身免疫性肝炎(AIH)患者生化缓解和不良结局的影响。方法2018年1月~2022年12月我院诊治的AIH患者58例,使用FibroScan 502型肝脏瞬时弹性测定仪行肝脏受控衰减参数(CAP)和肝脏硬度检测(LSM)。给予标准的泼尼松与硫唑嘌呤联合治疗观察6个月,以完全生化学缓解(CR)和不完全生化学缓解(IBR)考评疗效。应用多因素Logistic回归分析影响IBR和不良结局发生的危险因素。结果经过6个月治疗,在58例AIH患者中,35例(60.3%)获得CR,23例(39.7%)为IBR;IBR组BMI、高血压和糖尿病占比、血清球蛋白水平及CAP和LSM分别为(26.9±2.8)kg/m^(2)、43.5%和39.1%、34.6(28.4,38.4)g/L及(275.6±16.5)dB/m和9.8(6.5,13.6)kPa,显著高于CR组【分别为(22.1±2.8)kg/m^(2)、11.4%和5.7%、25.3(23.6,29.4)g/L及(192.0±33.5)dB/m和5.4(2.5,8.0)kPa,P<0.05】,而血清白蛋白水平为32.4(31.6,35.7)g/L,显著低于CR组【38.3(33.6,43.7)g/L,P<0.05】;经多因素Logistic回归分析显示,CAP、肝组织重度脂肪变和LSM是发生IBR和临床不良结局的独立危险因素(P<0.05)。结论肝组织脂肪变性可能影响AIH患者标准治疗后生化学缓解,从而导致不良结局的发生,需要密切关注。Objective This study was conducted to explore the impact of hepatic steatosis on biochemical remission in patients with autoimmune hepatitis(AIH)receiving standardized prednisone and azathioprine therapy.Methods 58 patients with AIH were encountered in our hospital between January 2018 and December 2022,and all received standardized prednisone and azathioprine therapy for six months.At admission,all patients underwent liver biopsies,and the controlled attenuation parameter(CAP)and liver stiffness measurement were detected by FibroScan 502.The therapeutic efficacy was assessed as complete remission(CR)and insufficient biochemical remission(IBR).The influencing factors on biochemical remission and untoward outcomes were analyzed by multivariate Logistic regression.Results At the end of six month treatment,35 patients(60.3%)responded,while 23 patients(39.7%)didn’t;the body mass index,the percentages of concomitant hypertension and diabetes,serum globulin level as well as the CAP and LSM in patients with IBR were(26.9±2.8)kg/m^(2),43.5%and 39.1%,34.6(28.4,38.4)g/L,and(275.6±16.5)dB/m and 9.8(6.5,13.6)kPa,all significantly higher than[(22.1±2.8)kg/m^(2),11.4% and 5.7%,25.3(23.6,29.4)g/L,and(192.0±33.5)dB/m and 5.4(2.5,8.0)kPa,respectively,P<0.05],while serum albumin level was 32.4(31.6,35.7)g/L,much lower than[38.3(33.6,43.7)g/L,P<0.05]in patients with CR;the multivariate Logistic regression analysis showed that the CAP,severe hepatic steatosis and the LSM were all the independent risk factors for the occurrence of IBR and untoward outcomes(P<0.05)in patients with AIH.Conclusion The hepatic steatosis could impact the response to standardized therapy in patients with AIH,which might lead to the untoward outcomes and needs carefully managed in clinical practice.

关 键 词：自身免疫性肝炎 泼尼松 硫唑嘌呤 肝脂肪变性 治疗 生化缓解 

分 类 号：R575.1[医药卫生—消化系统]