自身免疫性肝炎治疗后应答不佳或不耐受的预测因素分析

Analysis of predictors of poor response or intolerance in patients with autoimmune hepatitis after treatment

目的评估自身免疫性肝炎(AIH)患者治疗后应答不佳或不耐受的预测因素。方法回顾2012年1月至2020年7月AIH患者92例(男性26例、女性66例),年龄37(2,68)岁。定义ALT、AST正常为治疗后应答(应答组),ALT、AST维持在2倍正常值上限(ULN)(治疗应答不佳)或>2倍ULN(治疗不耐受)为治疗后不应答(非应答组)。M(P25,P75)表示计量资料,Kruskal-Wallis H检验比较;(%)表示计数资料,卡方检验比较;Logistic回归分析探讨AIH患者应答不佳或不耐受的影响因素。结果AIH患者中应答组55例,非应答组37例,比较两组患者一般资料可知,AIH确诊年龄、AIH病情进展及肝硬化等差异具有统计学意义(P<0.05),而性别、急性起病、AIH复发、自身免疫性疾病等差异不具有统计学意义(P>0.05)。应答组、非应答组AIH患者ALT、AST、抗平滑肌抗体(SMA)及抗肝特异性胞浆抗原I型抗体(LC-1)等差异具有统计学意义(P<0.05),而TBIL、白蛋白、IgG、抗核抗体(ANA)、抗肝可溶性抗原抗体(抗-SLA)、抗肝肾微粒体抗体(抗-LKM)及抗线粒体抗体(AMA)等差异不具有统计学意义(P>0.05)。将AIH确诊年龄、AIH病情进展、肝硬化、ALT、AST、AMA及LC-1纳入Logistic回归分析,结果得出AIH确诊年龄、肝硬化是影响AIH患者应答不佳或不耐受的独立危险因素(P<0.05)。结论AIH确诊时年龄较小和病情阶段肝硬化的出现是AIH患者治疗后应答不佳或不耐受的危险因素。

Objective To evaluate the predictors of poor response or intolerance in autoimmune hepatitis(AIH)patients after treatment.Methods A total of 92 patients(26 males and 66 females)with AIH between January 2012 and July 2020 were reviewed.Normal ALT and AST were defined as post-treatment response(response group),ALT and AST maintained at 2 times the normal upper limit of(ULN)(treatment response was not good)or>2 times ULN(treatment intolerance)was defined as no response after treatment(non-response group).M(P25,P75)denotes metrological data and Kruskal-Wallis H test comparison;(%)represents counting data and chi-square test comparison;Logistic regression analysis explores the influencing factors of poor response or intolerance in AIH patients.Results There were 55 cases in response group and 37 cases in non-response group.The age of diagnosis of AIH,the progression of AIH and liver cirrhosis were significantly different between the two groups(P<0.05),but there was no significant difference in sex,acute onset,AIH recurrence and autoimmune diseases between the two groups(P>0.05).There were significant differences in ALT,AST,anti-smooth muscle antibody(SMA)and anti-liver specific cytoplasmic antigen type I antibody(LC-1)between response group and non-response group(P<0.05),but there was no significant difference in TBIL,albumin,IgG,antinuclear antibody(ANA),anti-liver soluble antigen antibody(anti-SLA),anti-liver and kidney microsomal antibody(anti-LKM)and anti-mitochondrial antibody(AMA)(P>0.05).The age of diagnosis of AIH,the progression of AIH,liver cirrhosis,ALT,AST,AMA and LC-1 were included in Logistic regression analysis.The results showed that the age of diagnosis of AIH and liver cirrhosis were independent risk factors for poor response or intolerance in patients with AIH.Conclusion Younger age at the time of diagnosis of AIH and the occurrence of cirrhosis in the disease stage are the risk factors of poor response or intolerance in patients with AIH after treatment.