摘要
背景:自身免疫性肝炎在终止治疗后可出现复发,尤其是在那些肝酶恢复正常但并未取得组织学缓解的患者。欧洲肝脏研究协会(EASL)和美国肝病研究协会(AASLD)的指南均推荐在终止治疗前要进行肝脏活检。本研究的目的是评估那些经免疫抑制治疗疾病控制良好的成人患者在终止治疗后的临床结局,无论其在终止治疗前有没有进行肝活检。方法:本研究为回顾性观察研究,研究对象是经组织学证实的成人自身免疫性肝炎患者,其接受了2年免疫抑制治疗,且在终止治疗前6个月内天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)一直维持或接近正常水平。排除青少年自身免疫性肝炎、既往曾接受过治疗或采用了激素和硫唑嘌呤之外药物治疗的患者。主要结局指标是终止治疗后1年复发率。结果:满足纳入标准的34例连续病例纳入研究,其中24例在终止治疗前未行肝活检,10例行肝活检。两组一般资料、免疫抑制剂使用情况、治疗前肝硬化程度和肝酶水平的差异均无统计学意义。25%的患者在终止治疗后1年内出现肝酶升高,但未行肝活检组与行肝活检组1年复发率的差异并无统计学意义(20.8%vs.30.0%,P=0.57)。结论:经2年免疫抑制治疗疗效甚佳的成人自身免疫性肝炎患者,在终止治疗前无需行肝活检。
Background:Autoimmune hepatitis may flare up after treatment withdrawal,especially in those who had not achieved histological remission but had normal liver enzymes.The European Association for the Study of the Liver(EASL)and the American Association for the Study of Liver Disease(AASLD)Guidelines recommend performing liver biopsy before treatment withdrawal.The aim of the study is to define the outcome of treatment withdrawal in adults with wellcontrolled disease for 2 years with and without liver-biopsy guidance.Methods:A retrospective observational study was conducted on biopsy-proven autoimmune hepatitis patients who were treated for 2 years and with persistently normal aspartate aminotransferase(AST)and alanine aminotransferase(ALT)or nearly so for 6 months prior to treatment withdrawal.Exclusions were:juvenile onset autoimmune hepatitis and prior treatment or use of agents other than corticosteroids and azathioprine.The primary endpoint was to define freedomfrom flare-ups for 1 year after treatment withdrawal.Results:Thirty-four consecutive subjectsmeeting study criteria were identified.Treatment withdrawal was accomplished in 24 subjects without liver-biopsy guidance and 10 had pre-treatment withdrawal liver biopsy.Demographics,immunosuppressive usage,pre-treatment cirrhosis and pre-treatment liver enzymes were similar between the two groups,and 25%had an enzyme flare-up within 12months after treatment withdrawal,which was similar in the two groups(20.8 vs 30.0%,P=0.57).Conclusions:Adults with autoimmune hepatitis and excellent response to therapy for 2 years are candidates for treatment withdrawal without the need for liver biopsy.
