摘要
目的探讨自身免疫性肝炎(AIH)患者接受免疫抑制剂治疗不应答的影响因素。方法2015年1月~2018年10月我院收治的AIH患者68例,接受标准的泼尼松或联合硫唑嘌呤治疗2年。使用血细胞分析仪检测血小板(PLT),自动给出平均血小板体积(MPV),所有患者接受肝活检。采用单因素和多因素Logistic回归分析影响AIH患者治疗不完全应答的预测因素。结果在治疗2年结束时,在68例AIH患者中实现完全应答42例(61.8%);入院时,完全应答患者MPV、γ-球蛋白、白蛋白(ALB)、TBIL、凝血酶原时间国际标准化比值(INR)和肌酐(Cr)分别为(8.5±2.0)fL、(23.8±5.2)%、(40.0±1.3)g/L、(23.4±3.9)μmol/L、(1.0±0.3)和(80.6±10.3)μmol/L,与不应答患者【分别为(10.3±2.3)fL、(33.1±7.1)%、(30.1±0.9)g/L、(36.2±5.3)μmol/L、(1.4±0.7)和(135.0±12.5)μmol/L】比,差异具有统计学意义(P<0.05),完全应答患者有肝硬化的比率为11.9%,显著低于不应答组的54.2%(P<0.05);以AIH患者治疗后应答与否为应变量,赋值0=完全应答,1=不应答,建立多因素Logistic回归分析模型,将上表有统计学意义的因素如MPV、γ-球蛋白、ALB、TBIL、INR、Cr和肝硬化纳入Logistic回归模型分析,结果显示血清γ-球蛋白和白蛋白水平、MPV和是否存在肝硬化是AIH患者治疗不应答的独立预测因素(P<0.05)。结论AIH患者可能对免疫抑制剂治疗不应答,MPV增大、高γ-球蛋白血症、低蛋白血症或存在肝硬化均是AIH患者治疗不应答的独立影响因素,针对这些难治性AIH患者需要进一步研究,以期制定出最佳的治疗策略。
Objective This study aimed to investigate the impacting factors in response to immunosuppressive therapy in patients with autoimmune hepatitis(AIH).Methods A total of 68 patients with AIH were enrolled in our hospital between January 2015 and October 2018,including 18 males and 50 females,with an average age of(52.8±11.1)years old.All patients with AIH received standardized prednisone and azathioprine therapy for 24 months.All patients underwent twice liver biopsies before and after treatment,and blood mean platelet volume(MPV)and serum globulin level were detected.The univariate and multivariate Logistic regression analysis were applied to analyze the predictive factors that impact the poor response of patients with AIH to immunosuppressive treatment.Results At the end of two year treatment,42(61.8%)out of the 68 patients with AIH in our series obtained complete response(CR)to immunosuppressive therapy;at presentation,the MPV,serumγ-globulin,albumin(ALB),total serum bilirubin,prothrombin time international normalized ratio(INR)and serum creatinine(sCr)levels were(8.5±2.0)fL,(23.8±5.2)%,(40.0±1.3)g/L,(23.4±3.9)μmol/L,(1.0±0.3)and(80.6±10.3)μmol/L,all significantly different compared to[(10.3±2.3)fL,(33.1±7.1)%,(30.1±0.9)g/L,(36.2±5.3)μmol/L,(1.4±0.7)and(135.0±12.5)μmol/L,respectively,P<0.05],the percentage of liver cirrhosis in patients with CR was 11.9%,much lower than 54.2%(P<0.05)in nonresponders;We took the response of patients with AIH after treatment as dependent variable,assigning 0=CR,1=poor response,establishing a multivariate Logistic regression analysis model,and included the above-mentioned statistically significant factors such as MPV,γ-globulin,albumin,bilirubin,INR,sCr and liver cirrhosis into the Logistic regression model.The Logistic regression analysis showed that serumγ-globulin,albumin,MPV and liver cirrhosis were the independent predictors of poor response to immunosuppressive therapy in patients with AIH(P<0.05).Conclusion The patients with AIH might failed to immunosuppr
作者
齐玫
张瑞金
田树萍
于艳华
Qi Mei;Zhang Ruijin;Tian Shuping(Department of Blood Transfusion,Clinical Medical Center,You'an Hospital Affiliated to Capital Medical University,Beijing 100069,China)
出处
《实用肝脏病杂志》
CAS
2021年第3期371-374,共4页
Journal of Practical Hepatology
基金
国家自然科学基金资助项目(编号:81860114)。
