Long-Term Prognostic Significance of Persisting Histological Activity Despite Biochemical Remission in Autoimmune Hepatitis
Long-Term Prognostic Significance of Persisting Histological Activity Despite Biochemical Remission in Autoimmune Hepatitis
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DOI：
10.1038/ajg.2015.139
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发表时间：
2015-07-01
影响因子：
9.8
通讯作者：
Gleeson, Dermot
中科院分区：
文献类型：
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作者：
Dhaliwal, Harpreet K.;Hoeroldt, Barbara S.;Gleeson, Dermot
目的：生化缓解被广泛认为是自身免疫性肝炎（AIH）令人满意的治疗终点。尽管生化缓解，但持续的组织学活性的意义尚不清楚。我们的目的是评估经治疗达到生化缓解的AIH患者持续组织学炎症的频率和预后意义。方法：我们研究了120例符合国际标准的AIH患者（诊断时中位年龄57岁，81%为女性）（59%明确），这些患者接受免疫抑制治疗，并在持续生化缓解（定义为血清ALT和球蛋白正常）至少6个月后进行随访肝活检。结果：55例（46%）患者具有持续的组织学活性（Ishak组织学活性指数(HAI) >= 4）。这些患者在随访活检时血清ALT （24 vs. 18 IU/l, P = 0.003）和AST （27 vs. 23 IU/l, P = 0.03）高于达到组织学缓解的患者（HAI）
OBJECTIVES: Biochemical remission is widely considered a satisfactory treatment end point in autoimmune hepatitis (AIH). The signifi cance of persisting histological activity despite biochemical remission is unknown. We aimed to assess the frequency and prognostic significance of persisting histological infl ammation in patients with AIH who had achieved biochemical remission with treatment.METHODS: We studied 120 patients (median age at diagnosis 57 years; 81% female) with AIH by International Criteria (59% definite), who received immunosuppressive treatment and underwent a follow-up liver biopsy after at least 6 months of sustained biochemical remission (defined as normal serum ALT and globulin).RESULTS: Fifty-five patients (46%) had persisting histological activity (Ishak histological activity index (HAI) >= 4). These patients had higher serum ALT (24 vs. 18 IU/l, P = 0.003) and AST (27 vs. 23 IU/l, P = 0.03) at the time of follow-up biopsy, compared with patients who achieved histological remission (HAI