Follow-up of children with autoimmune hepatitis treated with cyclosporine
Follow-up of children with autoimmune hepatitis treated with cyclosporine
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DOI：
10.1097/01.mpg.0000235975.75120.38
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发表时间：
2006-11-01
影响因子：
2.9
通讯作者：
Alvarez, Fernando
中科院分区：
文献类型：
--
作者：
Cuarterolo, Miriam;Ciocca, Mirta;Alvarez, Fernando
目的：评价环孢素与低剂量强的松和硫唑嘌呤联合使用时，诱导和维持自身免疫性肝炎炎症过程缓解的有效性，并确定与持续缓解相关的预后因素。方法：1994年1月至2001年3月，从5个中心连续招募自身免疫性肝炎患者84例。前6个月给予环孢素。此后，对于转氨酶水平低于正常值两倍的患者，开始使用强的松和硫唑嘌呤。结果：94.05%（79/84）的患者转氨酶正常，其中72%的患者在治疗前6个月内出现转氨酶正常。诊断时血清总胆红素水平大于1.2 mg/dL和门静脉高压症共同预示着缓解期的显著延迟。与环孢素相关的不良反应仍然是轻微和短暂的。在随访期间，低剂量的泼尼松和标准剂量的硫唑嘌呤与疾病复发无关。结论：该方案可以控制肝脏炎症过程，并且耐受性良好。对这种免疫抑制疗法的反应可以准确地预测。延迟缓解的因素可以在诊断早期确定，并可能有助于制定更有效的治疗政策。
Objectives: To evaluate the effectiveness of cyclosporine in, inducing and maintaining remission of the inflammatory process in autoinumme hepatitis, when used in combination with low doses of prednisone and azathioprine and to identify the prognostic factors associated with sustained remission.Methods: Eighty-four patients with autoimmune hepatitis were consecutively recruited from 5 centers between January 1994 and March 2001. Cyclosporine was administered during the first 6 months. Thereafter, in patients with aminotransferase levels of lower than twice the normal values, prednisone and azathioprine were initiated.Results: Normal aminotransferase levels were observed in 94.05% (79/84) of the patients, 72% of them within the first 6 months of treatment. Total serum bilirubin level of greater than 1.2 mg/dL and portal hypertension at diagnosis jointly predicted a significant delay in remission. Adverse effects related to cyclosporine remained mild and transient. Low doses of prednisone and standard doses of azathioprine were not implicated in relapse of the disease during the follow-up of any patient.Conclusions: This protocol allowed control of the liver inflammatory process and was well tolerated. The response to this immunosuppressive therapy can be predicted with accuracy. Factors delaying remission can be identified early at diagnosis and may contribute to the development of more effective treatment policies for this condition.