Long-term Outcomes of Patients With Autoimmune Hepatitis Managed at a Nontransplant Center
Long-term Outcomes of Patients With Autoimmune Hepatitis Managed at a Nontransplant Center
复制标题
DOI：
10.1053/j.gastro.2011.02.065
复制
发表时间：
2011-06-01
期刊：
影响因子：
29.4
通讯作者：
Gleeson, Dermot
中科院分区：
文献类型：
--
作者：
Hoeroldt, Barbara;McFarlane, Elaine;Gleeson, Dermot
背景与目的：自身免疫性肝炎（AIH）患者的长期治疗结果被认为是良好的。然而，超过10年的随访数据是有限的，仅限于三级转诊中心。我们评估了来自非移植中心的AIH患者的长期预后和预后决定因素。方法：我们研究了245例AIH患者（204例女性;中位年龄56岁;范围2.5-87岁）（167例符合国际AIH组标准），从1971年到2007年在一个非移植中心接受治疗。结果：229例患者（93%）在治疗后12个月内达到正常血清丙氨酸转氨酶水平。在中位随访9.4年（范围0.01-36年）后，11例患者接受了肝移植（2例随后死亡）。2007年12月31日，另有70例患者死亡（30例死于肝病），15例被删失（离开、默认或发展为原发性胆汁性肝硬化），149例仍在随访。10年和20年后全因死亡或移植的存活率分别为82% +/- 3%和48% +/- 5%，肝脏相关死亡或移植的存活率分别为91% +/- 2%和70% +/-5%。全因死亡的标准化死亡率为1.63（95%置信区间[CI]，1.25-2.02），将肝移植视为“死亡”的标准化死亡率为1.86（95% CI，1.49-2.26），非肝脏相关死亡的标准化死亡率为0.91（95% CI，0.62-1.19）。通过考克斯回归分析，肝功能失代偿、任何时间的肝硬化、12个月内丙氨酸氨基转移酶水平未能恢复正常以及每10年复发>4次与肝脏相关死亡或移植显著相关。结论：尽管对免疫抑制剂的初始反应良好，但AIH患者的长期死亡率高于一般人群。
BACKGROUND & AIMS: The long-term outcomes of patients treated for autoimmune hepatitis (AIH) are considered to be good. However, follow-up data beyond 10 years are limited and confined to tertiary referral centers. We assessed long-term outcomes and determinants of outcome in patients with AIH from a nontransplant center. METHODS: We studied 245 patients (204 women; median age, 56 years; range, 2.5-87 years) with AIH (167 definite by International AIH Group criteria) managed at a single nontransplant center from 1971 to 2007. RESULTS: 229 patients (93%) achieved normal serum levels of alanine aminotransferase within 12 months after treatment. After a median follow-up period of 9.4 years (range, 0.01-36 years), 11 patients received liver transplants (2 subsequently died). Seventy other patients died (30 from liver disease), 15 were censored (moved away, defaulted, or developed primary biliary cirrhosis), and 149 were still being followed up on December 31, 2007. Survival rates from all-cause death or transplantation were 82% +/- 3% and 48% +/- 5% after 10 and 20 years, respectively, and from liver-related death or transplantation were 91% +/- 2% and 70% +/- 5%, respectively. The standardized mortality ratio was 1.63 for all-cause death (95% confidence interval [CI], 1.25-2.02), 1.86 also considering liver transplant as "death" (95% CI, 1.49-2.26), and 0.91 for non-liver-related death (95% CI, 0.62-1.19). By Cox regression analysis, liver decompensation, cirrhosis at any time, failure to normalize levels of alanine aminotransferase within 12 months, and >4 relapses per decade were significantly associated with liver-related death or transplant. CONCLUSIONS: Despite a good initial response to immunosuppression, long-term mortality of patients with AIH is greater than that of the general population.