Evaluation of risk factors for the development of cirrhosis in autoimmune hepatitis: Japanese NHO-AIH prospective study
Evaluation of risk factors for the development of cirrhosis in autoimmune hepatitis: Japanese NHO-AIH prospective study
复制标题
DOI：
10.1007/s00535-010-0337-y
复制
发表时间：
2011-01
影响因子：
6.3
通讯作者：
K. Migita;Yukio Watanabe;Yuka Jiuchi;Y. Nakamura;A. Saito;M. Yagura;H. Morimoto;M. Shimada;E. Mita;T. Hijioka;Haruhiro Yamashita;E. Takezaki;T. Muro;H. Sakai;M. Nakamuta;S. Abiru;K. Yano;A. Komori;H. Yatsuhashi;Minoru Nakamura;H. Ishibashi
中科院分区：
文献类型：
--
作者：
K. Migita;Yukio Watanabe;Yuka Jiuchi;Y. Nakamura;A. Saito;M. Yagura;H. Morimoto;M. Shimada;E. Mita;T. Hijioka;Haruhiro Yamashita;E. Takezaki;T. Muro;H. Sakai;M. Nakamuta;S. Abiru;K. Yano;A. Komori;H. Yatsuhashi;Minoru Nakamura;H. Ishibashi
自身免疫性肝炎（AIH）是一种以组织学界面性肝炎和循环自身抗体为特征的慢性进行性肝病。我们的目的是在AIH的前瞻性多中心队列研究中评估影响预后的危险因素，特别是肝硬化的发生。174例患者入组。组织学上，21例（12.1%）在最初观察时有肝硬化，其余153例在就诊时显示慢性或急性肝炎。在后153例患者中，14例在随访期间（平均8.0年）发生肝硬化。确定了与肝硬化发展相关的人口统计学、临床和实验室指标。发生肝硬化的患者在就诊时丙氨酸氨基转移酶（ALT; 158 ± 182 vs. 441 ± 423 IU/ml）和血小板计数（14.7 ± 5.5 vs. 19.4 ± 6.9 × 104/μl）的平均水平不同，接受了较低剂量的皮质类固醇（13.9 ± 15.8 vs. 31.8 ± 85.5 mg/d）。在多变量分析中，进展为肝硬化的独立预测因素是发病年龄较大（≥60岁）。AIH合并肝硬化或发展为肝硬化的患者生存率更低。AIH患者发病年龄大，易发生肝硬化，应加强观察，积极治疗。
Autoimmune hepatitis (AIH) is a chronic and progressive liver disease characterized by histological interface hepatitis and circulating autoantibodies. Our aims were to evaluate risk factors that contribute to the outcome and, particularly, the development of liver cirrhosis in a prospective multicenter cohort study of AIH. One hundred and seventy-four patients were enrolled. Histologically 21 (12.1%) had cirrhosis at the initial observation and the remaining 153 showed chronic or acute hepatitis at presentation. Among the latter 153 patients, 14 developed cirrhosis during the follow-up period (mean 8.0 years). Demographic, clinical, and laboratory indices associated with the development of cirrhosis were identified. Patients who developed cirrhosis differed in mean levels of alanine aminotransferase (ALT; 158 ± 182 vs. 441 ± 423 IU/ml) and platelet counts (14.7 ± 5.5 vs. 19.4 ± 6.9 × 104/μl) at presentation and received lower doses of corticosteroid (13.9 ± 15.8 vs. 31.8 ± 85.5 mg/day). In a multivariate analysis, an independent predictor for progression to cirrhosis was an older age of onset (≥60 years). AIH patients with cirrhosis, or those who developed cirrhosis, had a worse survival. AIH patients with an older age of onset were likely to develop cirrhosis, and careful observation and aggressive treatments are necessary for such patients.