COMPLETE RESOLUTION OF INFLAMMATORY ACTIVITY FOLLOWING CORTICOSTEROID TREATMENT OF HBSAG-NEGATIVE CHRONIC ACTIVE HEPATITIS
COMPLETE RESOLUTION OF INFLAMMATORY ACTIVITY FOLLOWING CORTICOSTEROID TREATMENT OF HBSAG-NEGATIVE CHRONIC ACTIVE HEPATITIS
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DOI：
10.1002/hep.1840040409
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发表时间：
1984-01-01
期刊：
影响因子：
13.5
通讯作者：
TASWELL, HF
中科院分区：
文献类型：
--
作者：
CZAJA, AJ;DAVIS, GL;TASWELL, HF
为了评估皮质类固醇治疗后炎症活动完全消退的频率和意义，对115例重度HBsAg[肝炎B表面抗原]阴性慢性活动性肝炎患者进行了84 . ±. 5个月。在83名有资格恢复正常肝组织的患者中，18名在56 . ±. 8个月。18人中有5人在停止治疗后复发。只有那些在停止治疗后从慢性持续性肝炎的组织学特征自发改善到正常的患者总是保持改善。在32例肝硬化患者中，17例在48 . ±. 10个月，但仅3例在停止治疗后仍无活性。有和无组织恢复正常的患者死亡率相似（0 vs. 14%，P > 0.2），但完全消退后复发率较低（28 vs. 76%，P < 0.001）。在缓解和停药后，恢复为非活动性肝硬化并不能改善生存率或降低复发频率。治疗前的发现不能预测结果。显然，炎症活动完全消退是可能的，但治疗后发生缓慢、罕见且不可预测。在没有肝硬化的患者中，恢复正常的肝组织降低了复发的可能性和重新治疗的需要。在肝硬化患者中，炎症活动的消除很少持续，并且在缓解和停止治疗后不会改善预后。
To assess the frequency and significance of complete resolution of inflammatory activity following corticosteroid therapy, 115 patients with severe HBsAg[hepatitis B surface antigen]-negative chronic active hepatitis were followed regularly for 84 .+-. 5 mo. Of 83 patients eligible to revert to normal liver tissue, 18 did so after 56 .+-. 8 mo. Five of the 18 relapsed after treatment withdrawal. Only patients who improved spontaneously after cessation of treatment from histologic features of chronic persistent hepatitis to normal invariably sustained the improvement. Of 32 patients with cirrhosis at presentation, 17 reverted to inactive cirrhosis after 48 .+-. 10 mo., but only 3 remained inactive after discontinuation of treatment. Mortality was similar in patients with and without reversion to normal tissue (0 vs. 14%, P > 0.2), but the frequency of relapse was less after complete resolution (28 vs. 76%, P < 0.001). Reversion to inactive cirrhosis did not improve survival or reduce relapse frequency after remission and treatment withdrawal. Findings prior to therapy did not predict outcome. Evidently, complete resolution of inflammatory activity is possible, but it occurs slowly, infrequently and unpredictably after therapy. In patients without cirrhosis, reversion to normal liver tissue decreases the likelihood of relapse and the requirement for retreatment. In patients with cirrhosis at presentation, elimination of inflammatory activity is rarely sustained and does not improve prognosis after remission and treatment withdrawal.