Features and consequences of untreated type 1 autoimmune hepatitis
Features and consequences of untreated type 1 autoimmune hepatitis
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DOI：
10.1111/j.1478-3231.2008.01904.x
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发表时间：
2009-07-01
影响因子：
6.7
通讯作者：
Czaja, Albert J.
中科院分区：
文献类型：
--
作者：
Czaja, Albert J.
存在一种不需要治疗的轻度自身免疫性肝炎仍然存在争议。本研究的目的是确定这种形式的存在，特点和结果。未治疗的1型自身免疫性肝炎患者谁不满足预先建立的严重疾病的标准进行了回顾性研究，并与治疗patients.Twenty-one 282例（7%）在32年期间进行了评估没有接受皮质类固醇治疗。这些无症状患者占137例符合轻度疾病相似标准的患者的15%。未接受治疗的轻度疾病患者与116例接受治疗的轻度疾病患者无法区分，他们与145例接受治疗的重度疾病患者的区别仅在于定义疾病严重程度的预先确定的特征。在77 +/- 31个月的观察期内，8名接受随访评估的未治疗患者的缓解率低于接受治疗的轻度或重度患者（12 vs 63%，P=0.006），10年生存率较低（67 vs 98%，P=0.01）。4例患者虽然未达到缓解标准，但确实自发改善，并在28 +/- 15个月（范围，5-73个月）内保持良好。在125 +/- 51个月的观察期内（范围32-239个月），有4例患者病情恶化，其中2例死于肝衰竭。轻度1型自身免疫性肝炎确实存在，其发生频率可能与重度肝炎一样高。未经治疗的轻度疾病患者可以自发改善，但没有可靠的指标来识别这个亚组并证明暂停治疗的合理性。
The existence of a mild form of autoimmune hepatitis that does not require treatment remains controversial. The aim of this study was to determine the existence, characteristics and outcome of this form.Untreated patients with type 1 autoimmune hepatitis who did not satisfy pre-established criteria for severe disease were identified retrospectively and compared with treated patients.Twenty-one of 282 patients (7%) who were evaluated during a 32-year period did not receive corticosteroid treatment. These asymptomatic patients constituted 15% of 137 patients who satisfied similar criteria for mild disease. Untreated patients with mild disease were indistinguishable from 116 treated patients with mild disease, and they differed from 145 treated patients with severe disease only by the pre-established features that defined disease severity. The eight untreated patients with follow-up assessments satisfied remission criteria less commonly than treated patients with mild or severe disease during 77 +/- 31 months of observation (12 vs 63%, P=0.006), and they had a lower 10-year survival (67 vs 98%, P=0.01). Four patients did improve spontaneously albeit short of remission criteria and remained well for 28 +/- 15 months (range, 5-73 months). Four patients worsened during 125 +/- 51 months of observation (range, 32-239 months), including two of three patients with cirrhosis who died of liver failure.Mild type 1 autoimmune hepatitis does exist, and it may be as frequent as severe disease. Untreated patients with mild disease can improve spontaneously, but there are no confident indices by which to identify this subgroup and justify withholding treatment.