Inductivo-Yu Ira, Adams Atoya, Gish Robert G, Wakil Adil, Bzowej Natalie H, Frederick R Todd, Bonacini Maurizio
Division of Hepatology and Complex GI, Physicians Foundation, Department of Transplantation, California Pacific Medical Center, San Francisco, California, USA.
Clin Gastroenterol Hepatol. 2007 Jul;5(7):799-802. doi: 10.1016/j.cgh.2007.02.030. Epub 2007 May 16.
BACKGROUND & AIMS: The immunosuppressive treatment for autoimmune hepatitis (AIH) patients is prednisone and azathioprine. Ten percent to 20% of patients do not respond or are intolerant of standard treatment. The aim of this study was to assess the biochemical, histologic, and hematologic parameters during mycophenolate mofetil (MMF) treatment in AIH patients who did not respond to or were intolerant of prednisone and/or azathioprine.
A retrospective study was performed of 15 AIH patients who received MMF either as monotherapy or in combination with prednisone after failure or intolerance of the initial regimen. Records were reviewed as to initial therapy, reasons why MMF was initiated, liver enzyme levels, histology on MMF, and complications.
The mean age was 60 +/- 15 years. All patients were started on MMF at 1 gram twice a day, 3 on MMF monotherapy, and 12 on prednisone and MMF. The average MMF treatment duration was 41 months. Alanine aminotransferase levels decreased significantly from 91.73 +/- 88.69 to 60.87 +/- 71.2 (P = .03) on MMF treatment. Inflammatory scores (2.59 +/- 0.97 to 1.14 +/- 1.21, P = .02) and Ishak fibrosis scores (4.10 +/- 1.37 to 2.5 +/- 1.51, P = .02) also decreased. No significant hematologic complications were noted during MMF treatment.
Administration of MMF, either as monotherapy or in combination with prednisone, results in biochemical and histologic improvement in AIH patients who are prednisone and/or azathioprine intolerant or resistant without the development of significant complications. MMF should be studied prospectively as an alternative agent in the treatment of autoimmune liver disease.
自身免疫性肝炎（AIH）患者的免疫抑制治疗药物为泼尼松和硫唑嘌呤。10%至20%的患者对标准治疗无反应或不耐受。本研究旨在评估在对泼尼松和/或硫唑嘌呤无反应或不耐受的AIH患者中，霉酚酸酯（MMF）治疗期间的生化、组织学和血液学参数。
对15例AIH患者进行回顾性研究，这些患者在初始治疗方案失败或不耐受后接受MMF单药治疗或与泼尼松联合治疗。回顾记录了初始治疗情况、启动MMF的原因、肝酶水平、MMF治疗时的组织学情况及并发症。
平均年龄为60±15岁。所有患者开始服用MMF，剂量为每日2次，每次1克，3例接受MMF单药治疗，12例接受泼尼松与MMF联合治疗。MMF平均治疗时长为41个月。MMF治疗期间，丙氨酸氨基转移酶水平从91.73±88.69显著降至60.87±71.2（P = 0.03）。炎症评分（从2.59±0.97降至1.14±1.21，P = 0.02）和伊沙克纤维化评分（从4.10±1.37降至2.5±1.51，P = 0.02）也有所下降。MMF治疗期间未发现明显的血液学并发症。
MMF单药治疗或与泼尼松联合治疗，可使对泼尼松和/或硫唑嘌呤不耐受或耐药的AIH患者在生化和组织学方面得到改善，且无明显并发症发生。MMF应作为治疗自身免疫性肝病的替代药物进行前瞻性研究。
