Al-Chalabi Thawab, Underhill James A, Portmann Bernard C, McFarlane Ian G, Heneghan Michael A
Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK.
J Hepatol. 2008 Jan;48(1):140-7. doi: 10.1016/j.jhep.2007.08.013. Epub 2007 Oct 22.
BACKGROUND/AIMS: Autoimmune hepatitis (AIH) predominantly affects women. Reasons for this are unclear and few series have assessed long-term outcomes of men with AIH.
To evaluate the clinical course and outcomes of 51 men from a total of 238 consecutive patients with definite AIH at a single centre from 1971 to 2005. The primary outcome measure was death or liver transplantation.
Median age at diagnosis was 39 y in men and 49 y in women (p = 0.0589). HLA A1, B8 and DR3 allotypes and the HLA A1-B8-DR3 haplotype were more frequently expressed in men (63% vs. 45%, p = 0.049; 74% vs. 38%, p < 0.001; 62% vs. 44%, p = 0.058; and 50% vs. 23%, p = 0.003; respectively). There were no significant differences in clinical manifestations at presentation. Over 96% of patients demonstrated a complete initial response to treatment. A greater number of men experienced at least one relapse (71% vs. 55%, p = 0.0591). However, women were significantly more likely to die or require liver transplantation (Log rank test p = 0.024).
Men with AIH appear to have a higher relapse rate and younger age of disease onset which may relate to increased prevalence of HLA A1-B8-DR3. Despite this, men have significantly better long-term survival and outcomes than women.
背景/目的：自身免疫性肝炎（AIH）主要影响女性。其原因尚不清楚，且很少有系列研究评估男性AIH患者的长期预后。
评估1971年至2005年在单一中心连续确诊的238例AIH患者中51例男性患者的临床病程及预后。主要结局指标为死亡或肝移植。
男性诊断时的中位年龄为39岁，女性为49岁（p = 0.0589）。HLA A1、B8和DR3等位基因以及HLA A1 - B8 - DR3单倍型在男性中表达更为频繁（分别为63%对45%，p = 0.049；74%对38%，p < 0.001；62%对44%，p = 0.058；50%对23%，p = 0.003）。就诊时临床表现无显著差异。超过96%的患者对治疗有完全的初始反应。更多男性经历至少一次复发（71%对55%，p = 0.0591）。然而，女性死亡或需要肝移植的可能性显著更高（对数秩检验p = 0.024）。
男性AIH患者似乎复发率更高且发病年龄更年轻，这可能与HLA A1 - B8 - DR3的患病率增加有关。尽管如此，男性的长期生存率和预后明显优于女性。
