Fédération des Spécialités Digestives bUnité d'Hépatologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Eur J Gastroenterol Hepatol. 2009 Dec;21(12):1413-8. doi: 10.1097/MEG.0b013e32832ad5f7.
The combination of corticosteroids and azathioprine is the standard therapy for autoimmune hepatitis. The aim of this study was to describe our experience on long-term corticosteroid doses reducing and withdrawal in a large cohort of children with autoimmune hepatitis (AIH).
All children presenting with AIH in our institution, from 1990 to 2006, were retrospectively included.
The study population included 55 children [38 females, 17 males, median age 8 years (ranging from 0.8 to 15)] with type 1 (74.5%), type 2 (20%) or seronegative (5.5%) AIH. The diagnosis was made in 41 of them at the time of acute hepatitis (75%); the other 14 were diagnosed as chronic liver disease (25%). Treatment consisted of corticosteroids and azathioprine in 45 patients or corticosteroids alone in five patients. Complete remission was obtained within 1 year in 31 (69%) patients. The median initial dose of corticosteroids was 1.6 mg/kg/day, and the dose was progressively reduced to 0.32 mg/kg/day at 1 year, 0.24 mg/kg/day at 3 years, 0.11 mg/kg/day at 5 years and 0.05 mg/kg/day at 10 years. Corticosteroids withdrawal was possible in 0% of patients at 1 year, 75% at 3 years, 78% at 5 years and 90% at 10 years. At the end of follow-up, azathioprine was maintained in 36 patients (80%). Total treatment withdrawal was obtained in four patients.
Our results strongly confirm that long-term corticosteroids withdrawal is possible in a large majority of children with autoimmune hepatitis.
皮质类固醇和硫唑嘌呤的联合治疗是自身免疫性肝炎的标准疗法。本研究旨在描述我们在大量自身免疫性肝炎（AIH）患儿中使用长期皮质类固醇剂量减少和停药的经验。
回顾性纳入我院 1990 年至 2006 年期间出现 AIH 的所有患儿。
研究人群包括 55 例患儿[38 例女性，17 例男性，中位年龄 8 岁（范围 0.8-15 岁）]，其中 1 型（74.5%）、2 型（20%）或血清阴性（5.5%）AIH。其中 41 例在急性肝炎时诊断（75%）；其余 14 例诊断为慢性肝病（25%）。45 例患儿接受皮质类固醇和硫唑嘌呤治疗，5 例患儿仅接受皮质类固醇治疗。31 例（69%）患儿在 1 年内获得完全缓解。皮质类固醇的初始剂量中位数为 1.6mg/kg/天，1 年后剂量逐渐减少至 0.32mg/kg/天，3 年后减少至 0.24mg/kg/天，5 年后减少至 0.11mg/kg/天，10 年后减少至 0.05mg/kg/天。1 年内有 0%的患儿可停用皮质类固醇，3 年内有 75%的患儿可停用皮质类固醇，5 年内有 78%的患儿可停用皮质类固醇，10 年内有 90%的患儿可停用皮质类固醇。在随访结束时，36 例患儿（80%）继续使用硫唑嘌呤。4 例患儿完全停药。
我们的结果强烈证实，在大多数自身免疫性肝炎患儿中，长期皮质类固醇停药是可行的。
