Zhu Bing, You Shao-Li, Wan Zhi-Hong, Liu Hong-Ling, Rong Yi-Hui, Zang Hong, Xin Shao-Jie
Bing Zhu, Shao-Li You, Zhi-Hong Wan, Hong-Ling Liu, Yi-Hui Rong, Hong Zang, Shao-Jie Xin, Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing 100039, China.
World J Gastroenterol. 2014 Jun 21;20(23):7473-9. doi: 10.3748/wjg.v20.i23.7473.
To investigate the clinical features, response to corticosteroids, and prognosis of autoimmune hepatitis (AIH)-induced liver failure in China.
A total of 22 patients (19 female and 3 male; average age 51 ± 15 years) with AIH-induced liver failure treated in our hospital from 2004 to 2012 were retrospectively analyzed. Clinical, biochemical and pathological characteristics of the 22 patients and responses to corticosteroid treatment in seven patients were examined retrospectively. The patients were divided into survivor and non-survivor groups, and the clinical characteristics and prognosis were compared between the two groups. The t test was used for data analysis of all categorical variables, and overall survival was calculated by the Kaplan-Meier method.
At the time of diagnosis, mean IgG was 2473 ± 983 mg/dL, with three (18.8%) patients showing normal levels. All of the patients had elevated serum levels of antinuclear antibody (≥ 1:640). Liver histology from one patient showed diagnostic pathological changes, including massive necrosis and plasma cell infiltration. Four patients survived (18.2%) and 18 died (81.8%) without liver transplantation. The results showed that patients with low admission Model for End-Stage Liver Disease (MELD) scores (21.50 ± 2.08 vs 30.61 ± 6.70, P < 0.05) and corticosteroid therapy (100% vs 16.7%, P < 0.05) had better prognosis. A total of seven patients received corticosteroid therapy, of whom, four responded and survived, and the other three died. Survivors showed young age, shorter duration from diagnosis to corticosteroid therapy, low MELD score, and absence of hepatic encephalopathy at the time of corticosteroid administration. Six patients who were administered corticosteroids acquired fungal infections but recovered after antifungal therapy.
Early diagnosis and corticosteroid therapy are essential for improving the prognosis of patients with AIH-induced liver failure without liver transplantation.
探讨中国自身免疫性肝炎（AIH）所致肝衰竭的临床特征、对糖皮质激素的反应及预后。
回顾性分析2004年至2012年在我院接受治疗的22例AIH所致肝衰竭患者（19例女性，3例男性；平均年龄51±15岁）。回顾性检查22例患者的临床、生化和病理特征以及7例患者对糖皮质激素治疗的反应。将患者分为存活组和非存活组，比较两组的临床特征和预后。采用t检验对所有分类变量进行数据分析，采用Kaplan-Meier法计算总生存率。
诊断时，平均IgG为2473±983mg/dL，3例（18.8%）患者水平正常。所有患者血清抗核抗体水平均升高（≥1:640）。1例患者的肝脏组织学检查显示诊断性病理改变，包括大片坏死和浆细胞浸润。4例患者存活（18.2%），18例未进行肝移植死亡（81.8%）。结果显示，入院时终末期肝病模型（MELD）评分较低的患者（21.50±2.08 vs 30.61±6.70，P<0.05）和接受糖皮质激素治疗的患者（100% vs 16.7%，P<0.05）预后较好。共有7例患者接受了糖皮质激素治疗，其中4例有反应并存活，另外3例死亡。存活者年龄较小，从诊断到接受糖皮质激素治疗的时间较短，MELD评分较低，且在接受糖皮质激素治疗时无肝性脑病。6例接受糖皮质激素治疗的患者发生真菌感染，但抗真菌治疗后康复。
早期诊断和糖皮质激素治疗对于改善未进行肝移植的AIH所致肝衰竭患者的预后至关重要。
