西罗莫司在治疗难治性自身免疫性肝炎中的应用。
Use of sirolimus in the treatment of refractory autoimmune hepatitis.
机构信息
Department of Medicine and Liver Research Institute, University of Arizona College of Medicine, Tucson.
Department of Medicine and Liver Research Institute, University of Arizona College of Medicine, Tucson.
出版信息
Am J Med. 2014 Nov;127(11):1128-1131. doi: 10.1016/j.amjmed.2014.06.016. Epub 2014 Jun 27.
BACKGROUND
Corticosteroids and azathioprine are widely accepted as the initial therapy for autoimmune hepatitis. However, the disease is refractory to steroids in about 10%-20% of patients, for whom currently there is no standardized treatment. Here we describe our experience with sirolimus in treatment of steroid refractory autoimmune hepatitis.
METHODS
This is a longitudinal follow-up study. Between November 2007 and January 2014, 5 subjects with steroid refractory autoimmune hepatitis were treated with sirolimus at our institution.
RESULTS
A response, defined as a sustained >50% fall in alanine aminotransferase (ALT) levels, was achieved in 4/5 patients. A complete response, sustained normalization of ALT levels, was achieved in 2/5 patients. The need for steroids was significantly reduced in all patients (P < .05).
CONCLUSIONS
In this small series, sirolimus appears to be useful in the treatment of patients with steroid refractory autoimmune hepatitis.
背景
皮质类固醇和硫唑嘌呤被广泛认为是自身免疫性肝炎的初始治疗方法。然而，大约 10%-20%的患者对类固醇治疗有反应，目前对于这些患者还没有标准化的治疗方法。在这里，我们描述了我们在治疗类固醇难治性自身免疫性肝炎中使用西罗莫司的经验。
方法
这是一项纵向随访研究。在 2007 年 11 月至 2014 年 1 月期间，我们机构对 5 例类固醇难治性自身免疫性肝炎患者使用了西罗莫司治疗。
结果
4/5 的患者出现应答，定义为丙氨酸氨基转移酶（ALT）水平持续下降>50%。2/5 的患者获得完全应答，ALT 水平持续正常化。所有患者对类固醇的需求均显著减少（P<0.05）。
结论
在这项小系列研究中，西罗莫司似乎对治疗类固醇难治性自身免疫性肝炎患者有用。
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