霉酚酸酯治疗自身免疫性肝炎的作用——一项观察性研究
Role of mycophenolate mofetil for the treatment of autoimmune hepatitis-an observational study.
作者信息
Jothimani Dinesh, Cramp Mathew E, Cross Tim J S
机构信息
Institute of Liver Disease and Transplantation, Global Hospitals, Chennai, India.
The South West Liver Unit, Plymouth Hospitals, Derriford Road, Plymouth, Devon PL6 8DH, United Kingdom.
出版信息
J Clin Exp Hepatol. 2014 Sep;4(3):221-5. doi: 10.1016/j.jceh.2014.05.003. Epub 2014 Jun 24.
BACKGROUND
Eighty percent (80%) of patients with Autoimmune hepatitis (AIH) respond to a combination of prednisolone and Azathioprine (AZA). Choice of treatment is limited for those who do not respond to this standard therapy. We evaluated the role of Mycophenolate mofetil (MMF) as a second line therapy in AIH.
METHOD
A retrospective observational study was carried out on all patients who received MMF for AIH.
RESULTS
Twenty out of 117 patients with AIH received MMF due to AZA intolerance (18 patients) or refractory disease (2 patients). Median age of the study patients was 56 (18-79) years, Male, n = 3 (15%) and Female, n = 18 (85%). After a median follow-up period of 47 (5-83) months, 14 (73.6%) patients were still on MMF with biochemical remission, including 4 out of 5 patients with cirrhosis. One patient was lost to follow-up. Three patients were intolerant of MMF due to adverse events, and two had disease refractory to MMF. Both these patients with refractory disease to MMF were initially unresponsive to AZA therapy.
CONCLUSION
MMF is a safe second line agent in patients with autoimmune hepatitis including those with cirrhosis.
背景
80%的自身免疫性肝炎（AIH）患者对泼尼松龙和硫唑嘌呤（AZA）联合治疗有反应。对于那些对这种标准疗法无反应的患者，治疗选择有限。我们评估了霉酚酸酯（MMF）作为AIH二线治疗的作用。
方法
对所有接受MMF治疗AIH的患者进行了一项回顾性观察研究。
结果
117例AIH患者中有20例因对AZA不耐受（18例）或难治性疾病（2例）接受了MMF治疗。研究患者的中位年龄为56（18 - 79）岁，男性3例（15%），女性18例（85%）。中位随访期为47（5 - 83）个月后，14例（73.6%）患者仍在接受MMF治疗且生化指标缓解，其中5例肝硬化患者中有4例。1例患者失访。3例患者因不良事件对MMF不耐受，2例患者疾病对MMF难治。这2例对MMF难治的患者最初对AZA治疗也无反应。
结论
MMF对于自身免疫性肝炎患者，包括肝硬化患者，是一种安全的二线药物。
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