UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and University College London, London, United Kingdom; Internal Medicine Unit, Department of Medicine, University of Udine, Udine, Italy; Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano- Bicocca, Monza, Italy.
UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and University College London, London, United Kingdom; UCL Institute of Immunity and Infection, Division of Medicine, University College London, London, United Kingdom.
Dig Liver Dis. 2020 Jul;52(7):761-767. doi: 10.1016/j.dld.2020.04.012. Epub 2020 May 27.
There is limited evidence linking achievement of biochemical response with outcomes in Autoimmune Hepatitis (AIH), and it is unclear whether normalization of serum immunoglobulin G (IgG) levels influences prognosis.
We aimed to investigate factors associated with death or liver transplantation in patients affected by AIH.
We undertook a retrospective analysis of all AIH patients attending a tertiary liver unit since 1980. Patients not meeting established diagnostic criteria for AIH or with a follow-up shorter than 18 months were excluded.
107 patients meeting inclusion criteria were included in the study. Mean age at diagnosis was 44 years, 29 patients (27.1%) had cirrhosis at baseline. Median follow-up was 79 months, and 70 patients (79.5%) reached biochemical response. Biochemical response was associated with reduced hazard of liver transplant or death (HR 0.07, 95% CI 0.01-0.46), whereas cirrhosis at diagnosis was an independent predictor of liver transplantation or death (Hazard ratio (HR) 11.8, 95%, confidence interval (CI) 1.18-117.4). Lack of normalization of serum IgG levels was associated with reduced 5-year transplant-free survival (95% in patients normalizing, compared to 86%, p = 0.02).
Normalization of serum IgG levels alone translates in better transplant-free survival in patients with AIH and should be a treatment target along with transaminases.
目前仅有有限的证据表明自身免疫性肝炎（AIH）患者的生化缓解与结局相关，且血清免疫球蛋白 G（IgG）水平恢复正常是否影响预后尚不清楚。
本研究旨在探讨影响 AIH 患者死亡或肝移植的相关因素。
我们对 1980 年以来在一家三级肝脏科就诊的所有 AIH 患者进行了回顾性分析。排除未符合 AIH 明确诊断标准或随访时间短于 18 个月的患者。
本研究共纳入 107 例符合纳入标准的患者。诊断时的平均年龄为 44 岁，29 例（27.1%）患者在基线时已发生肝硬化。中位随访时间为 79 个月，70 例（79.5%）患者达到生化缓解。生化缓解与降低肝移植或死亡风险相关（HR 0.07，95%CI 0.01-0.46），而诊断时的肝硬化是肝移植或死亡的独立预测因素（HR 11.8，95%CI 1.18-117.4）。血清 IgG 水平未恢复正常与降低 5 年无移植生存率相关（在 IgG 水平恢复正常的患者中为 95%，而在未恢复正常的患者中为 86%，p=0.02）。
仅血清 IgG 水平恢复正常可改善 AIH 患者的无移植生存率，应与转氨酶一起作为治疗目标。
Zotero 插件