Ueno Masayuki, Takabatake Hiroyuki, Kayahara Takahisa, Morimoto Youichi, Notohara Kenji, Mizuno Motowo
Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Hepatol Res. 2023 Nov;53(11):1073-1083. doi: 10.1111/hepr.13940. Epub 2023 Jul 5.
Pulse steroid therapy occasionally causes drug-induced autoimmune-like hepatitis (DI-ALH), but the long-term outcome of treated patients is not well known. In this study, we investigated the long-term outcomes of DI-ALH due to pulse steroid therapy.
We retrospectively reviewed the medical records of 405 patients treated with pulse high-dose methylprednisolone in Kurashiki Central Hospital. The frequency and clinicopathological characteristics of acute liver injury that occurred within 3 months after the therapy were analyzed. The diagnosis of DI-ALH was made according to the revised international autoimmune hepatitis group criteria.
Among the 405 patients treated with methylprednisolone, 61 (15.1%) had acute liver injury after the pulse steroid therapy, and DI-ALH was diagnosed in five patients (1.2%). Absence of oral prednisolone tapering after the pulse steroid therapy was a significant risk factor for the subsequent development of DI-ALH (odds ratio 11.9; p = 0.017). One patient was treated with 3 days of intravenous methylprednisolone followed by oral prednisolone. Two patients were treated with glycyrrhizin followed by oral prednisolone due to ineffectiveness of glycyrrhizin. Remission was achieved with glycyrrhizin alone, and spontaneous remission without drug therapy occurred in one patient each. During the median follow-up period of 34 months, no relapse was evident in all the patients without maintenance therapy.
Pulse steroid therapy can cause DI-ALH, especially when subsequent prednisolone is not tapered. Prednisolone is effective for DI-ALH due to pulse steroid therapy, and can be safely withdrawn once remission is achieved.
脉冲式类固醇疗法偶尔会引发药物性自身免疫样肝炎（DI-ALH），但接受治疗患者的长期预后尚不清楚。在本研究中，我们调查了因脉冲式类固醇疗法导致的DI-ALH的长期预后。
我们回顾性分析了仓敷中央医院405例接受大剂量脉冲式甲基泼尼松龙治疗患者的病历。分析了治疗后3个月内发生的急性肝损伤的频率和临床病理特征。DI-ALH的诊断依据修订后的国际自身免疫性肝炎小组标准。
在405例接受甲基泼尼松龙治疗的患者中，61例（15.1%）在脉冲式类固醇治疗后出现急性肝损伤，5例（1.2%）被诊断为DI-ALH。脉冲式类固醇治疗后未逐渐减少口服泼尼松龙剂量是随后发生DI-ALH的一个重要危险因素（比值比11.9；p = 0.017）。1例患者先静脉注射甲基泼尼松龙3天，随后口服泼尼松龙。2例患者因甘草酸治疗无效，先使用甘草酸，随后口服泼尼松龙。单独使用甘草酸实现了缓解，另有1例患者未经药物治疗自发缓解。在34个月的中位随访期内，所有未接受维持治疗的患者均未出现复发。
脉冲式类固醇疗法可导致DI-ALH，尤其是在随后未逐渐减少泼尼松龙剂量的情况下。泼尼松龙对脉冲式类固醇疗法导致的DI-ALH有效，一旦实现缓解即可安全停药。
