Czaja A J, Davis G L, Ludwig J, Baggenstoss A H, Taswell H F
Gastroenterology. 1983 Sep;85(3):713-7.
To determine if autoimmune features influence the prognosis of severe sporadic chronic active hepatitis of uncertain etiology, 126 corticosteroid-treated patients who had been screened to exclude active hepatitis B infection and possible drug effects or transfusion-related disease were categorized according to the presence of the lupus erythematosus cell, antinuclear antibody, smooth muscle antibody, and coexistent autoimmune diseases. Patients with autoimmune markers had findings similar to those without these features and responses to therapy were comparable. Remission (77% vs. 68%), treatment failure (16% vs. 14%), progression to cirrhosis (31% vs. 39%), and death from hepatic failure (4% vs. 12%) occurred with similar frequency in patients with and without the lupus erythematosus cell or antinuclear antibody. Although patients with the lupus erythematosus cell or antinuclear antibody tended to relapse less frequently than others, 5-yr survival was not increased (92% vs. 87%). Autoimmune diseases occurred as commonly in patients without the lupus erythematosus cell or antinuclear antibody as in those with these findings (16% vs. 17%), and the presence of these conditions did not identify patients with a different clinical behavior. In severe sporadic chronic active hepatitis of uncertain etiology, a clinically and prognostically distinct subgroup reflective of a possible autoimmune disorder cannot be defined.
为了确定自身免疫特征是否会影响病因不明的严重散发性慢性活动性肝炎的预后，我们对126例接受皮质类固醇治疗的患者进行了分类，这些患者经过筛查以排除活动性乙型肝炎感染以及可能的药物作用或输血相关疾病，分类依据是是否存在红斑狼疮细胞、抗核抗体、平滑肌抗体以及是否并存自身免疫性疾病。有自身免疫标志物的患者与没有这些特征的患者的检查结果相似，对治疗的反应也相当。有或没有红斑狼疮细胞或抗核抗体的患者，缓解率（77%对68%）、治疗失败率（16%对14%）、进展为肝硬化的比例（31%对39%）以及死于肝衰竭的比例（4%对12%）出现的频率相似。虽然有红斑狼疮细胞或抗核抗体的患者复发频率往往低于其他患者，但5年生存率并未提高（92%对87%）。没有红斑狼疮细胞或抗核抗体的患者与有这些检查结果的患者发生自身免疫性疾病的频率相同（16%对17%），并且这些情况的存在并不能识别出具有不同临床行为的患者。在病因不明的严重散发性慢性活动性肝炎中，无法定义一个在临床和预后方面具有明显特征、反映可能的自身免疫性疾病的亚组。
