Sherman K E, Narkewicz M, Pinto P C
Department of Clinical Investigation, Fitzsimons Army Medical Center, Aurora, CO.
J Hepatol. 1994 Dec;21(6):1040-7. doi: 10.1016/s0168-8278(05)80615-4.
Autoimmune chronic active hepatitis is traditionally treated with corticosteroids, or corticosteroids with azathioprine. These drug therapies require long treatment periods and are associated with many debilitating drug side effects. Five patients with type I autoimmune chronic active hepatitis, and one with a probable overlap syndrome were treated with cyclosporine. All patients had previously undergone treatment with corticosteroids or corticosteroids with azathioprine and had failed to achieve total remission. In addition, all patients had significant side effects associated with therapy. Five of six patients normalized or near normalized alanine aminotransferase levels within 10 weeks of starting cyclosporine therapy. Biochemical remission was sustained for periods of up to 1 year in all primary cyclosporine responders as long as therapeutic cyclosporine levels were maintained. All responders had symptomatic improvement. Post-treatment liver biopsy was performed in three patients and histologic improvement was demonstrated in all cases. Cyclosporine appears to be a viable alternative to corticosteroid/azathioprine therapy for autoimmune chronic active hepatitis in patients who experience an incomplete response or who cannot tolerate the side effects of standard therapy.
自身免疫性慢性活动性肝炎传统上采用皮质类固醇或皮质类固醇与硫唑嘌呤联合治疗。这些药物疗法需要较长的治疗周期，且伴有许多使人虚弱的药物副作用。5例I型自身免疫性慢性活动性肝炎患者和1例可能患有重叠综合征的患者接受了环孢素治疗。所有患者此前均接受过皮质类固醇或皮质类固醇与硫唑嘌呤的治疗，但均未实现完全缓解。此外，所有患者均有与治疗相关的明显副作用。6例患者中有5例在开始环孢素治疗后的10周内，丙氨酸转氨酶水平恢复正常或接近正常。只要维持治疗性环孢素水平，所有初次使用环孢素治疗有效的患者的生化缓解可持续长达1年。所有治疗有效的患者症状均有改善。3例患者在治疗后进行了肝脏活检，所有病例均显示有组织学改善。对于对标准治疗反应不完全或无法耐受标准治疗副作用的自身免疫性慢性活动性肝炎患者，环孢素似乎是皮质类固醇/硫唑嘌呤疗法的一种可行替代方案。
