Czaja A J, Carpenter H A, Santrach P J, Moore S B
Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Gastroenterology. 1993 Nov;105(5):1502-7. doi: 10.1016/0016-5085(93)90157-8.
HLA DR3 and DR4 have been recognized as independent risk factors for autoimmune hepatitis. We compared the clinical features and prognosis of patients with HLA DR4 to those with HLA DR3 and other phenotypes to determine if subclassification by HLA is a valid consideration.
Forty-four patients with HLA DR4; 41 patients with HLA DR3; and 16 patients with neither allele were studied. Ninety patients were treated with corticosteroids.
Patients with HLA DR4 were older (51 +/- 2 years vs. 38 +/- 3 years, P = 0.0001) and more commonly women (89% vs. 68%, P = 0.04) than counterparts with HLA DR3. Additionally, these patients had higher serum immunoglobulin G levels (3300 +/- 216 mg/dL vs. 2732 +/- 192 mg/dL, P = 0.05) and a greater frequency of concurrent immunologic diseases (59% vs. 27%, P = 0.005). Similar differences in clinical presentation distinguished the patients with HLA DR4 from those with other phenotypes. Remission during corticosteroid therapy (85% vs. 63%, P = 0.05) occurred more commonly in the patients with HLA DR4 than in those with HLA DR3 and treatment failure (10% vs. 32%, P = 0.03) occurred less frequently.
Patients with HLA DR4 have a different clinical profile than counterparts with other phenotypes, and they have a better response to corticosteroid therapy than patients with HLA DR3. Subclassification of patients by HLA DR phenotype may have clinical and prognostic value.
HLA DR3和DR4已被公认为自身免疫性肝炎的独立危险因素。我们比较了HLA DR4患者与HLA DR3及其他表型患者的临床特征和预后，以确定按HLA进行亚分类是否是一个有效的考虑因素。
研究了44例HLA DR4患者、41例HLA DR3患者和16例无这两个等位基因的患者。90例患者接受了皮质类固醇治疗。
与HLA DR3患者相比，HLA DR4患者年龄更大（51±2岁对38±3岁，P = 0.0001），女性更常见（89%对68%，P = 0.04）。此外，这些患者血清免疫球蛋白G水平更高（3300±216mg/dL对2732±192mg/dL，P = 0.05），并发免疫性疾病的频率更高（59%对27%，P = 0.005）。临床表现的类似差异区分了HLA DR4患者与其他表型患者。皮质类固醇治疗期间的缓解率（85%对63%，P = 0.05）在HLA DR4患者中比在HLA DR3患者中更常见，而治疗失败率（10%对32%，P = 0.03）在HLA DR4患者中更低。
HLA DR4患者与其他表型患者具有不同的临床特征，并且他们对皮质类固醇治疗的反应比HLA DR3患者更好。按HLA DR表型对患者进行亚分类可能具有临床和预后价值。
