影响泼尼松治疗自身免疫性肝炎患者完全应答的多因素分析*

doi:10.3969/j.issn.1672-5069.2025.04.022

摘要/Abstract

摘要： 目的探讨影响自身免疫性肝炎(AIH)患者接受标准疗法治疗应答的因素,以期为优化治疗方案提供临床依据。方法 2022年1月～2023年6月本合作团队医院诊治的AIH患者57例,均接受肝活检,并接受泼尼松或泼尼松联合硫唑嘌呤治疗。采用免疫比浊法检测血清免疫球蛋白,采用间接免疫荧光法或免疫印迹法检测血清自身抗体。应用多因素Logistic回归分析影响治疗应答的因素。结果在治疗1年末,57例AIH患者完全应答率为75.4%;非完全应答组基线年龄、存在肝硬化、腹水比例和Child-Pugh评分分别为57(44,62)岁、64.3%、42.8%和10(8,12)分,均显著大于或高于完全应答组【分别为53(41,60)岁、18.6%、11.6%和6(5,8)分,P<0.05】; 非完全应答组PLT计数和血清白蛋白水平分别为81(67,105)×10⁹/L和32.3(30.0,36.7)g/L,均显著低于完全应答组【分别为131(96,210)×10⁹/L和36.8(34.5,39.5)g/L,P<0.05】,而血清总胆红素、凝血酶原时间国际标准化比值(INR)、血清IgM和IgG水平分别为56.9(30.1,132.5)μmol/L、1.3(1.1,1.6)、14.0(12.3,16.7)g/L和17.7(14.5,19.4)g/L,均显著高于完全应答组【分别为34.3(16.7,67.9)μmol/L、1.1(1.0,1.2)、11.2(9.4,13.2)g/L和12.5(10.7,14.6)g/L,P<0.05】;两组肝组织界面性肝炎、玫瑰花环样表现、浆细胞浸润和胆管损伤发生率比较,差异不具有统计学意义(P>0.05);多因素Logistic回归分析发现肝硬化(OR=6.283,95%CI:1.728～10.769,P=0.002)、血清TBIL水平(OR=11.158,95%CI:2.200～18.758,P=0.001)和血清IgG水平(OR=16.894,95%CI:4.118～30.018,P<0.001)是影响AIH患者治疗应答的独立危险因素。结论一些因素,如合并肝硬化、高黄疸和血清IgG水平升高可能影响接受标准免疫抑制治疗的AIH患者应答反应,需优化治疗方案,以期提高疗效。

关键词: 自身免疫性肝炎, 泼尼松, 治疗, 应答, 影响因素

Abstract: Objective The aim of this study was to investigate impacting factors of poor response to immunosuppressive therapy in patients with autoimmune hepatitis (AIH). Methods 57 patients with AIH were enrolled in this study between January 2022 and June 2023, and all received liver biopsies. All patients were treated by prednisone or prednisone with combination of azathioprine. Blood biochemical indexes and immunoglobulin levels were routinely detected. Serum autoimmune antibodies were assayed by Western blot. Impacting factors of response was analyzed by multivariate Logistic regression. Results By end of one-year treatment, the complete response (CR) rate to immunosuppressive therapy in the 57 patients with AIH was 75.4%; ages, percentages of liver cirrhosis, ascites and Child-Pugh score in patients with partial response (PR) were 57(44, 62)yr, 64.3%, 42.8% and 10(8, 12)points, all significantly greater or higher than [53(41, 60)yr, 18.6%, 11.6% and 6(5, 8)points, respectively, P<0.05] in those with CR; PLT counts and serum albumin level in patients with PR were 81(67,105)×10⁹/L and 32.3(30.0, 36.7)g/L, both significantly lower than [131(96, 210)×10⁹/L and 36.8(34.5, 39.5)g/L, respectively, P<0.05], while total serum bilirubin (TSB) level, international normalized ratio of prothrombin time, serum IgM and IgG levels in patients with PR were 56.9(30.1, 132.5)μmol/L,1.3(1.1, 1.6),14.0(12.3, 16.7)g/L and 17.7(14.5, 19.4)g/L, all much higher than [34.3(16.7, 67.9)μmol/L, 1.1(1.0, 1.2),11.2(9.4, 13.2)g/L and 12.5(10.7, 14.6)g/L, respectively, P<0.05] in those with CR; there were no significant differences as respect to interfacial hepatitis, Rosette-like manifestations, plasma cell infiltration and bile duct damages between the two groups (P>0.05);multivariate Logistic regression analysis showed that liver cirrhosis (OR=6.283, 95%CI:1.728-10.769,P=0.002), TSB (OR=11.158, 95%CI:2.200-18.758, P=0.001) and serum IgG level (OR=16.894, 95%CI:4.118-30.018, P<0.001) were the independent factors impacting response to immunosuppressive therapy. Conclusion Clinicians should take some impacting factors into consideration when immunosuppressive therapy is administered in patients with AIH, and optimization of treatment might carry out as necessary as possible.

Key words: Autoimmune hepatitis, Prednisone, Therapy, Response, Impacting factors

李晓静, 黄丽, 莫波, 沈才飞. 影响泼尼松治疗自身免疫性肝炎患者完全应答的多因素分析^*[J]. 实用肝脏病杂志, 2025, 28(4): 565-568.

Li Xiaojing, Huang Li, Mo Bo, et al. Multivariate Logistic regression analysis of factors impacting response to immunosuppressive therapy in patients with autoimmune hepatitis[J]. Journal of Practical Hepatology, 2025, 28(4): 565-568.

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影响泼尼松治疗自身免疫性肝炎患者完全应答的多因素分析^*

Multivariate Logistic regression analysis of factors impacting response to immunosuppressive therapy in patients with autoimmune hepatitis

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