既往乙型肝炎病毒感染对自身免疫性肝炎治疗应答及预后的影响

摘要/Abstract

摘要： 目的探索既往乙型肝炎病毒(HBV)感染对自身免疫性肝炎(AIH)治疗应答及预后的影响。方法筛选从2002年1月至2020年12月在首都医科大学附属北京友谊医院诊断的AIH患者,分析既往HBV感染对AIH患者治疗应答及预后的影响。结果 114例患者中,既往HBV感染组患者40例,无既往HBV感染组患者74例。既往HBV感染组患者的ALT、AST显著低于无既往HBV感染组患者(99.5 vs.178.0,P=0.046;137.2 vs.161.0,P=0.049),抗中性粒细胞胞浆抗体高于无既往HBV感染的患者(35.7% vs. 4.8%,P=0.028)。两组患者在生化应答率及终点事件方面差异无统计学意义。既往HBV感染不是影响AIH患者治疗应答(OR=1.06,95%CI:0.03~1.21,P=0.106)及预后(HR=1.68,95%CI:0.42~6.75,P=0.463)的因素。而球蛋白(OR=1.06,95%CI:1.02~1.11,P=0.030)及3个月IgG复常(OR=3.75,95%CI:1.22~11.49,P=0.021)是免疫抑制治疗12个月时实现生化应答的独立预测因素。肝脏硬度(HR=1.06,95%CI:1.00~1.12,P=0.045)及失代偿期肝硬化(HR=7.54,95%CI:1.27~44.72,P=0.026)是AIH患者预后不佳的独立危险因素。结论在接受免疫抑制治疗后,与无既往HBV感染的AIH患者相比,既往HBV感染的AIH患者可获得相似的生化应答及预后。

关键词: 自身免疫性肝炎, 既往乙型肝炎病毒感染, 生化应答, 预后

Abstract: Objective To explore the impact of past infection of hepatitis B virus (HBV) on the biochemical response and prognosis of patients with autoimmune hepatitis (AIH).Methods Patients diagnosed with AIH from January 2002 to December 2020 at liver research center, Beijing Friendship Hospital, Capital Medical University were included. The clinical characteristics, biochemical response and end-point events such as hepatocellular carcinoma, liver transplantation and death from liver diseases were compared between the AIH patients with and without past HBV infection.Results 114 AIH patients with sufficient baseline and follow-up clinical data were retrieved, of which 74 patients were without past HBV infection and the rest of 40 patients were with HBV infection. The baseline levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly lower in AIH patients with past HBV infection (99.5 vs.178.0, P=0.046; 137.2 vs.161.0, P=0.049, respectively). When compared with AIH patients without past HBV infection, patients with past HBV infection showed higher positivity of antineutrophil cytoplasmic antibody (ANCA) (35.7% vs. 4.8%, P=0.028). No significant difference was shown in the biochemical responsive rate and the incidence of end-point events between these two groups. Past HBV infection was not associated with biochemical response (OR=1.06, 95%CI: 0.03-1.21, P=0.106) and end-point events (HR=1.68, 95%CI: 0.42-6.75, P=0.463). However, the level of globulin (OR=1.06, 95%CI: 1.02-1.11, P=0.030) and the normalization of IgG (OR=3.75, 95%CI: 1.22-11.49, P=0.021) at 3 months of immunosuppressive therapy were independent predictors of complete biochemical response of the AIH patients at 1 year of the treatment. Liver stiffness (HR=1.06, 95%CI: 1.00-1.12, P=0.045) and decompensated cirrhosis (HR=7.54, 95%CI: 1.27-44.72, P=0.026) were risk factors of poor prognosis.Conclusion Compared with AIH patients without past HBV infection, AIH patients with past HBV infection can achieve comparable biochemical response and prognosis once immunosuppressive therapy has been initiated.

Key words: Autoimmune hepatitis, Past hepatitis B viral infection, Biochemical response, Prognosis

苏雨, 孙小怡, 王倩怡, 赵新颜, 贾继东. 既往乙型肝炎病毒感染对自身免疫性肝炎治疗应答及预后的影响[J]. 肝脏, 2022, 27(7): 789-794.

SU Yu, SUN Xiao-yi, WANG Qian-yi, ZHAO Xin-yan, JIA Ji-dong. The impact of past hepatitis B virus infection on biochemical response and prognosis of patients with autoimmune hepatitis[J]. Chinese Hepatolgy, 2022, 27(7): 789-794.

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