自身免疫性肝炎患者硫嘌呤代谢物的水平及其对疗效的预测价值

肝脏 ›› 2026, Vol. 31 ›› Issue (2): 267-270.

自身免疫性肝炎患者硫嘌呤代谢物的水平及其对疗效的预测价值

吴本娟, 陈复喜, 孔纯玉

300190 天津天津市第一中心医院风湿免疫科(吴本娟,孔纯玉);300499 天津天津市北辰医院外科(陈复喜)

收稿日期:2025-05-13 出版日期:2026-02-28 发布日期:2026-04-17
通讯作者: 孔纯玉,Email: kongchunyu72@aliyun.com
基金资助:
天津市科技计划项目(25JCLMJC00250)

Levels of thiopurine metabolites in patients with autoimmune hepatitis and their predictive value for therapeutic effect

WU Ben-juan¹, CHEN Fu-xi², KONG Chun-yu¹

1. Department of Rheumatology and Immunology, Tianjin First Central Hospital, Tianjin 300190, China;
2. Department of Surgery, Beichen Hospital, Tianjin 300499, China

Received:2025-05-13 Online:2026-02-28 Published:2026-04-17
Contact: KONG Chun-yu,Email: kongchunyu72@aliyun.com

摘要/Abstract

摘要： 目的分析自身免疫性肝炎(AIH)患者硫嘌呤代谢物的水平及其对疗效的预测价值。方法选取2022年1月至2024年12月天津市第一中心医院收治的AIH患者52例,予以泼尼松联合硫唑嘌呤治疗,另选取同期健康体检者50名作为对照组。比较治疗前后AIH患者和对照组临床资料,分析不同治疗应答情况AIH患者6-硫鸟嘌呤核苷酸(6-TGN)、6-甲基巯基嘌呤核苷酸(6-MMPN)水平变化以及其对AIH患者应答情况的预测效能。结果治疗前,AIH患者ALT、AST、IgG、IgM及γ-球蛋白水平显著高于对照组(P<0.05),治疗后AIH患者ALT、AST、IgG、IgM及γ-球蛋白水平明显降低(P<0.05)。治疗结束时,应答完全31例,应答不完全21例,应答完全组6-TGN水平为225(74,717)pmol/8×10⁸ RBC,显著高于应答不完全组的150(53,370)pmol/8×10⁸ RBC(P<0.05),而两组6-MMPN水平差异无统计学意义(P>0.05)。在应答完全患者中,<3个月应答、3～6个月应答和>6个月应答病例数分别为12例、10例和9例。快速应答患者6-TGN水平显著高于相对延迟应答者,差异有统计学意义(P<0.05),而各应答时间AIH患者6-MMPN水平比较差异无统计学意义(P>0.05)。6-TGN预测AIH治疗应答的诊断效能较为理想,诊断截断点为174 pmol/8×10⁸ RBC、AUC为0.79。结论 6-TGN是AIH硫嘌呤治疗应答的核心预测指标,其浓度>174 pmol/8×10⁸ RBC时可作为完全应答的生物标志物。

关键词: 自身免疫性肝炎, 硫唑嘌呤, 6-硫鸟嘌呤核苷酸, 治疗应答

Abstract: Objective To analyze the levels of thiopurine metabolites in autoimmune hepatitis (AIH) patients and their predictive value for treatment efficacy. Methods Fifty-two AIH patients were enrolled between January 2022 and December 2024 and treated with prednisone combined with azathioprine. Fifty healthy individuals undergoing routine physical examinations during the same period were enrolled as control group. Clinical parameters of AIH group and control group were compared before and after treatment. Changes in 6-thioguanine nucleotides (6-TGNs) and 6-methylmercaptopurine nucleotides (6-MMPNs) levels were analyzed across different treatment response groups, and their predictive efficacy for AIH treatment response was evaluated. Results Before treatment, AIH patients showed significantly higher levels of ALT, AST, IgG, IgM, and gamma-globulin than controls (P<0.05). After treatment, these parameters decreased significantly in AIH patients (P<0.05). At the end of treatment, 31 patients achieved complete response, while 21 had incomplete response. The 6-TGN level in the complete response group [225 (74-717) pmol/8×10⁸ RBC] was significantly higher than in the incomplete response group [150 (53,370) pmol/8×10⁸ RBC, P<0.05], whereas 6-MMPN levels did not differ significantly between groups (P>0.05). Among complete responders, 12, 10, and 9 patients achieved response within <3 months, 3~6 months, and >6 months, respectively. Rapid responders (<6 months) had significantly higher 6-TGN levels than delayed responders (>6 months) (P<0.05), while 6-MMPN levels showed no significant differences across response timelines (P>0.05). 6-TGN demonstrated strong predictive value for treatment response (AUC=0.79; diagnostic cutoff: 174 pmol/8×10⁸ RBC). Conclusion 6-TGN is a core predictor of thiopurine treatment response in AIH. A concentration >174 pmol/8×10⁸ RBCs may serve as a biomarker for complete response.

Key words: Autoimmune hepatitis, Azathioprine, 6-thioguanine nucleotides, Treatment response

吴本娟, 陈复喜, 孔纯玉. 自身免疫性肝炎患者硫嘌呤代谢物的水平及其对疗效的预测价值[J]. 肝脏, 2026, 31(2): 267-270.

WU Ben-juan, CHEN Fu-xi, KONG Chun-yu. Levels of thiopurine metabolites in patients with autoimmune hepatitis and their predictive value for therapeutic effect[J]. Chinese Hepatolgy, 2026, 31(2): 267-270.

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