Objective: To investigate the clinical features of autoimmune hepatitis (AIH) patients with poor response to treatment. Methods: A total of 61 AIH patients were enrolled, among whom 49 (80.33%) achieved complete response (good response group) and 12 (19.67%) had incomplete response (poor response group). The two groups were compared in terms of clinical manifestations, laboratory markers, abdominal ultrasound findings, pathological features by liver biopsy, and response to treatment. Continuous data were expressed as mean ± standard deviation (x±s), and the t-test was used for comparison between groups; categorical data were expressed as rates or percentages, and the chi-square test was used for comparison between groups; a binary logistic regression analysis was used to determine influencing factors. Results: Most patients were female in both groups, and there were no significant differences in sex ratio, mean age of onset, and general status including extrahepatic autoimmune disease between the two groups. Compared with the good response group, the poor response group had significantly higher levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase (ALP), total bilirubin, immunoglobulin G, and immunoglobulin M (P < 0.05). Compared with the good response group, the poor response group had a significantly higher positive rate of autoimmune antibodies except anti-nuclear antibody (ANA), anti-smooth muscle antibody (SMA), antimitochondrial antibody (AMA), and AMA/M2 (75% vs 16.3%, P < 0.001), and there was a significant difference in the positive rate of gp210 antibody between the two groups (25% vs 0%, P < 0.01). There were significant differences between the poor response group and the good response group in the proportion of patients with liver cirrhosis (50.0 % vs 16.3%, P < 0.05) and splenomegaly (58.3% vs 22.4%, P < 0.05). The binary logistic regression analysis showed that a high serum level of ALP (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.001-1.033, P = 0.034), positive autoimmune antibodies except ANA, SMA, and AMA/M2 (OR = 70.842, 95% CI 2.132-2 354.371, P = 0.017), and liver cirrhosis (OR = 28.777, 95% CI 1.015-815.854, P = 0.049) were independent risk factors for initial treatment outcome. Conclusion: A high serum level of ALP, positive autoimmune antibodies except ANA, SMA, and AMA/M2, and liver cirrhosis are closely associated with poor response in AIH patients.
目的： 探讨自身免疫性肝炎初始治疗应答不良患者的临床特点。 方法： 61例AIH患者经过正规标准治疗之后，49例（80.33%）获得完全应答，为应答良好组，12例（19.67%）应答不完全，为应答不良组，比较分析两组患者的临床表现、实验室指标、腹部B超、肝穿刺活检病理学表现及治疗应答反应。文中所有计量资料以均数±标准差（x±s）表示，组间比较采用t检验；计数资料以率或百分比表示，采用χ(2)检验；影响因素分析采用二元logistic回归分析。 结果： 应答不良组与应答良好组均以女性为主，性别比例、平均发病年龄及伴发肝外自身免疫性疾病等一般状况无明显差异。应答不良组丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶（ALP）、总胆红素、免疫球蛋白（Ig）G与IgM均高于应答良好组，差异有统计学意义（P < 0.05）。与应答良好组相比，应答不良组合并除抗核抗体（ANA）、抗平滑肌抗体（SMA）、抗中性粒细胞抗体（AMA）及其M2型抗体之外的自身免疫性抗体阳性率更高（75.0%对比16.3%，P < 0.001），其中，抗gp210抗体在两组的阳性率分别为25%和0，差异有统计学差异(P < 0.01)。应答不良组和应答良好组肝硬化的比例分别为50%和16.3%，脾大的比例分别为58.3%和22.4%，两指标差异均有统计学意义（P < 0.05）。通过二元logistic回归分析，可以得出高ALP（P = 0.034，OR 1.017，95%CI 1.001～1.033）、合并除ANA、SMA、AMA/M2抗体之外的自身免疫性抗体阳性（P = 0.017，OR 70.842，95%CI 2.132～2 354.371）、肝硬化（P = 0.049，OR 28.777，95% CI 1.015～815.854）为影响初始治疗疗效的独立危险因素。 结论： 高ALP、合并除ANA、SMA、AMA/M2抗体之外自身免疫抗体阳性及肝硬化均与应答不良密切相关。.
Keywords: Autoantibodies; Hepatitis, autoimmune; Liver cirrhosis; Therapy.