平均血小板体积对自身免疫性肝炎患者治疗不应答的预测价值分析

目的 探讨自身免疫性肝炎(AIH)患者接受免疫抑制剂治疗不应答的影响因素.方法 2015年1月～2018年10月我院收治的AIH患者68例,接受标准的泼尼松或联合硫唑嘌呤治疗2年.使用血细胞分析仪检测血小板(PLT),自动给出平均血小板体积(MPV),所有患者接受肝活检.采用单因素和多因素Logistic回归分析影响A...

Impacting factors in response to immunosuppressive therapy in patients with autoimmune hepatitis

Objective This study aimed to investigate the impacting factors in response to immunosuppressive therapy in patients with autoimmune hepatitis(AIH).Methods A total of 68 patients with AIH were enrolled in our hospital between January 2015 and October 2018,including 18 males and 50 females,with an average age of(52.8±11.1)years old.All patients with AIH received standardized prednisone and azathioprine therapy for 24 months.All patients underwent twice liver biopsies before and after treatment,and blood mean platelet volume(MPV)and serum globulin level were detected.The univariate and multivariate Logistic regression analysis were applied to analyze the predictive factors that impact the poor response of patients with AIH to immunosuppressive treatment.Results At the end of two year treatment,42(61.8%)out of the 68 patients with AIH in our series obtained complete response(CR)to immunosuppressive therapy;at presentation,the MPV,serumγ-globulin,albumin(ALB),total serum bilirubin,prothrombin time international normalized ratio(INR)and serum creatinine(sCr)levels were(8.5±2.0)fL,(23.8±5.2)%,(40.0±1.3)g/L,(23.4±3.9)μmol/L,(1.0±0.3)and(80.6±10.3)μmol/L,all significantly different compared to[(10.3±2.3)fL,(33.1±7.1)%,(30.1±0.9)g/L,(36.2±5.3)μmol/L,(1.4±0.7)and(135.0±12.5)μmol/L,respectively,P<0.05],the percentage of liver cirrhosis in patients with CR was 11.9%,much lower than 54.2%(P<0.05)in nonresponders;We took the response of patients with AIH after treatment as dependent variable,assigning 0=CR,1=poor response,establishing a multivariate Logistic regression analysis model,and included the above-mentioned statistically significant factors such as MPV,γ-globulin,albumin,bilirubin,INR,sCr and liver cirrhosis into the Logistic regression model.The Logistic regression analysis showed that serumγ-globulin,albumin,MPV and liver cirrhosis were the independent predictors of poor response to immunosuppressive therapy in patients with AIH(P<0.05).Conclusion The patients with AIH might failed to immunosuppressive therapy,and elevated MPV,highγ-globulinemia and low serum albumin levels or even liver cirrhosis are the independent predictors of poor response.Further clinical trials are needed for these patients in order to get a best treatment strategy.