Histological regression of liver fibrosis with immunosuppressive therapy in autoimmune hepatitis

作者：Miguel Valera Jose; Smok Gladys; Marquez Sylvia; Poniachik Jaime; Brahm Javier^*

来源：Gastroenterologia y Hepatologia, 2011, 34(1): 10-15.

DOI：10.1016/j.gastrohep.2010.10.003

• Liver fibrosis
• Autoimmune
• hepatitis
• Cirrhosis
• Steroids
• Immunosuppressants

Reversibility of liver fibrosis with immunosuppressive therapy (IT) has been described in autoimmune hepatitis (AIH)
Objective: To compare initial fibrosis and fibrosis after IT in patients with AIH.
Methods: A total of 54 patients were admitted with positive ANA or AML antibodies, or both, elevated IgG immunoglobulins and who met international criteria for a diagnosis of AIH. The mean age was 39 years (range 13-65) and there were 47 women (87%). Two liver biopsies were taken: one at diagnosis and another at a mean of 28 +/- 8 months after initiation of IT with prednisone and azathioprine. The degree of inflammation (0-18) and fibrosis (0-6) according to Ishak score was compared between the initial and the follow-up biopsy.
Results: Fibrosis decreased from 2.9 +/- 0.3 to 2.2 +/- 0.3 (p = 0.005) and histological activity index from 6.8 +/- 0.45 to 2.6 +/- 0.2 (P<.001). In subgroups, fibrosis decreased from 3.6 +/- 0.4 to 1.4 +/- 0.3 (P<.001) in 22 patients (41%), was unchanged in 27 (50%) and increased in five (9%). There were seven patients with histological cirrhosis at IT initiation. After IT, four showed a reduction in Ishak score (achieving scores of 0-3). Transaminase values were not associated with histological improvement.
Conclusion: Fibrosis in patients with AIH significantly improved with IT, emphasizing the importance of studying the prognostic factors associated with this favorable response.

• 出版日期2011-1