Digestive diseases and sciences · 2010
Association of HLA-DR14 with the treatment response in Japanese patients with autoimmune hepatitis.
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Suzuki Yoshiyuki, Ikeda Kenji, Hirakawa Miharu, Kawamura Yusuke, Yatsuji Hiromi, Sezaki Hitomi, Hosaka Tetsuya, Akuta Norio, Kobayashi Masahiro, Suzuki Fumitaka, Saitoh Satoshi, Arase Yasuji, Kobayashi Mariko, Miyakawa Yuzo, Kumada Hiromitsu
Аннотация
BACKGROUND: Influence of human lymphocyte antigen (HLA) on the therapeutic response in autoimmune hepatitis (AIH) is not known.
AIMS: To evaluate if HLA-DR types influence biological and histological responses to corticosteroids in patients with AIH.
METHODS: During 28 years from 1979 through 2007, 48 patients with definite diagnosis of AIH received long-term corticosteroid therapy (median 9 years [range: 5-28 years]) in a single Japanese center. They were followed for transaminase levels and received liver biopsy before and after the treatment.
RESULTS: DR4 was detected in 32 and DR14 in 11 patients; seven possessed both DR4 and DR14. DR4 was more frequent in AIH patients than in the general population (67% vs. 22%), while DR14 was comparably frequent between them (23% vs. 17%). Overall, biochemical response was achieved in 43 (90%) of the 48 patients. The sustained biochemical response to a maintenance prednisolone dose < 10 mg was gained more frequently in the patients with than without DR14 (10/11 [91%] vs. 10/37 [27%], P < 0.001). Marked histological improvement with a decrease in histology activity index (HAI) score by > 2 points was achieved in 31 of the 32 (97%) biochemical responders. Histological aggravation with an increase in HAI score occurred in 4 of the 16 (25%) patients without biochemical response (non-responders and relapsers combined), but in none of the 32 responders.
CONCLUSION: Long-term immunosuppressive treatment can improve the outcome of Japanese patients with AIH, and DR14 is associated with excellent biochemical response.
AIMS: To evaluate if HLA-DR types influence biological and histological responses to corticosteroids in patients with AIH.
METHODS: During 28 years from 1979 through 2007, 48 patients with definite diagnosis of AIH received long-term corticosteroid therapy (median 9 years [range: 5-28 years]) in a single Japanese center. They were followed for transaminase levels and received liver biopsy before and after the treatment.
RESULTS: DR4 was detected in 32 and DR14 in 11 patients; seven possessed both DR4 and DR14. DR4 was more frequent in AIH patients than in the general population (67% vs. 22%), while DR14 was comparably frequent between them (23% vs. 17%). Overall, biochemical response was achieved in 43 (90%) of the 48 patients. The sustained biochemical response to a maintenance prednisolone dose < 10 mg was gained more frequently in the patients with than without DR14 (10/11 [91%] vs. 10/37 [27%], P < 0.001). Marked histological improvement with a decrease in histology activity index (HAI) score by > 2 points was achieved in 31 of the 32 (97%) biochemical responders. Histological aggravation with an increase in HAI score occurred in 4 of the 16 (25%) patients without biochemical response (non-responders and relapsers combined), but in none of the 32 responders.
CONCLUSION: Long-term immunosuppressive treatment can improve the outcome of Japanese patients with AIH, and DR14 is associated with excellent biochemical response.
Предметные рубрики MeSH
AdultAgedAutoantibodiesBiomarkersBiopsy, NeedleCohort StudiesFemaleFollow-Up StudiesHLA-DR AntigensHLA-DR Serological SubtypesHepatitis, AutoimmuneHumansImmunohistochemistryImmunosuppressive AgentsLaparoscopyMaleMiddle AgedPrednisoloneProbabilityRecurrenceRetrospective StudiesRisk AssessmentSeverity of Illness IndexStatistics, NonparametricTreatment OutcomeYoung Adult