拉丁美洲的自身免疫性肝炎：来自allatin队列的见解

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.101975

Ludmila Resende Guedes , Guilherme Grossi Lopes Cançado , Janaína Luz Narciso Schiavo , Luciana Costa Faria , Ezequiel Ridruejo , Maria Lucia Ferraz , Margarita Anders , Lorena Castro Solari , Alejandra Maria Villamil , Harlim Rodríguez , Nicolas Ortiz , Eira Cerda Reyes , Esteban Horacio Gonzalez Dominguez , Rodrigo Zapata , Débora Raquel Benedita Terrabio , Paulo Lisboa Bittencourt , Pablo Andrés Coste Murillo , Emilia Vera Pozo , Leonardo de Lucca Schiavon , Artur Maia de Castro Miranda , Cláudia Alves Couto

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引用次数: 0

摘要

自身免疫性肝炎（AIH）是一种慢性炎症性肝病，发病率高。非白种人被认为是不良结果的独立预测因子。先前的研究表明，拉丁美洲的疾病表型更为严重。我们的目的是描述拉丁美洲艾滋病的表现、治疗和结果。材料和方法回顾性、持续、多中心队列研究（ALLATIN），包括515例自身免疫性肝炎患者，分别来自巴西（246）、阿根廷（108）、智利（71）、厄瓜多尔（28）、古巴（22）、墨西哥（21）、哥斯达黎加（10）和秘鲁(1)。结果患者以女性为主（82.5%），1型AIH占90.9%，平均诊断年龄42.8±19.2岁。在发病时，报告的症状最多的是黄疸（42.3%），其次是虚弱（25.3%）、腹痛（19.8%）、关节痛（10.0%）和瘙痒（9.8%）。诊断时有门静脉高压症临床征象的占16.1%。急性表现为39.3%，主要表现为急性黄疸型肝炎（72.2%），42%无症状。第一次活检时，42.9%的患者为晚期纤维化（F3-F4），超声显示35.0%为肝硬化，26.6%为临床显著的门静脉高压症。首选的一线治疗是强的松（96.5%）和硫唑嘌呤（91.9%）。6个月生化缓解率为68.4%（数据来自336例患者），12个月生化缓解率为55.7%（数据来自329例患者）。在第一年内达到生化反应的患者中，大多数在前6个月内出现反应。报道的二线治疗是霉酚酸酯（63.6%）、他克莫司（13.6%）、环孢素（13.6%）、氯喹（6.8%）和利妥昔单抗（2.3%）。在平均6.72±6.0年的随访中，3.9%的患者接受了肝移植，3.1%的患者死亡。结论：尽管出现晚期肝病的负担很高，ALLATIN队列显示出与欧洲人群相当的治疗反应率。这些发现强调了种族、医疗保健获取和早期诊断在影响AIH结果方面的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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AUTOIMMUNE HEPATITIS IN LATIN AMERICA: INSIGHTS FROM THE ALLATIN COHORT

Introduction and Objectives

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease associated with significant morbidity. Non-white ethnicity has been described as an independent predictor of adverse outcomes. Previous studies suggest a more severe disease phenotype in Latin America. We aim to describe the presentation, treatment, and outcomes of AIH in Latin America.

Materials and Methods

Retrospective, ongoing, multicenter cohort study (ALLATIN) including 515 patients with autoimmune hepatitis from Brazil (246), Argentina (108), Chile (71), Ecuador (28), Cuba (22), Mexico (21), Costa Rica (10), and Peru (1).

Results

Most patients were female (82.5%), with type 1 AIH (90.9%) and a mean age at diagnosis of 42.8±19.2 years. At disease presentation, the most reported symptom was jaundice (42.3%), followed by asthenia (25.3%), abdominal pain (19.8%), arthralgia (10.0%) and pruritus (9.8%). Clinical signs of portal hypertension were seen in 16.1% at diagnosis. Acute presentation occurred in 39.3%, predominantly as acute icteric hepatitis(72.2%), while 42% were asymptomatic. At the first biopsy, 42.9% of patients had advanced fibrosis (F3–F4), 35.0% were cirrhotic on ultrasound, and 26.6% had clinically significant portal hypertension. The preferred first line therapy was prednisone (96.5%) and azathioprine (91.9%). Biochemical remission was achieved in 68.4% (data from 336 patients) at 6 months and 55.7% at 12 months and 55.7% (data from 329 patients) at 12 months. Among patients who achieved a biochemical response within the first year, most responded within the first 6 months. Reported second-line therapies were mycophenolate mofetil (63.6%), tacrolimus (13.6%), cyclosporine (13.6%), chloroquine (6.8%), and rituximab (2.3%). In a mean follow up of 6.72±6.0 years, 3.9% underwent liver transplantation and 3.1% died.

Conclusions

Despite a high burden of advanced liver disease at presentation, the ALLATIN cohort shows comparable treatment response rates to European populations. These findings highlight the importance of ethnicity, healthcare access, and early diagnosis in shaping AIH outcomes.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.