首页 期刊 论文 学科刊群 资讯 加盟 关于
EN
image
Article(id=1199337305333919845, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199337298941804946, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2450.2023.0823, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1669046400000, receivedDateStr=2022-11-22, revisedDate=null, revisedDateStr=null, acceptedDate=1678723200000, acceptedDateStr=2023-03-14, onlineDate=1763873896201, onlineDateStr=2025-11-23, pubDate=1706371200000, pubDateStr=2024-01-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763873896201, onlineIssueDateStr=2025-11-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763873896201, creator=13701087609, updateTime=1763873896201, updator=13701087609, issue=Issue{id=1199337298941804946, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='1', pageStart='1', pageEnd='120', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763873894677, creator=13701087609, updateTime=1763874094669, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1199338137823572576, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199337298941804946, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1199338137823572577, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199337298941804946, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=64, endPage=69, ext={EN=ArticleExt(id=1199337305753350264, articleId=1199337305333919845, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Effect of ANAs on hormone response in patients with AIH-PBC overlap syndrome and AIH-only, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the effect of antinuclear antibodies (ANAs) on hormone response in patients with autoimmune hepatitis (AIH)-primary biliary cholangitis (PBC) overlap syndrome (AIH-PBC OS) and AIH-only within half a year. Methods A retrospective analysis of 77 patients with autoimmune liver disease (AILD) admitted to First Clinical Medical College of Lanzhou University from January 2018 to December 2021, all of whom were confirmed by liver biopsy and receiving glucocorticoid treatment. Among them, 46 patients were in AIH-PBC OS group and 31 were in AIH-only group. The general clinical characteristics, liver puncture-related indexes, autoantibodies and immunoglobulin indexes of patients in each group at the time of diagnosis were collected and compared, and the biochemical and immunoglobulin indexes of patients at the time of hormone use and at the time of review within 6 months were also collected, and the hormone response within 6 months was evaluated according to the levels of glutamic transaminase (AST), glutamic alanine transaminase (ALT) and immunoglobulin G (IgG), and the effect of ANAs on hormone response outcomes in both groups over a six-month period was analyzed. Multifactorial ordered logistic analysis was performed to evaluate the effect of ANAs on hormone response between two groups. Results There was no statistically significant difference in the percentage of AIH-PBC OS and AIH-only patients among both ANAs-positive and -negative AILD patients (55.6% vs. 44.4% and 65.6% vs. 34.4%, P>0.05). Among 46 patients with AIH-PBC OS, there were 25 in ANAs-positive group and 21 in ANAs-negative group. The rate of complete hormone response within 6 months was lower than that of ANAs-negative group (44.0% vs. 76.2%), while the rate of hormone non-response was higher than that of ANAs-negative group (20.0% vs. 0), and the difference was statistically significant (P<0.05). There were 20 cases of ANAs-positive and 11 cases of ANAs-negative in the 31 AIH-only patients. There was no statistically significant difference in the results of hormone response within 6 months between the two groups (P>0.05). Multifactorial ordered logistic analysis showed that AIH-PBC OS patients were more likely to have a higher likelihood of 6-month hormone non-response rate in ANAs-positive patients, and the difference was statistically different (P<0.05). And there was no significant effect of ANAs type on hormone response outcome in AIH-only patients (P>0.05). Conclusion AIH-PBC OS ANAs-positive patients have a poor hormone response within half a year. In AIH-only patients, ANAs have no significant effect on hormone response results.

, correspAuthors=Xiao-Rong Mao, authorNote=null, correspAuthorsNote=
E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Qiong Li, Ai-Ping Tian, Yong-Wu Mao, Fu-Chun Wang, Xiao-Rong Mao), CN=ArticleExt(id=1199337307934388418, articleId=1199337305333919845, tenantId=1146029695717560320, journalId=1189873630562394117, language=CN, title=抗核抗体谱对AIH-PBC OS及单纯AIH患者激素应答的影响, columnId=1190310109164180259, journalTitle=解放军医学杂志, columnName=临床研究, runingTitle=null, highlight=null, articleAbstract=

目的 探讨抗核抗体谱(ANAs)对自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)及单纯AIH患者半年内激素应答的影响。方法 回顾性分析2018年1月-2021年12月兰州大学第一医院收治的77例自身免疫性肝病(AILD)患者的资料，其中AIH-PBC OS组46例，单纯AIH组31例。均经肝穿刺活检组织病理检查确诊，并行糖皮质激素治疗。比较两组患者的一般临床特征、肝穿刺相关指标、自身抗体及免疫球蛋白指标，以及患者使用糖皮质激素初始及6个月内复查的生化及免疫球蛋白指标，根据谷草转氨酶(AST)、谷丙转氨酶(ALT)及免疫球蛋白G(IgG)水平评估治疗6个月内的激素应答情况，采用多因素有序logistic分析ANAs对两组患者激素应答结果的影响。结果 ANAs阳性及阴性AILD患者中，AIH-PBC OS及单纯AIH患者占比均无统计学差异(55.6% vs. 44.4%，65.6% vs. 34.4%，P>0.05)。46例AIH-PBC OS患者中，ANAs阳性组25例，ANAs阴性组21例。ANAs阳性组半年内激素完全应答率低于ANAs阴性组(44.0% vs. 76.2%)，而激素不应答率高于ANAs阴性组(20.0% vs. 0)，差异有统计学意义(P<0.05)。31例单纯AIH患者中，ANAs阳性组20例，ANAs阴性组11例。两组患者半年内激素应答结果差异无统计学意义(P>0.05)。多因素有序logistic分析结果显示，AIH-PBC OS患者中，ANAs阳性者半年内激素不应答的可能性较大，差异有统计学意义(P<0.05)。而单纯AIH患者中ANAs类型对激素应答结果无明显影响(P>0.05)。结论 在AIH-PBC OS患者中，ANAs阳性者半年内激素应答结果欠佳；在单纯AIH患者中，ANAs对激素应答结果无明显影响。

, correspAuthors=毛小荣, authorNote=null, correspAuthorsNote=
毛小荣，E-mail：
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=1lVcn50pE8YMOIRs2B2GVg==, magXml=4BARyOgJSBHO7ibPQW274g==, pdfUrl=null, pdf=pu6YVUnhBDpZ6YSPVwd2DA==, pdfFileSize=1449537, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=tYxpX8jxTPtOkemP3Z1JTw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=GXX3Mk+HtubtH0vPYNc3yQ==, mapNumber=null, authorCompany=null, fund=null, authors=

李琼，硕士研究生，主要从事肝病临床诊疗方面的研究

, authorsList=李琼, 田爱平, 毛永武, 王富春, 毛小荣)}, authors=[Author(id=1199376211609747535, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1199376211722993745, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376211609747535, language=EN, stringName=Qiong Li, firstName=Qiong, middleName=null, lastName=Li, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1199376211832045652, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376211609747535, language=CN, stringName=李琼, firstName=琼, middleName=null, lastName=李, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1兰州大学第一临床医学院，甘肃兰州 730000, bio={"content":"

李琼，硕士研究生，主要从事肝病临床诊疗方面的研究

"}, bioImg=null, bioContent=

李琼，硕士研究生，主要从事肝病临床诊疗方面的研究

, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1199376211311951941, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, xref=1, ext=[AuthorCompanyExt(id=1199376211316146246, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211311951941, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China), AuthorCompanyExt(id=1199376211337117767, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211311951941, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1兰州大学第一临床医学院，甘肃兰州 730000)])]), Author(id=1199376211953680472, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, orderNo=1, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1199376212092092509, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376211953680472, language=EN, stringName=Ai-Ping Tian, firstName=Ai-Ping, middleName=null, lastName=Tian, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=2, address=2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1199376212238893153, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376211953680472, language=CN, stringName=田爱平, firstName=爱平, middleName=null, lastName=田, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=2, address=2兰州大学第一医院感染科，甘肃兰州 730000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1199376211471335497, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, xref=2, ext=[AuthorCompanyExt(id=1199376211479724107, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China), AuthorCompanyExt(id=1199376211509084236, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2兰州大学第一医院感染科，甘肃兰州 730000)])]), Author(id=1199376212368916582, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, orderNo=2, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1199376212511522924, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376212368916582, language=EN, stringName=Yong-Wu Mao, firstName=Yong-Wu, middleName=null, lastName=Mao, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=2, address=2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1199376212628963443, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376212368916582, language=CN, stringName=毛永武, firstName=永武, middleName=null, lastName=毛, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=2, address=2兰州大学第一医院感染科，甘肃兰州 730000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1199376211471335497, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, xref=2, ext=[AuthorCompanyExt(id=1199376211479724107, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China), AuthorCompanyExt(id=1199376211509084236, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2兰州大学第一医院感染科，甘肃兰州 730000)])]), Author(id=1199376212738015352, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, orderNo=3, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1199376212855455870, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376212738015352, language=EN, stringName=Fu-Chun Wang, firstName=Fu-Chun, middleName=null, lastName=Wang, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1199376213040005253, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376212738015352, language=CN, stringName=王富春, firstName=富春, middleName=null, lastName=王, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1兰州大学第一临床医学院，甘肃兰州 730000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1199376211311951941, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, xref=1, ext=[AuthorCompanyExt(id=1199376211316146246, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211311951941, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China), AuthorCompanyExt(id=1199376211337117767, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211311951941, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1兰州大学第一临床医学院，甘肃兰州 730000)])]), Author(id=1199376213140668555, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, orderNo=4, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=mxr2013@126.com, emailSecond=null, emailThird=null, correspondingAuthor=1, authorType=1, ext={EN=AuthorExt(id=1199376213237137552, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376213140668555, language=EN, stringName=Xiao-Rong Mao, firstName=Xiao-Rong, middleName=null, lastName=Mao, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=2, *, address=2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1199376213337800856, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, authorId=1199376213140668555, language=CN, stringName=毛小荣, firstName=小荣, middleName=null, lastName=毛, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=2, *, address=2兰州大学第一医院感染科，甘肃兰州 730000, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1199376211471335497, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, xref=2, ext=[AuthorCompanyExt(id=1199376211479724107, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China), AuthorCompanyExt(id=1199376211509084236, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2兰州大学第一医院感染科，甘肃兰州 730000)])])], keywords=[Keyword(id=1199376213513961637, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, orderNo=1, keyword=autoimmune hepatitis), Keyword(id=1199376213614624943, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, orderNo=2, keyword=primary biliary cholangitis), Keyword(id=1199376213715288246, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, orderNo=3, keyword=overlap syndrome), Keyword(id=1199376213920809154, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, orderNo=4, keyword=antinuclear antibodies), Keyword(id=1199376214038249673, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, orderNo=5, keyword=hormone biochemical response), Keyword(id=1199376214151495885, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, orderNo=1, keyword=自身免疫性肝炎), Keyword(id=1199376214277325011, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, orderNo=2, keyword=原发性胆汁性胆管炎), Keyword(id=1199376214377988314, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, orderNo=3, keyword=重叠综合征), Keyword(id=1199376214461874402, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, orderNo=4, keyword=抗核抗体谱), Keyword(id=1199376214575120618, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, orderNo=5, keyword=激素生化应答)], refs=[Reference(id=1199376216739381602, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=1, pageStart=194, pageEnd=196, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Heo NY, Kim H, journalName=Clin Mol Hepatol, refType=null, unstructuredReference=Heo NY, Kim H. Epidemiology and updated management for autoimmune liver disease[J]. Clin Mol Hepatol, 2023, 29(1): 194-196., articleTitle=Epidemiology and updated management for autoimmune liver disease, refAbstract=null), Reference(id=1199376216848433514, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2023, volume=48, issue=5, pageStart=609, pageEnd=614, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=丁健, 宋亮, 阮柏, journalName=解放军医学杂志, refType=null, unstructuredReference=丁健, 宋亮, 阮柏, 等. 间充质干细胞及其修饰体在肝纤维化治疗中的作用研究进展[J]. 解放军医学杂志, 2023, 48(5): 609-614., articleTitle=间充质干细胞及其修饰体在肝纤维化治疗中的作用研究进展, refAbstract=null), Reference(id=1199376216961679723, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2022, volume=42, issue=4, pageStart=310, pageEnd=313, 318, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=程苕莼, 刘一村, 薛红, journalName=中国实用内科杂志, refType=null, unstructuredReference=程苕莼, 刘一村, 薛红, 等. 原发性胆汁性胆管炎合并肝细胞脂肪变性的临床特征及预后分析[J]. 中国实用内科杂志, 2022, 42(4): 310-313, 318., articleTitle=原发性胆汁性胆管炎合并肝细胞脂肪变性的临床特征及预后分析, refAbstract=null), Reference(id=1199376217045565807, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2021, volume=15, issue=2, pageStart=223, pageEnd=257, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=Wang GQ, Tanaka A, Zhao H, journalName=Hepatol Int, refType=null, unstructuredReference=Wang GQ, Tanaka A, Zhao H, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis[J]. Hepatol Int, 2021, 15(2): 223-257., articleTitle=The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis, refAbstract=null), Reference(id=1199376217183977844, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2015, volume=21, issue=2, pageStart=150, pageEnd=157, url=null, language=null, rfNumber=[5], rfOrder=4, authorNames=Park Y, Cho Y, Cho EJ, journalName=Clin Mol Hepatol, refType=null, unstructuredReference=Park Y, Cho Y, Cho EJ, et al. Retrospective analysis of autoimmune hepatitis-primary biliary cirrhosis overlap syndrome in Korea: characteristics, treatments, and outcomes[J]. Clin Mol Hepatol, 2015, 21(2): 150-157., articleTitle=Retrospective analysis of autoimmune hepatitis-primary biliary cirrhosis overlap syndrome in Korea: characteristics, treatments, and outcomes, refAbstract=null), Reference(id=1199376217297224057, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=1, pageStart=42, pageEnd=49, url=null, language=null, rfNumber=[6], rfOrder=5, authorNames=马雄, 王绮夏, 肖潇, journalName=临床肝胆病杂志, refType=null, unstructuredReference=马雄, 王绮夏, 肖潇, 等. 自身免疫性肝炎诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 42-49., articleTitle=自身免疫性肝炎诊断和治疗指南(2021), refAbstract=null), Reference(id=1199376217506939264, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2019, volume=18, issue=3, pageStart=488, pageEnd=493, url=null, language=null, rfNumber=[7], rfOrder=6, authorNames=Mané F, Cardoso H, Liberal R, journalName=Ann Hepatol, refType=null, unstructuredReference=Mané F, Cardoso H, Liberal R, et al. Treatment response in primary biliary cholangitis: the role of autoimmune hepatitis features[J]. Ann Hepatol, 2019, 18(3): 488-493., articleTitle=Treatment response in primary biliary cholangitis: the role of autoimmune hepatitis features, refAbstract=null), Reference(id=1199376217704071558, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2020, volume=72, issue=2, pageStart=671, pageEnd=722, url=null, language=null, rfNumber=[8], rfOrder=7, authorNames=Mack CL, Adams D, Assis DN, journalName=Hepatology, refType=null, unstructuredReference=Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American association for the study of liver diseases[J]. Hepatology, 2020, 72(2): 671-722., articleTitle=Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American association for the study of liver diseases, refAbstract=null), Reference(id=1199376217938952589, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2016, volume=36, issue=3, pageStart=155, pageEnd=160, url=null, language=null, rfNumber=[9], rfOrder=8, authorNames=郭丽萍, 周璐, 李树倩, journalName=中华消化杂志, refType=null, unstructuredReference=郭丽萍, 周璐, 李树倩, 等. 熊去氧胆酸单药或联合免疫抑制剂治疗原发性胆汁性肝硬化-自身免疫性肝炎重叠综合征的疗效分析[J]. 中华消化杂志, 2016, 36(3): 155-160., articleTitle=熊去氧胆酸单药或联合免疫抑制剂治疗原发性胆汁性肝硬化-自身免疫性肝炎重叠综合征的疗效分析, refAbstract=null), Reference(id=1199376218010255760, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=1998, volume=28, issue=2, pageStart=296, pageEnd=301, url=null, language=null, rfNumber=[10], rfOrder=9, authorNames=Chazouillères O, Wendum D, Serfaty L, journalName=Hepatology, refType=null, unstructuredReference=Chazouillères O, Wendum D, Serfaty L, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: clinical features and response to therapy[J]. Hepatology, 1998, 28(2): 296-301., articleTitle=Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: clinical features and response to therapy, refAbstract=null), Reference(id=1199376218119307668, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2022, volume=76, issue=4, pageStart=841, pageEnd=849, url=null, language=null, rfNumber=[11], rfOrder=10, authorNames=Pape S, RJALM Snijders, Gevers TJG, journalName=J Hepatol, refType=null, unstructuredReference=Pape S, RJALM Snijders, Gevers TJG, et al. Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group[J]. J Hepatol, 2022, 76(4): 841-849., articleTitle=Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group, refAbstract=null), Reference(id=1199376218198999449, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2016, volume=36, issue=2, pageStart=142, pageEnd=144, url=null, language=null, rfNumber=[12], rfOrder=11, authorNames=郭丽萍, 周璐, 王邦茂, journalName=中华消化杂志, refType=null, unstructuredReference=郭丽萍, 周璐, 王邦茂. 自身免疫性肝病合并肝外自身免疫病的研究进展[J]. 中华消化杂志, 2016, 36(2): 142-144., articleTitle=自身免疫性肝病合并肝外自身免疫病的研究进展, refAbstract=null), Reference(id=1199376218312245660, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2018, volume=38, issue=5, pageStart=715, pageEnd=724, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=Radovanović-Dinić B, Tešić-Rajković S, Zivkovic V, journalName=Rheumatol Int, refType=null, unstructuredReference=Radovanović-Dinić B, Tešić-Rajković S, Zivkovic V, et al. Clinical connection between rheumatoid arthritis and liver damage[J]. Rheumatol Int, 2018, 38(5): 715-724., articleTitle=Clinical connection between rheumatoid arthritis and liver damage, refAbstract=null), Reference(id=1199376218391937439, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2018, volume=34, issue=9, pageStart=2021, pageEnd=2026, url=null, language=null, rfNumber=[14], rfOrder=13, authorNames=田辉, journalName=临床肝胆病杂志, refType=null, unstructuredReference=田辉. 自身免疫性肝病相关性风湿病样及皮肤表现 [J]. 临床肝胆病杂志, 2018, 34(9): 2021-2026., articleTitle=自身免疫性肝病相关性风湿病样及皮肤表现, refAbstract=null), Reference(id=1199376218500989347, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2021, volume=9, issue=3, pageStart=392, pageEnd=398, url=null, language=null, rfNumber=[15], rfOrder=14, authorNames=Jiang Y, Xu BH, Rodgers B, journalName=J Clin Transl Hepatol, refType=null, unstructuredReference=Jiang Y, Xu BH, Rodgers B, et al. Characteristics and inpatient outcomes of primary biliary cholangitis and autoimmune hepatitis overlap syndrome[J]. J Clin Transl Hepatol, 2021, 9(3): 392-398., articleTitle=Characteristics and inpatient outcomes of primary biliary cholangitis and autoimmune hepatitis overlap syndrome, refAbstract=null), Reference(id=1199376218589069737, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2013, volume=19, issue=31, pageStart=5131, pageEnd=5137, url=null, language=null, rfNumber=[16], rfOrder=15, authorNames=Wang L, Zhang FC, Chen H, journalName=World J Gastroenterol, refType=null, unstructuredReference=Wang L, Zhang FC, Chen H, et al. Connective tissue diseases in primary biliary cirrhosis: a population-based cohort study[J]. World J Gastroenterol, 2013, 19(31): 5131-5137., articleTitle=Connective tissue diseases in primary biliary cirrhosis: a population-based cohort study, refAbstract=null), Reference(id=1199376218681344428, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2023, volume=380, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[17], rfOrder=16, authorNames=Muratori L, Lohse AW, Lenzi M, journalName=BMJ, refType=null, unstructuredReference=Muratori L, Lohse AW, Lenzi M. Diagnosis and management of autoimmune hepatitis[J]. BMJ, 2023, 380: e070201., articleTitle=Diagnosis and management of autoimmune hepatitis, refAbstract=null), Reference(id=1199376218790396335, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2016, volume=50, issue=1, pageStart=114, pageEnd=123, url=null, language=null, rfNumber=[18], rfOrder=17, authorNames=Yang F, Wang QX, Wang ZY, journalName=Clin Rev Allergy Immunol, refType=null, unstructuredReference=Yang F, Wang QX, Wang ZY, et al. The natural history and prognosis of primary biliary cirrhosis with clinical features of autoimmune hepatitis[J]. Clin Rev Allergy Immunol, 2016, 50(1): 114-123., articleTitle=The natural history and prognosis of primary biliary cirrhosis with clinical features of autoimmune hepatitis, refAbstract=null), Reference(id=1199376218853310896, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, doi=null, pmid=null, pmcid=null, year=2011, volume=10, issue=1, pageStart=28, pageEnd=32, url=null, language=null, rfNumber=[19], rfOrder=18, authorNames=Coss Adame E, Granados J, Uribe M, journalName=Ann Hepatol, refType=null, unstructuredReference=Coss Adame E, Granados J, Uribe M, et al. Does HLA-DR7 differentiate the overlap syndrome of auto-immune hepatitis-primary biliary cirrhosis (AIH-PBC) from those with auto-immune hepatitis type 1?[J]. Ann Hepatol, 2011, 10(1): 28-32., articleTitle=Does HLA-DR7 differentiate the overlap syndrome of auto-immune hepatitis-primary biliary cirrhosis (AIH-PBC) from those with auto-immune hepatitis type 1?, refAbstract=null)], funds=[Fund(id=1199376216177344836, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, awardId=21JR1RA070, language=EN, fundingSource=Natural Science Foundation of Gansu Province(21JR1RA070), fundOrder=null, country=null), Fund(id=1199376216265425226, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, awardId=21JR1RA070, language=CN, fundingSource=甘肃省自然科学基金(21JR1RA070), fundOrder=null, country=null), Fund(id=1199376216382865744, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, awardId=2020B-016, language=EN, fundingSource=Gansu Province Higher Education Innovation Capacity Enhancement Project(2020B-016), fundOrder=null, country=null), Fund(id=1199376216508694868, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, awardId=2020B-016, language=CN, fundingSource=甘肃省高等学校创新能力提升项目(2020B-016), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1199376211311951941, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, xref=1, ext=[AuthorCompanyExt(id=1199376211316146246, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211311951941, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China), AuthorCompanyExt(id=1199376211337117767, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211311951941, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1兰州大学第一临床医学院，甘肃兰州 730000)]), AuthorCompany(id=1199376211471335497, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, xref=2, ext=[AuthorCompanyExt(id=1199376211479724107, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China), AuthorCompanyExt(id=1199376211509084236, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, companyId=1199376211471335497, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2兰州大学第一医院感染科，甘肃兰州 730000)])], figs=[ArticleFig(id=1199376214839361791, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, label=Fig.1, caption=Flow chart of enrolled patients, figureFileSmall=vsefo6VbGgXA8IfvuUw8Jg==, figureFileBig=Jqv+nnqUhoSVlCF+cR09jQ==, tableContent=null), ArticleFig(id=1199376214952608005, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, label=图1, caption=入组患者筛选流程图

AIH-PBC OS. 自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征；AIH. 自身免疫性肝炎；ANAs. 抗核抗体谱

, figureFileSmall=vsefo6VbGgXA8IfvuUw8Jg==, figureFileBig=Jqv+nnqUhoSVlCF+cR09jQ==, tableContent=null), ArticleFig(id=1199376215086825739, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, label=Fig.2, caption=Hormonal response in AIH-PBC OS (A) and AIH-only (B) patients with positive and negative ANAs, figureFileSmall=yJ44fqnQfrAWMK92iYW0bg==, figureFileBig=RT1lSBGxDFK1f4CLp5eMVg==, tableContent=null), ArticleFig(id=1199376215195877650, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, label=图2, caption=ANAs阳性与阴性的AIH-PBC OS(A)及单纯AIH患者(B)激素应答情况

AIH-PBC OS. 自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征；AIH. 自身免疫性肝炎；ANAs. 抗核抗体谱；*P<0.05

, figureFileSmall=yJ44fqnQfrAWMK92iYW0bg==, figureFileBig=RT1lSBGxDFK1f4CLp5eMVg==, tableContent=null), ArticleFig(id=1199376215317512472, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, label=Tab.1, caption=

Comparison of general information between ANAs-positive and negative patients with autoimmune liver disease

, figureFileSmall=null, figureFileBig=null, tableContent=
指标总体(n=77)ANAs阳性组(n=45)ANAs阴性组(n=32)x2/t/ZP
男/女(例)18/596/3912/206.0980.014
BMI (kg/m2, $\bar{x}±s$)23.12±2.8123.00±2.7823.28±2.900.4300.669
年龄(岁, $\bar{x}±s$)50.47±11.1151.42±9.1849.13±13.41-0.8390.405
平均动脉压[mmHg, M(Q1, Q3)]86.00(80.50, 95.50)85.00(80.00, 91.50)90.00(81.25, 97.75)-0.9420.346
自身免疫性肝病类型[例(%)]0.7880.375
单纯AIH31(40.3)20(44.4)11(34.4)
AIH-PBC OS46(59.7)25(55.6)21(65.6)
病理损伤模式[例(%)]0.9390.625
小叶炎9(11.7)4(8.9)5(15.6)
界面炎42(54.5)26(57.8)16(50.0)
小叶炎合并界面炎26(33.8)15(33.3)11(34.4)
GS分期[例(%)]0.0800.778
<G3S323(29.9)14(31.1)9(28.1)
≥G3S354(70.1)31(68.9)23(71.9)
免疫球蛋白[g/L, M(Q1, Q3)]
IgG18.70(15.58, 23.05)18.90(15.95, 23.90)17.60(13.20, 21.90)-1.2680.205
IgM2.14(1.23, 4.12)1.99(1.15, 4.89)2.52(1.30, 3.39)-0.3440.731
), ArticleFig(id=1199376215510450462, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, label=表1, caption=

ANAs阳性及阴性自身免疫性肝病患者一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标总体(n=77)ANAs阳性组(n=45)ANAs阴性组(n=32)x2/t/ZP
男/女(例)18/596/3912/206.0980.014
BMI (kg/m2, $\bar{x}±s$)23.12±2.8123.00±2.7823.28±2.900.4300.669
年龄(岁, $\bar{x}±s$)50.47±11.1151.42±9.1849.13±13.41-0.8390.405
平均动脉压[mmHg, M(Q1, Q3)]86.00(80.50, 95.50)85.00(80.00, 91.50)90.00(81.25, 97.75)-0.9420.346
自身免疫性肝病类型[例(%)]0.7880.375
单纯AIH31(40.3)20(44.4)11(34.4)
AIH-PBC OS46(59.7)25(55.6)21(65.6)
病理损伤模式[例(%)]0.9390.625
小叶炎9(11.7)4(8.9)5(15.6)
界面炎42(54.5)26(57.8)16(50.0)
小叶炎合并界面炎26(33.8)15(33.3)11(34.4)
GS分期[例(%)]0.0800.778
<G3S323(29.9)14(31.1)9(28.1)
≥G3S354(70.1)31(68.9)23(71.9)
免疫球蛋白[g/L, M(Q1, Q3)]
IgG18.70(15.58, 23.05)18.90(15.95, 23.90)17.60(13.20, 21.90)-1.2680.205
IgM2.14(1.23, 4.12)1.99(1.15, 4.89)2.52(1.30, 3.39)-0.3440.731
), ArticleFig(id=1199376215619502372, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, label=Tab.2, caption=

Influence of different factors on the outcome of hormone response in patients with AIH-PBC OS

, figureFileSmall=null, figureFileBig=null, tableContent=
相关因素βSEWald χ2POR(95%CI)
常数项
完全应答-12.0955.6934.5140.034-
应答不充分-9.6855.5373.0600.080-
性别
男1.4450.9722.2110.1374.243(0.700~25.707)
女0.000----
年龄(岁)-0.0610.0431.9930.1580.941(0.868~1.019)
BMI(kg/m2)-0.2800.1443.7900.0520.756(0.582~0.982)
平均动脉压-0.0260.0290.7570.3840.975(0.924~1.028)
IgM(g/L)-0.0030.1220.0000.9820.997(0.796~1.250)
IgG(g/L)-0.0730.0502.1900.1390.929(0.849~1.017)
GS分期
<G3S3-1.3430.9761.8950.1690.261(0.043~1.592)
≥G3S30.000----
ANAs
阳性2.0880.8006.8110.0098.073(1.815~35.904)
阴性0.000----
), ArticleFig(id=1199376215703388457, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, label=表2, caption=

AIH-PBC OS患者中不同因素对激素应答结果的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
相关因素βSEWald χ2POR(95%CI)
常数项
完全应答-12.0955.6934.5140.034-
应答不充分-9.6855.5373.0600.080-
性别
男1.4450.9722.2110.1374.243(0.700~25.707)
女0.000----
年龄(岁)-0.0610.0431.9930.1580.941(0.868~1.019)
BMI(kg/m2)-0.2800.1443.7900.0520.756(0.582~0.982)
平均动脉压-0.0260.0290.7570.3840.975(0.924~1.028)
IgM(g/L)-0.0030.1220.0000.9820.997(0.796~1.250)
IgG(g/L)-0.0730.0502.1900.1390.929(0.849~1.017)
GS分期
<G3S3-1.3430.9761.8950.1690.261(0.043~1.592)
≥G3S30.000----
ANAs
阳性2.0880.8006.8110.0098.073(1.815~35.904)
阴性0.000----
), ArticleFig(id=1199376215808246064, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=EN, label=Tab.3, caption=

Influence of different factors on the outcome of hormone response in patients with AIH-only

, figureFileSmall=null, figureFileBig=null, tableContent=
相关因素βSEWald χ2POR(95%CI)
常数项
完全应答-5.6225.6690.9840.321-
应答不充分-4.5825.6280.6630.416-
性别
男2.0591.4002.1650.1417.840(0.343~179.169)
女0.000----
年龄(岁)0.0730.0591.5380.2151.076(0.945~1.224)
BMI (kg/m2)-0.2320.2051.2870.2570.793(0.525~1.198)
平均动脉压-0.0940.0562.8560.0910.910(0.810~1.023)
IgM (g/L)-0.0290.2930.0100.9220.972(0.529~1.783)
IgG (g/L)0.1730.1012.8990.0891.189(0.962~1.469)
GS分期
<G3S3-0.7290.9550.5830.4450.482(0.069~3.356)
≥G3S30.000----
ANAs
阳性0.2481.3940.0320.8591.282(0.058~28.472)
阴性0.000----
), ArticleFig(id=1199376215967629622, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199337305333919845, language=CN, label=表3, caption=

单纯AIH患者中不同因素对激素应答结果的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
相关因素βSEWald χ2POR(95%CI)
常数项
完全应答-5.6225.6690.9840.321-
应答不充分-4.5825.6280.6630.416-
性别
男2.0591.4002.1650.1417.840(0.343~179.169)
女0.000----
年龄(岁)0.0730.0591.5380.2151.076(0.945~1.224)
BMI (kg/m2)-0.2320.2051.2870.2570.793(0.525~1.198)
平均动脉压-0.0940.0562.8560.0910.910(0.810~1.023)
IgM (g/L)-0.0290.2930.0100.9220.972(0.529~1.783)
IgG (g/L)0.1730.1012.8990.0891.189(0.962~1.469)
GS分期
<G3S3-0.7290.9550.5830.4450.482(0.069~3.356)
≥G3S30.000----
ANAs
阳性0.2481.3940.0320.8591.282(0.058~28.472)
阴性0.000----
)], attaches=null, journal=Journal(id=1146441329971666965, delFlag=0, nameCn=解放军医学杂志, nameEn=Medical Journal of Chinese People’s Liberation Army, nameHistory1=null, nameHistory2=null, issn=0577-7402, eissn=null, cn=11-1056/R, coden=null, periodic=0, language=CN, oaType=是, ccby=CC BY-NC-ND, superviseOffice=null, ownerOffice=null, pubOffice=null, editorOffice=null, officeType=null, aims=null, clcCode=null, officeProv=null, officeCity=null, officeAddr=null, officeZip=null, officeEmail=null, officePhone=null, editDirector=null, officeDirector=null, officeDirectorPhone=null, officeStaffNum=null, officeEmpNum=null, coverPicUrl=6srot5PcoYX30Oa4xeTmeg==, journalPrice=null, startedYear=null, abbrevIsoEn=null, journalRemark=null, publicationField=null, createdTime=1751262512917, updatedTime=1761735725513, createdBy=18614031015, updatedBy=13701087609, firstLetterCn=M, firstLetterEn=M, subjectCode=Life Sciences, subjectName=Life Sciences, subjectCodeEn=Life Sciences, subjectNameEn=null, picCn=6srot5PcoYX30Oa4xeTmeg==, picEn=ELwBh5xqrSTlIs7HmSNt2Q==, jcr=null, cjcr=null, exts=[JournalExt(id=1190369167564968109, language=CN, name=解放军医学杂志, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1761735725537, updatedTime=1761735725537, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=#, submissionEditorUrl=#, submissionReviewUrl=#, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""}), JournalExt(id=1190369167615299758, language=EN, name=Medical Journal of Chinese People’s Liberation Army, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1761735725549, updatedTime=1761735725549, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=#, submissionEditorUrl=#, submissionReviewUrl=#, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""})], databaseList=null, tenantJournalId=1189873630562394117, websiteList=[Website(id=1189873845923287108, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1189873630562394117, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN, language=CN, createTime=1761617631655, createBy=18614031015, updateTime=1761622010471, updateBy=18614031015, name=解放军医学杂志-中文, tplId=1146099689490845704, title=解放军医学杂志, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1189924939378520839, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=articleTextType, value=kx, createTime=1761629813284, updateTime=1761629813284, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939353355012, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=banner, value=null, createTime=1761629813278, updateTime=1761629813278, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939399492362, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=grayFlag, value=0, createTime=1761629813289, updateTime=1761629813289, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939344966403, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=logo, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/file/pic?fileId=+zXjYVhun8ZOAA6+aKx2hw==, createTime=1761629813276, updateTime=1761629813276, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939412075276, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=minRunFlag, value=0, createTime=1761629813292, updateTime=1761629813292, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939374326534, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/file/pic, createTime=1761629813283, updateTime=1761629813283, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939407880971, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=silenceFlag, value=0, createTime=1761629813291, updateTime=1761629813291, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939361743621, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_cn_619/, createTime=1761629813280, updateTime=1761629813280, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939386909448, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=themeColor, value=null, createTime=1761629813286, updateTime=1761629813286, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939395298057, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=themeStyle, value=null, createTime=1761629813288, updateTime=1761629813288, creator=18614031015, updator=18614031015)]), Website(id=1189873846057504839, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1189873630562394117, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN, language=EN, createTime=1761617631687, createBy=18614031015, updateTime=1761622030030, updateBy=18614031015, name=解放军医学杂志-英文, tplId=1146101810881728533, title=Medical Journal of Chinese People’s Liberation Army, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1189924968168223505, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=articleTextType, value=kx, createTime=1761629820148, updateTime=1761629820148, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968147251982, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=banner, value=null, createTime=1761629820143, updateTime=1761629820143, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968185000724, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=grayFlag, value=0, createTime=1761629820152, updateTime=1761629820152, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968138863373, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=logo, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/file/pic?fileId=+zXjYVhun8ZOAA6+aKx2hw==, createTime=1761629820141, updateTime=1761629820141, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968197583638, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=minRunFlag, value=0, createTime=1761629820155, updateTime=1761629820155, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968159834896, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/file/pic, createTime=1761629820146, updateTime=1761629820146, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968193389333, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=silenceFlag, value=0, createTime=1761629820154, updateTime=1761629820154, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968155640591, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_en_623/, createTime=1761629820145, updateTime=1761629820145, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968172417810, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=themeColor, value=null, createTime=1761629820149, updateTime=1761629820149, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968180806419, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=themeStyle, value=null, createTime=1761629820151, updateTime=1761629820151, creator=18614031015, updator=18614031015)])], journalTitle=解放军医学杂志, weixinUrl=null, journalUrl=http://zh.jfjyxzz.org.cn/, iacademicId=null, status=1, seqNo=null, journalTitleEn=Medical Journal of Chinese People’s Liberation Army, journalPhotoCn=6srot5PcoYX30Oa4xeTmeg==, journalPhotoEn=ELwBh5xqrSTlIs7HmSNt2Q==, journalFirstLetter=M, journalRecommend=null, journalNew=null, journalCollection=null, jcrJf=null, cjcrJf=null, jcrJfStr=null, cjcrJfStr=null, submissionFirstDecision=null, sciSubjectClassification=null, casSubjectClassification=null, citeScore=null, totalCitationFrequency=null, icpCode=null, psCode=null, advertisingLicenseCode=null, copyrightInformation=null, country=null, option=, provinceCode=null, provinceName=null, collectFlag=false), detailUrlCn=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2450.2023.0823, detailUrlEn=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/10.11855/j.issn.0577-7402.2450.2023.0823, pdfUrlCn=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/PDF/10.11855/j.issn.0577-7402.2450.2023.0823, pdfUrlEn=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/PDF/10.11855/j.issn.0577-7402.2450.2023.0823, aliStartDate=null, aliEndDate=null, collectionFlag=false, citedCount=null, citedUrl=null, reference=null)
收藏切换
抗核抗体谱对AIH-PBC OS及单纯AIH患者激素应答的影响
收藏切换
PDF下载
李琼 1 , 田爱平 2 , 毛永武 2 , 王富春 1 , 毛小荣 2, *
解放军医学杂志 | 临床研究 2024,49(1): 64-69
收起
收藏切换
解放军医学杂志 | 临床研究 2024, 49(1): 64-69
抗核抗体谱对AIH-PBC OS及单纯AIH患者激素应答的影响
全屏
李琼1, 田爱平2, 毛永武2, 王富春1, 毛小荣2, *
作者信息
  • 1兰州大学第一临床医学院，甘肃兰州 730000
  • 2兰州大学第一医院感染科，甘肃兰州 730000

    • 李琼，硕士研究生，主要从事肝病临床诊疗方面的研究

通讯作者:

毛小荣，E-mail：
Effect of ANAs on hormone response in patients with AIH-PBC overlap syndrome and AIH-only
Qiong Li1, Ai-Ping Tian2, Yong-Wu Mao2, Fu-Chun Wang1, Xiao-Rong Mao2, *
Affiliations
  • 1First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
  • 2Department of Infectious Diseases, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
出版时间: 2024-01-28 doi: 10.11855/j.issn.0577-7402.2450.2023.0823
文章导航
收藏切换
摘要
收起

目的 探讨抗核抗体谱(ANAs)对自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)及单纯AIH患者半年内激素应答的影响。方法 回顾性分析2018年1月-2021年12月兰州大学第一医院收治的77例自身免疫性肝病(AILD)患者的资料，其中AIH-PBC OS组46例，单纯AIH组31例。均经肝穿刺活检组织病理检查确诊，并行糖皮质激素治疗。比较两组患者的一般临床特征、肝穿刺相关指标、自身抗体及免疫球蛋白指标，以及患者使用糖皮质激素初始及6个月内复查的生化及免疫球蛋白指标，根据谷草转氨酶(AST)、谷丙转氨酶(ALT)及免疫球蛋白G(IgG)水平评估治疗6个月内的激素应答情况，采用多因素有序logistic分析ANAs对两组患者激素应答结果的影响。结果 ANAs阳性及阴性AILD患者中，AIH-PBC OS及单纯AIH患者占比均无统计学差异(55.6% vs. 44.4%，65.6% vs. 34.4%，P>0.05)。46例AIH-PBC OS患者中，ANAs阳性组25例，ANAs阴性组21例。ANAs阳性组半年内激素完全应答率低于ANAs阴性组(44.0% vs. 76.2%)，而激素不应答率高于ANAs阴性组(20.0% vs. 0)，差异有统计学意义(P<0.05)。31例单纯AIH患者中，ANAs阳性组20例，ANAs阴性组11例。两组患者半年内激素应答结果差异无统计学意义(P>0.05)。多因素有序logistic分析结果显示，AIH-PBC OS患者中，ANAs阳性者半年内激素不应答的可能性较大，差异有统计学意义(P<0.05)。而单纯AIH患者中ANAs类型对激素应答结果无明显影响(P>0.05)。结论 在AIH-PBC OS患者中，ANAs阳性者半年内激素应答结果欠佳；在单纯AIH患者中，ANAs对激素应答结果无明显影响。

自身免疫性肝炎  /  原发性胆汁性胆管炎  /  重叠综合征  /  抗核抗体谱  /  激素生化应答

Objective To investigate the effect of antinuclear antibodies (ANAs) on hormone response in patients with autoimmune hepatitis (AIH)-primary biliary cholangitis (PBC) overlap syndrome (AIH-PBC OS) and AIH-only within half a year. Methods A retrospective analysis of 77 patients with autoimmune liver disease (AILD) admitted to First Clinical Medical College of Lanzhou University from January 2018 to December 2021, all of whom were confirmed by liver biopsy and receiving glucocorticoid treatment. Among them, 46 patients were in AIH-PBC OS group and 31 were in AIH-only group. The general clinical characteristics, liver puncture-related indexes, autoantibodies and immunoglobulin indexes of patients in each group at the time of diagnosis were collected and compared, and the biochemical and immunoglobulin indexes of patients at the time of hormone use and at the time of review within 6 months were also collected, and the hormone response within 6 months was evaluated according to the levels of glutamic transaminase (AST), glutamic alanine transaminase (ALT) and immunoglobulin G (IgG), and the effect of ANAs on hormone response outcomes in both groups over a six-month period was analyzed. Multifactorial ordered logistic analysis was performed to evaluate the effect of ANAs on hormone response between two groups. Results There was no statistically significant difference in the percentage of AIH-PBC OS and AIH-only patients among both ANAs-positive and -negative AILD patients (55.6% vs. 44.4% and 65.6% vs. 34.4%, P>0.05). Among 46 patients with AIH-PBC OS, there were 25 in ANAs-positive group and 21 in ANAs-negative group. The rate of complete hormone response within 6 months was lower than that of ANAs-negative group (44.0% vs. 76.2%), while the rate of hormone non-response was higher than that of ANAs-negative group (20.0% vs. 0), and the difference was statistically significant (P<0.05). There were 20 cases of ANAs-positive and 11 cases of ANAs-negative in the 31 AIH-only patients. There was no statistically significant difference in the results of hormone response within 6 months between the two groups (P>0.05). Multifactorial ordered logistic analysis showed that AIH-PBC OS patients were more likely to have a higher likelihood of 6-month hormone non-response rate in ANAs-positive patients, and the difference was statistically different (P<0.05). And there was no significant effect of ANAs type on hormone response outcome in AIH-only patients (P>0.05). Conclusion AIH-PBC OS ANAs-positive patients have a poor hormone response within half a year. In AIH-only patients, ANAs have no significant effect on hormone response results.

autoimmune hepatitis  /  primary biliary cholangitis  /  overlap syndrome  /  antinuclear antibodies  /  hormone biochemical response
李琼, 田爱平, 毛永武, 王富春, 毛小荣. 抗核抗体谱对AIH-PBC OS及单纯AIH患者激素应答的影响. 解放军医学杂志, 2024 , 49 (1) : 64 -69 . DOI: 10.11855/j.issn.0577-7402.2450.2023.0823
Qiong Li, Ai-Ping Tian, Yong-Wu Mao, Fu-Chun Wang, Xiao-Rong Mao. Effect of ANAs on hormone response in patients with AIH-PBC overlap syndrome and AIH-only[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (1) : 64 -69 . DOI: 10.11855/j.issn.0577-7402.2450.2023.0823
正文
收起
自身免疫性肝炎(autoimmune hepatitis，AIH)及原发性胆汁性胆管炎(primary biliary cholangitis，PBC)均是因自身免疫系统紊乱引起的慢性肝胆炎性疾病，二者在临床特征及疾病预后方面各有特征[1-3]。部分患者可同时出现AIH合并PBC的生化及病理特征，诊断为AIH-PBC重叠综合征(AIH-PBC overlap syndromes，AIH-PBC OS)[4]。AIH-PBC OS是最常见的肝内自身免疫性疾病的重叠类型。由于遗传背景与致病机制之间存在交叉，自身免疫性肝病(autoimmune liver disease，AILD)也可合并不同的肝外自身免疫系统疾病[5]，特别是风湿免疫性疾病。抗核抗体谱(antinuclear antibodies，ANAs)对于风湿系统疾病的病情判断有一定意义，由于免疫共存，其在不同AILD中表达也不同。
AIH发病隐匿，30%的患者诊断时即进展为肝硬化，目前主要通过给予糖皮质激素等行免疫调节治疗。对于确诊的AIH，一般优先推荐泼尼松(龙)[6]。对于AIH-PBC OS的治疗，多数学者建议泼尼松(龙)联合熊去氧胆酸(ursodeoxycholic acid，UDCA)，既往研究也发现糖皮质激素对此类疾病有一定疗效[7-9]。但关于表达ANAs的AIH-PBC OS及单纯AIH患者半年内激素应答情况目前尚未明确。本研究探讨ANAs对AIH-PBC OS与单纯AIH患者半年内激素应答情况的影响，以协助临床评估ANAs阳性的AIH-PBC OS及单纯AIH患者激素应答情况，早期发现对激素应答不佳的患者，避免患者肝脏损害持续加重或长期大剂量使用激素，从而改善患者预后。
1 资料与方法
收起
1.1 一般资料
选取2018年1月-2021年12月于兰州大学第一医院感染科确诊的AIH-PBC OS及单纯AIH患者为研究对象。纳入标准：(1)行肝穿刺活检及肝病理组织学检查，证实符合AIH-PBC OS或AIH病理学损伤模式；(2)给予糖皮质激素治疗，AIH-PBC OS患者同时给予UDCA药物治疗。排除标准：(1)合并病毒性肝炎、药物性肝损伤、酒精性肝病、代谢性肝病及肝豆状核变性等；(2)临床资料及检验检查指标不完整；(3)治疗过程中更换激素为其他免疫抑制剂；(4)使用糖皮质激素半年内自行停用；(5)既往使用糖皮质激素。AIH-PBC OS诊断参照巴黎标准[10]，单纯AIH诊断参照2021版亚太肝脏研究协会临床实践指南[4]。所有患者均签署肝脏穿刺活检知情同意书及激素使用知情同意书。
1.2 研究指标及定义
收集入组患者行肝脏穿刺活检确诊时的基本资料，包括年龄、性别、身高、体重及血压，计算体重指数(body mass index，BMI)=体重(kg)/身高2(m2)；平均动脉压=舒张压+1/3×(收缩压-舒张压)。同时收集确诊时ANAs中部分抗体及使用激素时初始、1个月、3个月及6个月时的肝功能、免疫球蛋白等指标，根据谷丙转氨酶(alanine aminotransferase，ALT)、谷草转氨酶(aspartate aminotransferase，AST)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、碱性磷酸酶(alkaline phosphatase，ALP)及γ-谷氨酰转移酶(γ-glutamyl transferase，GGT)水平评估患者半年内激素应答情况。
入组患者糖皮质激素(泼尼松)初始剂量按0.5~1.0 mg/(kg.d)计算(甲泼尼龙剂量根据以下公式确定：1.6 mg甲泼尼龙=2 mg泼尼松)，激素减量遵循个体化原则。AIH-PBC OS患者UDCA剂量按照13~15 mg/(kg.d)计算。生物化学指标应答情况参照国际自身免疫肝炎小组的共识[9]，并结合本研究的观察指标，激素完全应答定义为：ALT、AST、IgG水平降至正常范围，ALP、GGT水平下降>40%或降至正常范围。应答不充分定义为：AST、ALT及IgG水平较前下降但未复常。不应答定义为：治疗启动后4周内血清转氨酶水平下降<40%。
本研究中ANAs包括抗平滑肌抗体(SMA)、抗SS-A抗体、抗Ro-52抗体、着丝点B蛋白抗体(CNEP-B)、抗中性粒细胞浆抗体(PANCA)及抗双链DNA抗体(dsDNA)，以上任意抗体阳性均定义为ANAs阳性。
1.3 研究方法
分析ANAs阳性及阴性AILD患者特点，以及ANAs阳性与阴性不同类型AILD患者激素应答情况。采用多因素有序logistic分析AIH-PBC OS及单纯AIH 患者激素应答结果的影响因素。由于患者GS分期中包含病理损伤模式的因素，为避免共线性影响，病理损伤模式的因素未纳入logistic分析。
1.4 统计学处理
采用SPSS 24.0软件进行统计分析。正态分布的计量资料以$\bar{x}±s$表示，两组间比较采用独立样本t检验；非正态分布的计量资料以M(Q1，Q3)表示，两组间比较采用Mann-Whitney U检验；计数资料以例(%)表示，两组间比较采用χ2检验，三组比较采用Kruskal-Wallis H检验；多因素分析采用多因素有序logistic回归方法。P<0.05为差异有统计学意义。
2 结果
收起
2.1 ANAs阳性及阴性AILD患者特点
共筛选出157例经肝脏穿刺活检术后确诊为AILD的患者，根据纳入及排除标准，最终纳入77例经激素治疗的AILD患者，分为AIH-PBC OS组46例，单纯AIH组31例，其中AIH-PBC OS组中ANAs阳性及阴性者分别有25例及21例，单纯AIH 组中ANAs阳性及阴性者分别有20例及11例(图1)。77例AILD患者中，ANAs阳性组中女性患者所占比例高于ANAs阴性组(P<0.05)。两组患者年龄、平均动脉压、IgG、IgM及AILD类型方面的差异均无统计学意义(P>0.05，表1)。
2.2 ANAs阳性与阴性不同类型AILD患者激素应答情况
46例AIH-PBC OS患者按ANAs表达情况分为两组，其中ANAs阳性组25例，ANAs阴性组21例。ANAs阳性组半年内激素完全应答率低于ANAs阴性组(44.0% vs. 76.2%)，而激素不应答率高于ANAs阴性组(20.0% vs. 0)，差异有统计学意义(P<0.05)。31例单纯AIH患者按ANAs表达情况分为两组，其中ANAs阳性组20例，ANAs阴性组11例。ANAs阳性及阴性组激素应答结果差异无统计学意义(P>0.05，图2)。
2.3 AIH-PBC OS及单纯AIH 患者激素应答结果的影响因素
AIH-PBC OS患者中，ANAs的表达对于半年内激素应答结果具有一定影响，ANAs阳性患者激素不应答的可能性为ANAs阴性患者的8.073倍，差异有统计学意义(P<0.05，表2)。而单纯AIH患者中，所纳入的因素对激素应答结果的影响差异无统计学意义(P>0.05，表3)。
3 讨论
收起
AILD患者容易出现炎症反应及肝功能损伤，同时由于遗传背景与致病机制之间存在交叉，AILD也可与其他类型自身免疫性疾病合并发生，且种类繁多[5,12]。不同类型AILD合并肝外自身免疫性疾病的类型不同，以风湿免疫性疾病最为常见[13]。AIH常合并系统性红斑狼疮等[14]，而在AIH-PBC OS患者中，干燥综合征的发生率较高[15]。与自身免疫病共存是否影响AILD的自然进程及预后目前尚不明确。
有研究发现，免疫病共存的现象可能会加重炎症反应[16]，目前AILD的主要治疗策略为通过糖皮质激素减轻炎症反应。激素应答结果包括生化应答及组织学应答，在临床上，AILD的缓解通过组织学诊断最精确，需要进行肝脏活检，但这与当前的临床实际不符。目前，临床实践中肝脏活检仅在诊断时进行，患者很少接受后续活检。正如本研究中，仅有少数患者行二次肝脏穿刺以评估肝脏炎症及纤维化程度，故无法进行组织学应答的评估，仅进行生化应答评估。国际专家根据血清转氨酶及免疫球蛋白水平的变化，就AILD的生化应答结果达成共识，包括完全生化应答、应答不充分、无应答[11,17]。在临床上，治疗应答效果在很大程度上取决于患者相关因素及AILD的严重程度。应答不充分并不一定意味着治疗方案应该改变，但可能对预后评估有部分价值，而对于无应答的患者，应探讨其依从性，对AILD的诊断提出质疑，并由肝脏病理学家重新评估组织学。由于合并其他类型自身免疫性疾病后的免疫共存原因，AILD患者可不同程度表达ANAs，但免疫共存时ANAs阳性是否影响患者激素应答目前尚未明确。本研究发现，ANAs阳性对于单纯AIH的激素应答无明显影响。
本研究结果显示，ANAs对于AIH-PBC OS患者的激素应答有一定影响，ANAs阳性患者半年内激素完全应答率明显低于ANAs阴性患者，激素不应答率明显高于ANAs阴性患者。AIH-PBC OS是AILD中最常见的重叠综合征类型，虽然目前发病机制尚未完全明确，但存在潜在的免疫功能障碍，遗传、免疫、环境与激素之间的相互作用在疾病的发展中起一定作用。表达ANAs的AIH-PBC OS患者可被视为肝内及肝外自身免疫性疾病的多重重叠患者，上述因素之间的多重相互作用可能导致肝外自身免疫性疾病患病率的可变性及病情变化的不确定性，对患者的病程及激素应答可能产生不良影响。来自韩国的研究显示，AIH-PBC OS患者的激素生化应答较单纯AIH患者差[5]，并且与单纯AIH患者相比，AIH-PBC OS患者发生肝硬化的速度可能更快，预后更差[5,18]。同时，在不同的HLA-DR等位基因中，HLA-DR7在AIH-PBC OS中较在AIH患者中更常见[19]。HLA-DR7增多反映T细胞增殖活跃，提示炎症反应加重。综上，AIH-PBC OS患者炎症反应较单纯AIH患者可能加重，当此类患者出现ANAs阳性时，免疫系统可能遭受进一步破坏，一定程度上会影响激素的应答结果。
本研究存在以下局限性：首先，为回顾性研究，未对患者进行长期随访，且目前仅少量患者完成整个疗程，同时行二次肝脏穿刺活检评估肝脏炎症及纤维化程度，故无法大样本比较激素长期应答的效果。其次，为单中心研究，选取的单纯AIH应用激素患者样本量较少。因此，未来仍需大样本、前瞻性及长期随访研究加以证实。
综上所述，在AIH-PBC OS患者中，ANAs阳性者半年内激素应答效果欠佳。而单纯AIH患者中，ANAs对激素应答结果无明显影响。因此，在临床实践中，若AIH-PBC OS患者具有明确的激素使用指征，临床医师应关注患者的ANAs，对于ANAs阳性的患者，应密切随访并严格评估激素应答结果；对治疗反应不佳、转氨酶反应与IgG反应不一致的患者，应及时调整诊治方案，必要时建议患者再次进行随访活检，以再次确认疾病的组织学情况，避免患者肝脏损害持续加重或长期大剂量使用激素，从而改善患者预后。
基金
收起
  • 甘肃省自然科学基金(21JR1RA070)
  • 甘肃省高等学校创新能力提升项目(2020B-016)
文献
收起
参考文献 引证文献
排序方式：
[1]
Heo NY, Kim H. Epidemiology and updated management for autoimmune liver disease[J]. Clin Mol Hepatol, 2023, 29(1): 194-196.
[2]
丁健, 宋亮, 阮柏, 等. 间充质干细胞及其修饰体在肝纤维化治疗中的作用研究进展[J]. 解放军医学杂志, 2023, 48(5): 609-614.
[3]
程苕莼, 刘一村, 薛红, 等. 原发性胆汁性胆管炎合并肝细胞脂肪变性的临床特征及预后分析[J]. 中国实用内科杂志, 2022, 42(4): 310-313, 318.
[4]
Wang GQ, Tanaka A, Zhao H, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis[J]. Hepatol Int, 2021, 15(2): 223-257.
[5]
Park Y, Cho Y, Cho EJ, et al. Retrospective analysis of autoimmune hepatitis-primary biliary cirrhosis overlap syndrome in Korea: characteristics, treatments, and outcomes[J]. Clin Mol Hepatol, 2015, 21(2): 150-157.
[6]
马雄, 王绮夏, 肖潇, 等. 自身免疫性肝炎诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 42-49.
[7]
Mané F, Cardoso H, Liberal R, et al. Treatment response in primary biliary cholangitis: the role of autoimmune hepatitis features[J]. Ann Hepatol, 2019, 18(3): 488-493.
[8]
Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American association for the study of liver diseases[J]. Hepatology, 2020, 72(2): 671-722.
[9]
郭丽萍, 周璐, 李树倩, 等. 熊去氧胆酸单药或联合免疫抑制剂治疗原发性胆汁性肝硬化-自身免疫性肝炎重叠综合征的疗效分析[J]. 中华消化杂志, 2016, 36(3): 155-160.
[10]
Chazouillères O, Wendum D, Serfaty L, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: clinical features and response to therapy[J]. Hepatology, 1998, 28(2): 296-301.
[11]
Pape S, RJALM Snijders, Gevers TJG, et al. Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group[J]. J Hepatol, 2022, 76(4): 841-849.
[12]
郭丽萍, 周璐, 王邦茂. 自身免疫性肝病合并肝外自身免疫病的研究进展[J]. 中华消化杂志, 2016, 36(2): 142-144.
[13]
Radovanović-Dinić B, Tešić-Rajković S, Zivkovic V, et al. Clinical connection between rheumatoid arthritis and liver damage[J]. Rheumatol Int, 2018, 38(5): 715-724.
[14]
田辉. 自身免疫性肝病相关性风湿病样及皮肤表现 [J]. 临床肝胆病杂志, 2018, 34(9): 2021-2026.
[15]
Jiang Y, Xu BH, Rodgers B, et al. Characteristics and inpatient outcomes of primary biliary cholangitis and autoimmune hepatitis overlap syndrome[J]. J Clin Transl Hepatol, 2021, 9(3): 392-398.
[16]
Wang L, Zhang FC, Chen H, et al. Connective tissue diseases in primary biliary cirrhosis: a population-based cohort study[J]. World J Gastroenterol, 2013, 19(31): 5131-5137.
[17]
Muratori L, Lohse AW, Lenzi M. Diagnosis and management of autoimmune hepatitis[J]. BMJ, 2023, 380: e070201.
[18]
Yang F, Wang QX, Wang ZY, et al. The natural history and prognosis of primary biliary cirrhosis with clinical features of autoimmune hepatitis[J]. Clin Rev Allergy Immunol, 2016, 50(1): 114-123.
[19]
Coss Adame E, Granados J, Uribe M, et al. Does HLA-DR7 differentiate the overlap syndrome of auto-immune hepatitis-primary biliary cirrhosis (AIH-PBC) from those with auto-immune hepatitis type 1?[J]. Ann Hepatol, 2011, 10(1): 28-32.
2024年第49卷第1期
PDF下载
213
96
引用本文
BibTeX
文章信息
doi: 10.11855/j.issn.0577-7402.2450.2023.0823
  • 接收时间：2022-11-22
  • 首发时间：2025-11-23
  • 出版时间：2024-01-28
补充材料
相关文章
文章信息
作者
出版历史
  • 收稿日期：2022-11-22
  • 录用日期：2023-03-14
基金
Natural Science Foundation of Gansu Province(21JR1RA070)
甘肃省自然科学基金(21JR1RA070)
Gansu Province Higher Education Innovation Capacity Enhancement Project(2020B-016)
甘肃省高等学校创新能力提升项目(2020B-016)
作者信息
    1兰州大学第一临床医学院，甘肃兰州 730000
    2兰州大学第一医院感染科，甘肃兰州 730000

通讯作者:

毛小荣，E-mail：
参考文献
分享链接
https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2450.2023.0823
分享至
全文二维码

扫描看全文

引用本文
BibTeX
本文的引用情况
2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
关闭全屏
相关链接
论文
最新文章
热读文章
热点专题
内参
蓝皮书
产业发展报告
传播力报告
期刊分级目录
资讯
学术新闻
行业新闻
学术会议
行业会议
关于
关于我们
联系我们
北京市海淀区学院南路86号
100081
010-62199257
qkjq@cast.org.cn

中国科学技术协会版权所有 京ICP 备10216604号-4 海淀分局备案 1101084647
科技导报社主办 中国科协信息中心技术支持