Regresión histológica de la fibrosis hepática con tratamiento inmunosupresor en hepatitis autoinmune / Histological regression of liver fibrosis with immunosuppressive therapy in autoimmune hepatitis

RESUMEN

Resumen La reversibilidad de la fibrosis hepática se describe en hepatitis autoinmune(HAI) con tratamiento inmunosupresor (TI). Objetivo Comparar fibrosis inicial y con TI en HAI.MétodosIngresaron 54 pacientes con anticuerpos antinucleares y/o antimúsculo liso (+), IgG elevada y biopsia compatible, edad promedio 39 años (rango 13-65), 47 mujeres (87%), en tratamiento con prednisona y azatioprina. Se comparó grado de inflamación (0-18) y fibrosis (0-6) según score de Ishak entre biopsia inicial y control (prom 28±8 meses). Resultados La fibrosis disminuyó de 2,9±0,3 a 2,2±0,3 (p=0,005) y el índice de actividad histológica de 6,8±0,45 a 2,6±0,2 (p<0,001). En subgrupos esta disminuyó de 3,6±0,4 a 1,4±0,3 (p<0,001) en 22 pacientes (41%), no varió en 27 (50%) y aumentó en 5 (9%); 4/7 con cirrosis histológica inicial mejoraron a score 0-3 en control. La evolución de transaminasas no permitió predecir la mejoría histológica. Conclusión En pacientes con HAI el TI mejora significativamente la fibrosis, acentuando la importancia de estudiar factores pronósticos asociados a esta favorable respuesta (AU)

ABSTRACT

Abstract 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 (AU)