自身免疫性肝病治疗进展.pptVIP

**3Conventionalandempirictreatmentsforsuboptimalresponsestofirstlinetreatmentinpatientswithautoimmunehepatitis.ClinicaleventConventionaltreatmentsPossibleempirictreatments1stchoice2ndchoice3rdchoice4thchoiceTreatmentfailurePrednisone(30mgdaily)andazathioprine(150mgdaily),orprednisonealone(60mgdaily)Prednisone(30mgdaily)plusmercaptopurine(1.5mg/kgbodyweightdaily)Ciclosporin(5–6mg/kgbodyweightdaily)orprednisone(30mgdaily)plusmycophenolatemofetil(2gdaily)Tacrolimus(4mgtwicedaily)DrugtoxicityAzathioprine(2mg/kgbodyweightdaily)ifprednisoneintolerantPrednisone(20mgdaily)ifazathioprineintolerantBudesonide(3mgtwicedaily)UDCA(13–15mg/kgbodyweightdaily)IncompleteresponsePrednisonemaintenance(≤10mgdaily)ifserumASTlevelthreetimesnormalvalueAzathioprinemaintenance(2mg/kgbodyweightdaily)ifserumASTlevelthreetimesnormalvalueBudesonidemaintenance(3mgtwicedaily)UDCAmaintenance(13–15mg/kgbodyweightdaily)RelapseAzathioprinemaintenance(2mg/kgbodyweightdaily)ifserumASTlevelthreetimesnormalvaluePrednisonemaintenancereducedto(≤10mgdaily)ifserumASTlevelthreetimesnormalvalueMycophenolatemofetilmaintenance(2gdaily)Ciclosporinmaintenance(5–6mg/kgbodyweightdaily)Abbreviations:AST,aspartateaminotransferase;UDCA,ursodeoxycholicacid.**ExcellentLong-TermSurvivalinPatientsWithPrimaryBiliaryCirrhosisandBiochemicalResponsetoUrsodeoxycholicAcidALBERTPARéS,LLOREN?CABALLERíA,andJUANRODéSLiverUnit,DigestiveDiseasesInstitute,HospitalClínic,IDIBAPS,Barcelona,SpainBackgroundAims:Becausetheef.cacyofUDCAonlong-termoutcomeofprimarybiliarycirrhosis(PBC)hasnotbeencompletelyelucidated,wehaveassessedthecourseandsurvivalofpatientswithPBCtreatedwithUDCAandcomparedwiththesurvivalpredictedbytheMayomodelandtheestimatedsurvivalofasta