关键词: 淀粉样蛋白A, 25-羟基维生素D, 自身免疫性肝炎, 免疫抑制剂, 治疗应答

Abstract:

Objective To investigate the predictive roles of serum amyloid A（SAA） and 25-hydroxyvitamin D [25（OH）D] levels in patients with autoimmune hepatitis（AIH） for the response to immunosuppressive therapy. Methods A total of 141 patients with AIH（AIH group） and 141 healthy subjects（healthy control group） from Weifang Yidu Central Hospital from October 2019 to October 2023 were enrolled. The AIH group was classified into good response subgroup（113 cases） and poor response subgroup（28 cases） based on the response to immunosuppressive therapy within 4 weeks. The general data were collected. Serum SAA，25（OH）D， white blood cell（WBC） count，alanine aminotransferase（ALT），aspartate aminotransferase（AST），total bilirubin（TB），IgG and gamma-globulin levels were determined in AIH group before and after treatment for 4 weeks. The SAA，25（OH）D，ALT，AST and TB levels were determined in healthy control group. Pearson correlation analysis was used to evaluate the correlation between SAA，25（OH）D and AST，ALT and TB. Logistic regression analysis was used to evaluate the influencing factors of poor response to immunosuppressive therapy in AIH patients. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of single and combined determinations of SAA and 25（OH）D in predicting the response status of AIH patients to immunosuppressive therapy. Results SAA，AST，ALT and TB in AIH group were higher than those in healthy control group（P<0.001），and 25（OH）D was lower（P<0.001）. After treatment，SAA，AST，ALT，TB，IgG and gamma-globulin in AIH group were decreased（P<0.001），and 25（OH）D levels were increased（P<0.001）. Serum 25（OH）D levels in poor response subgroup before and after treatment were lower than those in good response subgroup（P<0.001），and SAA before and after treatment and AST，ALT，TB，IgG and gamma-globulin after treatment were higher（P<0.001）. SAA in AIH patients was positively correlated with AST，ALT and TB（r values were 0.062，0.147 and 0.325，respectively，P<0.05）. The 25（OH）D was negatively correlated with AST，ALT and TB（r values were -0.235，-0.183 and -0.275，respectively，P<0.05）. Pre- and post-treatment 25（OH）D decreasing，pre-treatment SAA increasing were risk factors for poor response to immunosuppressive therapy in AIH patients（P<0.05）. The areas under curves（AUC） of pre-treatment SAA，25（OH）D single and combined determinations for predicting poor response to immunosuppressive therapy in AIH patients were 0.792，0.881 and 0.910，respectively. Conclusions SAA and 25（OH）D are related to the response to immunosuppressive therapy，which can serve as effective indicators for evaluating therapeutic effect.

Key words: Serum amyloid A, 25-Hydroxyvitamin D, Autoimmune hepatitis, Immunosuppressant, Treatment response