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为了确定严重慢性活动性肝病(CALD)对常规治疗反应变化不定的原因,作者连续对101例患者研究了最初和以后的肝活检形态改变与疾病结局之间的关系。101例中,23例为慢性活动性肝炎(CAH);21例为亚急性肝炎具有纤维组织“架”(bridging)(SHB),24例为亚急性肝炎具有多小叶坏死(SHMN);33例为活动性肝炎伴有肝硬化(AC)。72例随机分配每天用20毫克强的松或用10毫克强的松加50毫克硫唑嘌呤维持治疗。对照组29例随机分配给予安慰剂或硫唑嘌呤(100毫克),两者效果相仿。与对照组比较,在CAH(P<0.05)、SHB(P<0.025)和SHMN(P<0.01)中,此种治疗可增加缓解,减少治疗失败;AC的治疗反应只有在除外了治疗头6个月内死亡的患者后才较优越(P<0.05)。在治疗期间,CAH发生肝硬化比SHB或SHMN少见(P<0.05)。AC发生缓解比无肝硬化病变者为慢(P<
To determine the cause of the variable response to routine treatment in patients with severe chronic active liver disease (CALD), the authors studied consecutively the relationship between initial and subsequent liver biopsy morphological changes and disease outcomes in 101 patients. Twenty-three of the 101 patients had chronic active hepatitis (CAH); 21 had fibrous tissue “bridging” (SHB) in subacute hepatitis, 24 had multiple leaflet necrosis (SHMN) in subacute hepatitis and 33 For active hepatitis associated with cirrhosis (AC). Seventy-two patients were randomized to receive 20 mg of prednisone daily or 10 mg of prednisone plus 50 mg of azathioprine. Twenty-nine patients in the control group were randomized to placebo or azathioprine (100 mg), both of which had similar effects. Compared with the control group, the treatment can increase remission and reduce treatment failure in CAH (P <0.05), SHB (P <0.025) and SHMN (P <0.01); AC treatment response only with the exception of the treatment of head 6 Patients who died within a month were superior (P <0.05). Cirrhosis of CAH was less common than SHB or SHMN during treatment (P <0.05). AC remission was slower than those without cirrhosis (P <