Diagnosis and Management of Autoimmune Hepatitis
Diagnosis and Management of Autoimmune Hepatitis
复制标题
DOI：
10.1016/j.cld.2014.09.004
复制
发表时间：
2015-02-01
影响因子：
5.1
通讯作者：
Czaja, Albert J.
中科院分区：
文献类型：
--
作者：
Czaja, Albert J.
自身免疫性肝炎的特征是血清转氨酶水平升高、自身抗体、高丙种球蛋白血症和界面性肝炎。表现可以是急性、严重（暴发性）、无症状或慢性。诊断需要多项发现并排除类似疾病。建议使用泼尼松或泼尼松龙联合硫唑嘌呤治疗。布地奈德联合硫唑嘌呤的实验室检查已正常化，副作用很少，但组织学消退、反应持久性和目标人群尚不确定。进行性恶化、不完全改善、药物不耐受和停药后复发是次优结局。钙调磷酸酶抑制剂和霉酚酸酯是小系列的挽救剂，肝移植对肝功能衰竭有效。
Autoimmune hepatitis is characterized by increased serum aminotransferase levels, autoantibodies, hypergammaglobulinemia, and interface hepatitis. Presentation can be acute, severe (fulminant), asymptomatic, or chronic. Diagnosis requires multiple findings and exclusion of similar diseases. Treatment with prednisone or prednisolone with azathioprine is recommended. Budesonide with azathioprine has normalized laboratory test with few side effects, but histologic resolution, durability of response, and target population are uncertain. Progressive worsening, incomplete improvement, drug intolerance, and relapse after drug withdrawal are suboptimal outcomes. Calcineurin inhibitors and mycophenolate mofetil are salvage agents in small series and liver transplantation is effective for liver failure.