Autoimmune hepatitis--approach to diagnosis.

Autoimmune hepatitis--approach to diagnosis.
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自身免疫性肝炎——诊断方法。

DOI：
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发表时间：
2006
期刊：
MedGenMed : Medscape general medicine
影响因子：
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通讯作者：
A. Czaja
A. Czaja
中科院分区：
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文献类型：
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作者：
A. Czaja

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上下文 自身免疫性肝炎具有多种特征，可延迟其诊断和潜在挽救生命的糖皮质激素治疗。 目的 回顾自身免疫性肝炎的临床、实验室和组织学特征，并公布其编纂的诊断标准的常规应用。 数据源 参考文献列表和MEDLINE。 资料选择 所有临床相关的已发表的观察结果，表明诊断中的表现和陷阱的多样性。 数据提取 选择具有常见临床相关性和可能混淆诊断或延迟治疗机构的结果。 资料综合 自身免疫性肝炎可以急性表现，并具有小叶中心区3炎症的组织学特征。许多患者可能无症状，但他们经常患有严重或晚期疾病，通常会在以后出现症状。自身抗体反映了免疫介导的机制，但它们不是诊断性的，致病性的，甚至不是诊断所必需的。遗传因素影响易感性，临床表型和治疗结果，他们可能是土著病原体的线索。肝移植后自身免疫性肝炎可能会复发或重新发生，所有出现同种异体移植功能障碍的移植患者都应考虑到这一点。诊断标准已被编纂，评分系统量化诊断的强度，并容纳非典型或缺陷的功能。 结论 自身免疫性肝炎是一个重要的诊断考虑在所有慢性肝炎患者的原因不明。
CONTEXT Autoimmune hepatitis has diverse features that can delay its diagnosis and the institution of potentially lifesaving corticosteroid therapy. OBJECTIVE Review the clinical, laboratory, and histologic features of autoimmune hepatitis and promulgate routine application of its codified diagnostic criteria. DATA SOURCES Reference lists and MEDLINE. STUDY SELECTION All clinically pertinent published observations that indicate the diversity of manifestations and pitfalls in diagnosis. DATA EXTRACTION Findings that had common clinical relevance and the potential to confuse the diagnosis or delay institution of therapy were selected. DATA SYNTHESIS Autoimmune hepatitis can present acutely and have histologic features of centrilobular zone 3 inflammation. Many patients may be asymptomatic, but they frequently have severe or advanced disease and typically develop symptoms later. Autoantibodies are reflective of immune-mediated mechanisms, but they are not diagnostic, pathogenic, or even required for the diagnosis. Genetic factors affect susceptibility, clinical phenotype, and treatment outcome, and they may be clues to indigenous etiologic agents. Autoimmune hepatitis can recur or develop de novo after liver transplantation, and it should be considered in all transplanted patients with allograft dysfunction. Diagnostic criteria have been codified, and a scoring system quantifies the strength of the diagnosis and accommodates atypical or deficient features. CONCLUSION Autoimmune hepatitis is an important diagnosis to consider in all patients with chronic hepatitis of undetermined cause.