特殊类型自身免疫性肝炎的诊断和治疗

摘要/Abstract

摘要： 自身免疫性肝炎病因尚未完全阐明,多数患者表现为慢性肝炎,以血清转氨酶、免疫球蛋白G升高伴自身抗体阳性、肝脏淋巴-浆细胞界面炎为特征。但少数患者表现不典型,以急性甚至重型肝炎、肝衰竭起病,或诊断前有明确的用药史,病程进展快、预后相对差,因此亟需早期识别并及时给予免疫抑制治疗,以改善其预后。本文结合国内外研究进展,对几类特殊类型的AIH的诊断进行简要综述,以期对临床医师有所帮助。

周睿, 贾继东. 特殊类型自身免疫性肝炎的诊断和治疗[J]. 肝脏, 2025, 30(1): 1-3.

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[1] TanakaA, Mori M, Matsumoto K, et al. Increase trend in the prevalence and male-to-female ratio of primary biliary cholangitis, autoimmune hepatitis, and primary sclerosing cholangitis in Japan[J]. Hepatol Res, 2019,49(8):881-889.
[2] LvT, Li M, Zeng N, et al. Systematic review and meta-analysis on the incidence and prevalence of autoimmune hepatitis in Asian, European, and American population[J]. J Gastroenterol Hepatol, 2019,34(10):1676-1684.
[3] KomoriA. Recent updates on the management of autoimmune hepatitis[J]. Clin Mol Hepatol, 2021,27(1):58-69.
[4] ShenY, Lu C, Men R, et al. Clinical and Pathological Characteristics of Autoimmune Hepatitis with Acute Presentation[J]. Can J Gastroenterol Hepatol, 2018,2018:3513206.
[5] FujiwaraK, Fukuda Y, Sanada M, et al. Analysis of autoimmune hepatitis with acute presentation in the early stage of illness[J]. J Gastroenterol Hepatol, 2024,39(10):2120-2128.
[6] DalekosGN, Gatselis NK, Zachou K. Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?[J]. Liver Transpl, 2019,25(10):1588-1589.
[7] YeomanAD, Westbrook RH, Zen Y, et al. Early predictors of corticosteroid treatment failure in icteric presentations of autoimmune hepatitis[J]. Hepatology, 2011,53(3):926-934.
[8] ChineseSociety of Hepatology, Chinese Medical Association.[Guidelines on the diagnosis and management of autoimmune hepatitis (2021)][J]. Zhonghua Nei Ke Za Zhi, 2021,60(12):1038-1049.
[9] MackCL, Adams D, Assis DN, et al. Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases[J]. Hepatology, 2020,72(2):671-722.
[10] OhiraH, Takahashi A, Zeniya M, et al. Clinical practice guidelines for autoimmune hepatitis[J]. Hepatol Res, 2022,52(7):571-585.
[11] MuratoriP, Granito A, Lenzi M, et al. Limitation of the simplified scoring system for the diagnosis of autoimmune Hepatitis with acute onset[J]. Liver Int, 2021,41(3):529-534.
[12] AlvarezF, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis[J]. J Hepatol, 1999,31(5):929-938.
[13] EuropeanAssociation for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis[J]. J Hepatol, 2015,63(4):971-1004.
[14] 刘钰佩,王瑞,梁树人,等. 药物诱导自身免疫性肝炎与原发自身免疫性肝炎患者临床资料对比分析[J]. 山东医药, 2019,59(21):54-57.
[15] ShinginaA, Mukhtar N, Wakim-Fleming J, et al. Acute Liver Failure Guidelines[J]. Am J Gastroenterol, 2023,118(7):1128-1153.
[16] AndradeRJ, Aithal GP, de Boer YS, et al. Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report[J]. J Hepatol, 2023,79(3):853-866.
[17] BjörnssonE, Talwalkar J, Treeprasertsuk S, et al. Drug-induced autoimmune hepatitis: clinical characteristics and prognosis[J]. Hepatology, 2010,51(6):2040-2048.
[18] YeomanAD, Westbrook RH, Zen Y, et al. Prognosis of acute severe autoimmune hepatitis (AS-AIH): the role of corticosteroids in modifying outcome[J]. J Hepatol, 2014,61(4):876-882.
[19] LammertC, Zhu C, Lian Y, et al. Exploratory Study of Autoantibody Profiling in Drug-Induced Liver Injury with an Autoimmune Phenotype[J]. Hepatol Commun, 2020,4(11):1651-1663.
[20] ChungY, Morrison M, Zen Y, et al. Defining characteristics and long-term prognosis of drug-induced autoimmune-like hepatitis: A retrospective cohort study[J]. United European Gastroenterol J, 2024,12(1):66-75.
[21] Robles-DiazM, Lucena MI, Kaplowitz N, et al. Use of Hy's law and a new composite algorithm to predict acute liver failure in patients with drug-induced liver injury[J]. Gastroenterology, 2014,147(1):109-118.e105.
[22] QiX, Liu C, Jiang Z, et al. Multicenter analysis of clinical characteristics and outcomes in patients with COVID-19 who develop liver injury[J]. J Hepatol, 2020,73(2):455-458.
[23] WangY, Liu S, Liu H, et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19[J]. J Hepatol, 2020,73(4):807-816.
[24] Qin C, Zhou L, Hu Z, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China[J]. Clin Infect Dis, 2020,71(15):762-768.

特殊类型自身免疫性肝炎的诊断和治疗

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