Carpenter Herschel A, Czaja Albert J
Department of Laboratory Medicine and Pathology, Mayo Medical School, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Clin Liver Dis. 2002 Aug;6(3):685-705. doi: 10.1016/s1089-3261(02)00022-3.
The diagnosis of autoimmune hepatitis requires a constellation of clinical, laboratory, and histologic features that exclude other conditions and support the syndrome. Interface hepatitis is the histologic hallmark of the disease, and it may be associated with panacinar hepatitis with or without bridging necrosis or multiacinar necrosis. The liver tissue examination at accession supports the diagnosis and assesses disease severity. It can also suggest the diagnosis in patients with atypical presentations, including those with an acute onset or cryptogenic disease. The liver tissue examination during therapy defines end points of treatment (remission) and evaluates unexpected outcomes (treatment failure, incomplete response). Manifestations of bile duct injury are incompatible with the classic diagnosis of autoimmune hepatitis, and they may be coincidental findings of no or uncertain clinical significance or weak expressions of a variant form. Histologic features of autoimmune hepatitis may intermix with those of PBC, PSC, and chronic hepatitis C infection, or they may occur in autoimmune cholangitis or cryptogenic chronic hepatitis. Conditions in which the histologic findings suggest the overlap of two disorders or are insufficient for designation as classic disease constitute the variant syndromes.
自身免疫性肝炎的诊断需要一系列临床、实验室和组织学特征，这些特征可排除其他疾病并支持该综合征的诊断。界面性肝炎是该疾病的组织学标志，它可能伴有或不伴有桥接坏死或多腺泡坏死的全腺泡性肝炎。接收时的肝组织检查有助于诊断并评估疾病严重程度。它还可以为非典型表现的患者提供诊断线索，包括急性起病或不明原因疾病的患者。治疗期间的肝组织检查可确定治疗终点（缓解）并评估意外结果（治疗失败、反应不完全）。胆管损伤的表现与自身免疫性肝炎的经典诊断不符，它们可能是无临床意义或临床意义不确定的偶然发现，或是变异型的轻微表现。自身免疫性肝炎的组织学特征可能与原发性胆汁性胆管炎、原发性硬化性胆管炎和慢性丙型肝炎感染的特征相互混杂，或者它们可能出现在自身免疫性胆管炎或不明原因的慢性肝炎中。组织学结果提示两种疾病重叠或不足以诊断为经典疾病的情况构成变异综合征。
