Czaja Albert J
Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Semin Liver Dis. 2002 Nov;22(4):365-78. doi: 10.1055/s-2002-35706.
Corticosteroid therapy is effective in all forms of autoimmune hepatitis, and the combination of prednisone and azathioprine is preferred. Remission can be achieved in 80% of patients within 3 years, and the 10- and 20-year survival rates exceed 80%. Histological cirrhosis does not affect response or longevity, and all patients with severe disease should be treated, including children, elderly adults, postmenopausal women, individuals with acute or fulminant presentations, and those without conventional autoantibodies. Relapse is common, and long-term low-dose prednisone or azathioprine therapy is preferred after multiple relapses. Sustained remission is achievable, even after relapse, in 47% within 10 years, and the long-term maintenance regimens need not be indefinite. Liver transplantation is effective, and its actuarial 10-year survival rate is 75%. Drugs such as cyclosporine, tacrolimus, and mycophenolate mofetil promise greater blanket immunosuppression, and site-specific interventions are feasible, including blocking peptides, soluble cytotoxic T lymphocyte antigen-4, cytokine manipulations, T cell vaccination, oral tolerance, and gene therapy.
皮质类固醇疗法对各种形式的自身免疫性肝炎均有效，泼尼松和硫唑嘌呤联合使用为首选。80%的患者可在3年内实现缓解，10年和20年生存率超过80%。组织学肝硬化不影响疗效或生存期，所有重症患者均应接受治疗，包括儿童、老年人、绝经后女性、急性或暴发性发病者以及无传统自身抗体者。复发很常见，多次复发后首选长期小剂量泼尼松或硫唑嘌呤治疗。即使复发后，47%的患者在10年内仍可实现持续缓解，长期维持治疗方案不必是无限期的。肝移植有效，其10年精算生存率为75%。环孢素、他克莫司和霉酚酸酯等药物有望实现更强的全面免疫抑制，并且特定部位的干预措施是可行的，包括阻断肽、可溶性细胞毒性T淋巴细胞抗原-4、细胞因子调控、T细胞疫苗接种、口服耐受和基因治疗。
