Prelipcean Cristina Cijevschi, Mihai Cătălina, Stefănescu Carmen, Drug V L
Institutul de Gastroenterologie şi Hepatologie Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2004 Jan-Mar;108(1):32-9.
Autoimmune hepatitis is a self-perpetuating hepatocellular inflammation. The diagnosis is established by a number of diagnostic criteria, defined by the International Autoimmune Hepatitis Group, and the exclusion of other causes of chronic hepatitis. There are two fundamental goals in therapy: induction of remission and maintenance of remission. The standard initial treatment is prednisone monotherapy or combination therapy with prednisone and azathioprine, which induce a clinical, biochemical and histologic remission in 65-87% of patients within 3 years. Other typical treatment endpoints in autoimmune hepatitis are an incomplete response, treatment failure and intolerance of the administrated drugs. If the treatment results are unsatisfactory, liver transplantation and alternative drugs such as Cyclosporin A, tacrolimus, cyclophosphamide, mycophenolate mofetil, budesonide, ursodeoxycholic acid should be considered; however, efficacy in clinical trials has not been shown. Future investigations must focus on the clarification of pathogenic mechanisms, characterization of target autoantigens, identification of host susceptibility factors, and assessment of alternative treatment strategies.
自身免疫性肝炎是一种持续存在的肝细胞炎症。其诊断依据国际自身免疫性肝炎小组制定的多项诊断标准,并排除慢性肝炎的其他病因。治疗有两个基本目标:诱导缓解和维持缓解。标准的初始治疗是泼尼松单药治疗或泼尼松与硫唑嘌呤联合治疗,这能使65% - 87%的患者在3年内实现临床、生化和组织学缓解。自身免疫性肝炎的其他典型治疗终点包括反应不完全、治疗失败以及对所用药物不耐受。如果治疗效果不理想,应考虑肝移植以及环孢素A、他克莫司、环磷酰胺、霉酚酸酯、布地奈德、熊去氧胆酸等替代药物;然而,临床试验中尚未显示出其疗效。未来的研究必须聚焦于阐明发病机制、确定靶自身抗原的特征、识别宿主易感因素以及评估替代治疗策略。