Ishibashi Hiromi, Komori Atsumasa, Shimoda Shinji, Gershwin M Eric
Clinical Research Center, National Hospital Organization (NHO), Nagasaki Medical Center, and Department of Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Semin Liver Dis. 2007 May;27(2):214-26. doi: 10.1055/s-2007-979472.
The principle of therapy for chronic inflammatory liver diseases is the removal of causal agents. For autoimmune liver diseases, however, total removal of causal agents and immune cells is impossible. Therefore, autoimmune liver diseases are presently treated by suppression of the immune response. Autoimmune hepatitis is characteristically responsive to corticosteroids, often used in combination with azathioprine to obtain a steroid-sparing effect. For primary biliary cirrhosis, ursodeoxycholic acid is safe and is the first choice for treatment. Treatment of this autoimmune liver disease should also address various symptoms and complications arising from any associated autoimmune diseases, particularly cholestasis and cirrhosis-related complications. For primary sclerosing cholangitis there are no established immunomodulatory therapies, but medical, endoscopic, and surgical treatments are applicable to this disease. Liver transplantation becomes indicated during the eventual end stages of each of these immune-mediated liver diseases.
慢性炎症性肝病的治疗原则是去除病因。然而，对于自身免疫性肝病，完全去除病因和免疫细胞是不可能的。因此，目前自身免疫性肝病通过抑制免疫反应来治疗。自身免疫性肝炎对皮质类固醇有特征性反应，皮质类固醇常与硫唑嘌呤联合使用以获得激素节省效应。对于原发性胆汁性肝硬化，熊去氧胆酸安全，是治疗的首选。这种自身免疫性肝病的治疗还应处理由任何相关自身免疫性疾病引起的各种症状和并发症，特别是胆汁淤积和肝硬化相关并发症。对于原发性硬化性胆管炎，尚无既定的免疫调节疗法，但药物、内镜和手术治疗适用于该疾病。在这些免疫介导的肝病的最终终末期需要进行肝移植。
