Department of Medicine, University Medical Centre Hamburg-Eppendorf, Germany.
J Hepatol. 2011 Jul;55(1):171-82. doi: 10.1016/j.jhep.2010.12.012. Epub 2010 Dec 15.
Autoimmune hepatitis was one of the first liver diseases for which an effective treatment was developed and the benefit proven by randomized controlled trials. Nonetheless, both the diagnosis and the treatment of autoimmune hepatitis remain full of challenges. The clinical spectrum is very wide, ranging from subclinical non-progressive disease to fulminant hepatic failure. Diagnostic criteria based on elevation of IgG, demonstration of characteristic autoantibodies, and histological features of hepatitis in the absence of viral disease are very helpful. However, in some patients, diagnosis remains a clinical challenge. Adequately dosed steroids are the mainstay of remission induction treatment, while remission maintenance is best achieved by azathioprine. Therapeutic alternatives are required in a small group of patients responding insufficiently to these drugs or intolerant to their side effects.
自身免疫性肝炎是最早开发出有效治疗方法并通过随机对照试验证明获益的肝脏疾病之一。尽管如此，自身免疫性肝炎的诊断和治疗仍然充满挑战。其临床谱非常广泛，从亚临床非进展性疾病到暴发性肝衰竭不等。基于 IgG 升高、特征性自身抗体的检测以及在无病毒疾病情况下的肝炎组织学特征的诊断标准非常有帮助。然而，在一些患者中，诊断仍然具有挑战性。足量的类固醇是缓解诱导治疗的主要方法，而通过硫唑嘌呤可达到最佳的缓解维持。对于一小部分对这些药物反应不佳或不能耐受其副作用的患者，需要治疗选择。
