Fukuda Shinichiroh, Komori Atsumasa, Itoh Masahiro, Mihara Yumi, Hashimoto Satoru, Bae Sung Kwan, Nagaoka Shinya, Abiru Seigo, Yatsuhashi Hiroshi, Ishibashi Hiromi
Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki University Graduate School of Biomedical Sciences, Omura, Japan.
Case Rep Gastroenterol. 2011 Sep;5(3):553-7. doi: 10.1159/000332152. Epub 2011 Sep 16.
Concurrence of nonalcoholic steatohepatitis (NASH) with autoimmune hepatitis (AIH) is a rare condition that is challenging to diagnosis, due to the relatively high prevalence of autoantibodies in NASH. It is also difficult to determine the most effective treatment as corticosteroids are likely to worsen NASH despite being effective in the treatment of AIH. In this case report, we present a female diagnosed with NASH-AIH overlap with accompanying diabetes mellitus, who successfully achieved normalization of serum alanine aminotransferase levels following prednisolone therapy and weight loss. A follow-up liver biopsy performed 40 months after the initial diagnosis showed only minimal inflammatory infiltrates in the portal area without any NASH histology. Resolution of NASH, in conjunction with a reduction in hepatic fibrosis, might suggest that prednisolone itself does not aggravate steatohepatitis, but rather prevents disease progression. Appropriate immunosuppressive treatment may therefore be an important component of the optimum therapy for NASH-AIH overlap.
非酒精性脂肪性肝炎（NASH）与自身免疫性肝炎（AIH）并存是一种罕见病症，由于NASH中自身抗体的患病率相对较高，诊断颇具挑战性。确定最有效的治疗方法也很困难，因为尽管皮质类固醇对AIH有效，但可能会使NASH恶化。在本病例报告中，我们介绍了一名被诊断为NASH-AIH重叠且伴有糖尿病的女性，她在接受泼尼松龙治疗和减肥后，血清丙氨酸转氨酶水平成功恢复正常。初次诊断40个月后进行的随访肝活检显示，门管区仅有轻微炎症浸润，无任何NASH组织学表现。NASH的消退以及肝纤维化的减轻，可能表明泼尼松龙本身不会加重脂肪性肝炎，反而能阻止疾病进展。因此，适当的免疫抑制治疗可能是NASH-AIH重叠最佳治疗方案的重要组成部分。
