Medizinische Klinik und Polikklinik I, University of Bonn Medical Center, Bonn, Germany.
Dig Dis. 2013;31(1):155-63. doi: 10.1159/000347211. Epub 2013 Jun 17.
Autoimmune hepatitis (AIH) was the first chronic liver disease in which remission was achieved by immunosuppression. Prognosis is poor when left untreated. Since the original description in 1950 by Waldenström, the initially reported treatment option has remained until today and is the core of the basic therapeutic strategy of inducing remission with steroids and azathioprine. Immunosuppression as a treatment concept spans different situations including the induction and maintenance of remission, treatment of nonresponders, avoidance of side effects, perioperative treatment of liver transplantation candidates and the issue of withdrawal. Alternative immunosuppressive drugs such as transplantation immunosuppressants have been administered and reported in small series. In an attempt to optimize side effect management, a recent large multicenter prospective treatment trial suggests that budesonide may offer an alternative for noncirrhotic AIH patients with lower steroid side effects. With an early diagnosis and effective therapy, only 4% of transplant candidates are transplanted for AIH. After liver transplantation there is a considerable risk for graft loss because of recurrent AIH, and lifelong vigilance and therapeutic attention is important.
自身免疫性肝炎（AIH）是第一种通过免疫抑制治疗实现缓解的慢性肝脏疾病。如果不治疗，预后很差。自 Waldenström 于 1950 年首次描述以来，最初报告的治疗选择一直沿用至今，是诱导缓解使用类固醇和硫唑嘌呤的基本治疗策略的核心。免疫抑制作为一种治疗概念涵盖了不同的情况，包括诱导和维持缓解、治疗无应答者、避免副作用、肝移植候选者的围手术期治疗以及停药问题。在小系列中报告了移植免疫抑制剂等替代免疫抑制剂的应用。为了优化副作用管理，最近一项大型多中心前瞻性治疗试验表明，布地奈德可能为非肝硬化 AIH 患者提供一种替代方案，可降低类固醇的副作用。通过早期诊断和有效治疗，只有 4%的移植候选者因 AIH 而接受移植。肝移植后，由于复发性 AIH，移植物丢失的风险相当大，因此需要终身警惕和治疗关注。
