Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Aliment Pharmacol Ther. 2014 May;39(10):1043-58. doi: 10.1111/apt.12701. Epub 2014 Mar 13.
Autoimmune hepatitis can be rendered treatment-free, but the difficulty, frequency and risks associated with the pursuit of this outcome are unclear.
To describe the frequency that autoimmune hepatitis can be rendered treatment-free, identify the features that characterise these patients, examine the pathogenic pathways that may sustain or terminate the disease and indicate management protocols that can obtain this result.
Studies cited in Pub Med from 1972-2014 for autoimmune hepatitis, treatment, relapse, remission and outcome were selected.
The frequency of a treatment-free state varies from 19% to 40% in patients observed for ≥3 years after drug withdrawal. Complete laboratory resolution and reversion to normal liver tissue prior to drug withdrawal favours this response. The development of cirrhosis during therapy may increase treatment-dependence. Persistent liver damage and the generation of neo-antigens during the apoptosis of hepatocytes may perpetuate the disease. Genetic and age-related effects on the vigour of the immune response may also contribute. Reversion to normal liver tissue is achieved in only 22% of patients during conventional corticosteroid therapy, and the emerging pharmacological and biological interventions may improve this frequency. A management strategy designed to achieve a treatment-free state accommodates all candidates for this outcome, and it can be modified to a long-term maintenance strategy as warranted by the clinical response.
Permanent drug withdrawal is a treatment outcome that is desirable and achievable in patients with autoimmune hepatitis. Normalisation of liver tests and liver tissue during treatment enhances this occurrence.
自身免疫性肝炎可以实现无需治疗，但追求这一结果的难度、频率和风险尚不清楚。
描述自身免疫性肝炎实现无需治疗的频率，确定具有这些特征的患者，检查可能维持或终止疾病的发病机制，并指出可以获得这一结果的管理方案。
从 1972 年至 2014 年在 Pub Med 上选择了与自身免疫性肝炎、治疗、复发、缓解和结局相关的研究。
停药后观察≥3 年的患者中，无需治疗的状态频率为 19%至 40%。在停药前完全缓解实验室检查和恢复正常肝组织有利于这种反应。治疗过程中发生肝硬化可能会增加对治疗的依赖。在肝细胞凋亡过程中持续的肝损伤和新抗原的产生可能会使疾病持续存在。遗传和年龄相关的免疫反应活力也可能有影响。在常规皮质类固醇治疗期间，仅有 22%的患者恢复正常肝组织，新兴的药理学和生物学干预可能会提高这一频率。旨在实现无需治疗状态的管理策略适用于所有符合这一结果的候选者，并且可以根据临床反应修改为长期维持策略。
永久性停药是自身免疫性肝炎的一种治疗结果，是理想且可实现的。在治疗过程中肝酶和肝组织的正常化增强了这种发生。
