Czaja Albert J
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
Clin Liver Dis. 2015 Feb;19(1):57-79. doi: 10.1016/j.cld.2014.09.004. Epub 2014 Nov 21.
Autoimmune hepatitis is characterized by increased serum aminotransferase levels, autoantibodies, hypergammaglobulinemia, and interface hepatitis. Presentation can be acute, severe (fulminant), asymptomatic, or chronic. Diagnosis requires multiple findings and exclusion of similar diseases. Treatment with prednisone or prednisolone with azathioprine is recommended. Budesonide with azathioprine has normalized laboratory test with few side effects, but histologic resolution, durability of response, and target population are uncertain. Progressive worsening, incomplete improvement, drug intolerance, and relapse after drug withdrawal are suboptimal outcomes. Calcineurin inhibitors and mycophenolate mofetil are salvage agents in small series and liver transplantation is effective for liver failure.
自身免疫性肝炎的特征为血清转氨酶水平升高、自身抗体、高球蛋白血症及界面性肝炎。其表现可为急性、严重（暴发性）、无症状或慢性。诊断需要多项检查结果并排除相似疾病。推荐使用泼尼松或泼尼松龙联合硫唑嘌呤进行治疗。布地奈德联合硫唑嘌呤可使实验室检查结果恢复正常且副作用较少，但组织学缓解情况、反应的持久性及目标人群尚不确定。病情进行性恶化、改善不完全、药物不耐受及停药后复发均为不理想的结果。钙调神经磷酸酶抑制剂和霉酚酸酯在小样本研究中为挽救性药物，肝移植对肝衰竭有效。
