Rizvi Syed, Gawrieh Samer
Gastroenterology and Hepatology Division, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Gastroenterology and Hepatology Division, Indiana University School of Medicine, 702 Rotary Cir, Indianapolis, IN, 46202-5175, USA.
Drugs Aging. 2018 Jul;35(7):589-602. doi: 10.1007/s40266-018-0556-0.
Autoimmune hepatitis (AIH) may present as acute or chronic hepatitis in the elderly. Advanced hepatic fibrosis and cirrhosis are common on first presentation in this population. In this review, we discuss the presentation, approach to diagnosis and management of AIH in the elderly. As polypharmacy is common in the elderly, careful medication use history is essential for detecting drug-induced AIH-like hepatitis. Steroid-sparing or minimizing therapeutic regimens are preferred to treat AIH in the elderly. For the purpose of induction, budesonide or lower dose prednisone in combination with azathioprine (AZA) regimens are preferred over high-dose prednisone monotherapy due to the higher risk of side effects of the later in the elderly. The goal of maintenance therapy should be to achieve full biochemical and histologic remission. Bone density monitoring and interventions to prevent steroid-related bone disease should be implemented throughout the course of the disease. Liver transplantation should be considered in the elderly patient with liver failure or early hepatocellular carcinoma if there are no significant comorbidities or compromise in functional status.
自身免疫性肝炎（AIH）在老年人中可能表现为急性或慢性肝炎。在这一人群中，初次就诊时晚期肝纤维化和肝硬化很常见。在本综述中，我们讨论了老年人AIH的表现、诊断方法及管理。由于老年人常使用多种药物，仔细询问用药史对于检测药物性AIH样肝炎至关重要。在老年人中治疗AIH时，优选使用能减少或尽量减少类固醇使用的治疗方案。在诱导治疗方面，由于高剂量泼尼松单药治疗在老年人中副作用风险更高，因此布地奈德或低剂量泼尼松联合硫唑嘌呤（AZA）方案优于高剂量泼尼松单药治疗。维持治疗的目标应是实现完全的生化和组织学缓解。在疾病全过程中都应进行骨密度监测及采取干预措施以预防类固醇相关骨病。对于肝功能衰竭或早期肝细胞癌的老年患者，如果没有明显的合并症或功能状态受损，应考虑进行肝移植。
