Institute of Internal Medicine and Hepatology, Larissa, Greece; Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece.
Institute of Internal Medicine and Hepatology, Larissa, Greece.
Clin Res Hepatol Gastroenterol. 2019 Jun;43(3):e25-e32. doi: 10.1016/j.clinre.2018.12.002. Epub 2018 Dec 26.
Development of autoimmune hepatitis (AIH) has been sporadically reported in patients with multiple sclerosis (MS) either concurrently or after treatment with immunomodulatory drugs, including interferon-beta (IFN-β) and steroids.
To report a large cohort of 14 patients with MS diagnosed with AIH during an assessment of deranged liver function tests (LFTs).
From 2005 to 2017, we prospectively identified 14 (13 women) patients with MS who suffered also from AIH after investigation in our department for the presence of deranged LFTs. Age at diagnosis of MS was 36.7 ± 9.3 years while at diagnosis of AIH 43.1 ± 12 years.
AIH diagnosis was based on elevation of aminotransferases in all patients [alanine aminotransferase: 520 IU/L (range: 115-1219)], elevation of IgG in 6, compatible autoantibody profile in all, including 5 patients with liver-specific autoantibodies and typical or compatible histological features in 11 patients. 5 patients were under treatment with IFN-β plus methylprednisolone pulses, 3 with IFN-β plus oral steroids, 1 with IFN-β, 4 with methylprednisolone pulses whereas 1 patient was free of treatment. The median time from IFN-β initiation to the development of hepatitis was 12 months (range:1-120). Treatment for AIH was initiated in 13 patients with prednisolone (0.5-1 mg/kg/day) plus mycophenolate myfetil (2 g/day) in 10 and prednisolone plus azathioprine in 3 with complete and partial response in 11 and 2 patients, respectively.
The differential diagnosis of hepatitis in MS patients should include AIH and in particular when immunomodulatory treatment has been preceded. Autoantibody testing and liver histology play fundamental role in establishing a prompt diagnosis of AIH in these patients. Treatment of AIH in patients with MS seems safe and efficient as complete or partial response was recorded in all of our patients.
自身免疫性肝炎（AIH）在多发性硬化症（MS）患者中并发或在免疫调节药物（包括干扰素-β（IFN-β）和类固醇）治疗后偶有报道。
报告一组 14 例 MS 患者的大病例队列，这些患者在评估肝功能检查（LFT）异常时被诊断为 AIH。
从 2005 年到 2017 年，我们前瞻性地在我们的科室中发现了 14 名（13 名女性）患有 MS 的患者，这些患者在存在肝功能异常的情况下也患有 AIH。MS 的诊断年龄为 36.7±9.3 岁，而 AIH 的诊断年龄为 43.1±12 岁。
所有患者的氨基转移酶升高均诊断为 AIH[丙氨酸氨基转移酶：520IU/L（范围：115-1219）]，6 例患者 IgG 升高，所有患者均有相容的自身抗体谱，包括 5 例患者有肝脏特异性自身抗体和 11 例患者有典型或相容的组织学特征。5 例患者接受 IFN-β联合甲基强的松龙脉冲治疗，3 例患者接受 IFN-β联合口服类固醇治疗，1 例患者接受 IFN-β治疗，4 例患者接受甲基强的松龙脉冲治疗，1 例患者未接受治疗。从 IFN-β开始到发生肝炎的中位时间为 12 个月（范围：1-120）。13 例患者开始 AIH 治疗，泼尼松龙（0.5-1mg/kg/天）+霉酚酸酯（2g/天）治疗 10 例，泼尼松龙+硫唑嘌呤治疗 3 例，11 例患者完全缓解，2 例患者部分缓解。
MS 患者的肝炎鉴别诊断应包括 AIH，特别是在免疫调节治疗之前。自身抗体检测和肝组织学在这些患者中及时诊断 AIH 方面发挥着重要作用。在 MS 患者中治疗 AIH 似乎是安全有效的，因为我们所有患者均记录到完全或部分缓解。
