Manns M, Meyer zum Büschenfelde K H, Arnold W
Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.
Leber Magen Darm. 1988 Dec;18(6):290-2, 295, 298 passim.
Various types of virus induced and non-virus induced chronic active hepatitis (CAH) as well as chronic non-suppurative destructive cholangitis (PBC) and primary sclerosing cholangitis have to be distinguished. Classical autoimmune type "lupoid" CAH is characterized by antinuclear antibodies (ANA), liver membrane antibodies (LMA) and smooth muscle antibodies (SMA). A second subgroup of autoimmune type CAH is characterized by anti liver kidney-microsomal antibodies (LKM) which are directed against a specific cytochrome p-450 isoenzyme. A third subgroup of autoimmune type CAH is identified by auto-antibodies to a soluble cytoplasmic liver antigen (SLA). Autoimmune type CAH profits from immuno-suppressive therapy, i.e. corticosteroids alone or in combination with azathioprin. Chronic hepatitis B virus infection is nowadays treated with Interferon when HBV-DNA is detectable in serum, duration of liver disease is less than 5 years and superinfection with HDV and HIV can be excluded. PBC is diagnosed through the detection of antimitochondrial antibodies (AMA) and its PBC specific subtypes anti p 62 (M2) and anti p 48. Aetiology and pathogenesis of PBC are still unknown. Liver transplantation is an established therapy for endstage PBC. This is also true for primary sclerosing cholangitis (PSC).
必须区分各种类型的病毒诱导型和非病毒诱导型慢性活动性肝炎（CAH），以及慢性非化脓性破坏性胆管炎（PBC）和原发性硬化性胆管炎。经典的自身免疫型“狼疮样”CAH的特征是抗核抗体（ANA）、肝膜抗体（LMA）和平滑肌抗体（SMA）。自身免疫型CAH的第二个亚组的特征是抗肝肾微粒体抗体（LKM），其针对特定的细胞色素p - 450同工酶。自身免疫型CAH的第三个亚组通过针对可溶性细胞质肝抗原（SLA）的自身抗体来识别。自身免疫型CAH可从免疫抑制治疗中获益，即单独使用皮质类固醇或与硫唑嘌呤联合使用。当血清中可检测到HBV - DNA、肝病病程小于5年且可排除丁型肝炎病毒（HDV）和人类免疫缺陷病毒（HIV）重叠感染时，慢性乙型肝炎病毒感染目前用干扰素治疗。PBC通过检测抗线粒体抗体（AMA）及其PBC特异性亚型抗p 62（M2）和抗p 48来诊断。PBC的病因和发病机制仍然未知。肝移植是终末期PBC的既定治疗方法。原发性硬化性胆管炎（PSC）也是如此。
