Li Jing, Wang Huanhuan, Lin Jie, Wang Aili, Miao Shuiyin, Liu Huaie
Department of Geriatric Digestive Diseases, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Department of General practice, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
J Clin Transl Hepatol. 2025 Jun 28;13(6):493-503. doi: 10.14218/JCTH.2025.00008. Epub 2025 May 13.
Autoimmune hepatitis (AIH) is a chronic, progressive inflammatory liver disease characterized by autoimmune-mediated hepatic injury. Currently, glucocorticoid drugs, primarily prednisone, with or without azathioprine, are commonly recommended as first-line therapeutic agents in treatment guidelines by many scientific associations. However, the primary objective of treatment is to achieve a complete biochemical response, which is defined as the normalization of both transaminases and immunoglobulin G levels within six to twelve months. Ideally, this should also be accompanied by histological remission. Nevertheless, corticosteroid therapy is associated with significant adverse effects, potentially resulting in treatment discontinuation. In this context, it has become evident that standard treatment is inadequate for a proportion of patients, leading to the emergence of other treatment options and lines. Novel immunomodulatory agents, a class of drugs that regulate the body's immune functions, have been confirmed to possess properties that modulate immune balance and induce immune tolerance. In recent years, these agents have played an increasingly significant role in the clinical management of AIH. This article provided an in-depth review of recent advancements in the development of novel immunomodulators, including immune cell nucleic acid inhibitors, calmodulin phosphate inhibitors, mammalian target of rapamycin inhibitors, tumor necrosis factor-α inhibitors, interleukin-2, anti-CD20 monoclonal antibodies, and B cell-activating factor inhibitors, for the treatment of AIH.
自身免疫性肝炎（AIH）是一种慢性进行性炎症性肝病，其特征为自身免疫介导的肝损伤。目前，许多科学协会在治疗指南中普遍推荐以糖皮质激素药物（主要是泼尼松）联合或不联合硫唑嘌呤作为一线治疗药物。然而，治疗的主要目标是实现完全生化缓解，即转氨酶和免疫球蛋白G水平在6至12个月内恢复正常。理想情况下，这还应伴有组织学缓解。尽管如此，皮质类固醇治疗会带来显著的不良反应，可能导致治疗中断。在这种情况下，很明显标准治疗对一部分患者并不充分，从而催生了其他治疗选择和治疗方案。新型免疫调节剂是一类调节机体免疫功能的药物，已被证实具有调节免疫平衡和诱导免疫耐受的特性。近年来，这些药物在AIH的临床管理中发挥着越来越重要的作用。本文深入综述了新型免疫调节剂（包括免疫细胞核酸抑制剂、磷酸钙调蛋白抑制剂、雷帕霉素靶蛋白抑制剂、肿瘤坏死因子-α抑制剂、白细胞介素-2、抗CD20单克隆抗体和B细胞活化因子抑制剂）在AIH治疗方面的最新进展。
