Paumgartner G
Schweiz Med Wochenschr. 1978 Jan 28;108(4):120-3.
Chronic active hepatitis (CAH) as an entity covers a histologically, biochemically, and clinically heterogenous group of patients. Hence, there is no justification for treating all patients with this diagnosis with corticosteroids. On the basis of histological, biochemical, and clinical criteria, different degrees of severity of CAH can be distinguished. While corticosteroids appear to be indicated in severe CAH, they should, in general, not be administered in mild CAH. However, the course of disease must be carefully followed in these patients. In moderate CAH, the risk should be carefully weighed against the benefit of therapy in every individual patient, taking into account the severity of symptoms. In HBsAg-negative cases, a therapeutic trial of at least 6 months' duration is worthwhile. In HBsAg-positive patients, treatment with corticosteroids should be delayed and the course of the disease followed. Once the decision for corticosteroid therapy has been made, administration of 10 mg prednisolone and 50 mg azathioprine daily as a maintenance dose represents the therapy of choice. This combination is approximately as effective as 15--20 mg prednisolone alone, but is associated with a lower incidence of side effects.
慢性活动性肝炎（CAH）作为一种疾病实体，涵盖了一组在组织学、生物化学和临床上具有异质性的患者。因此，没有理由对所有诊断为此病的患者都使用皮质类固醇进行治疗。根据组织学、生物化学和临床标准，可以区分出不同严重程度的CAH。虽然皮质类固醇似乎适用于重度CAH，但一般而言，不应给予轻度CAH患者使用。然而，必须密切观察这些患者的疾病进程。在中度CAH中，对于每一位患者，都应仔细权衡治疗的风险与益处，同时考虑症状的严重程度。对于乙肝表面抗原（HBsAg）阴性的病例，进行至少6个月的治疗试验是值得的。对于HBsAg阳性的患者，应推迟使用皮质类固醇治疗并观察疾病进程。一旦决定进行皮质类固醇治疗，每日给予10毫克泼尼松龙和50毫克硫唑嘌呤作为维持剂量是首选治疗方法。这种联合用药的效果与单独使用15 - 20毫克泼尼松龙大致相同，但副作用发生率较低。
