Thaler H
Hepatogastroenterology. 1984 Feb;31(1):6-11.
Chronic aggressive (active) hepatitis (CAH) is an extraordinarily multifaceted disease. If attempts are made to obtain objective evidence concerning the effectivity of therapeutic procedures, the proposed controlled studies are beset by virtually insoluble problems. Because of this it seems, in this particular case, legitimate to take account of retrospective studies based on sufficient numbers of cases. Corticoid monotherapy and combined corticoid and azathioprine therapy have proved effective for immunosuppression in CAH. While the effectivity of immunosuppressive therapy in HBsAg negative CAH is undisputed, it is questionable for HBsAg positive CAH. The fact, which is now indisputable, that the mortality rate of HBsAg positive CAH is increased by steroid treatment, is an unequivocal contraindication for the general application of immunosuppressive therapy in this disease-group. However, the use of such treatment should not be excluded on purely theoretical grounds in cases of HBsAg positive CAH with an unfavourable prognosis. The success, even with such patients, can be astonishing. Under certain circumstances indirect immunostimulation can be attempted for HBeAg positive CAH, which is at least partially successful in a large percentage of cases.
慢性侵袭性（活动性）肝炎（CAH）是一种极为复杂的疾病。如果试图获取有关治疗方法有效性的客观证据，那么所提议的对照研究几乎会面临无法解决的问题。因此，在这种特殊情况下，考虑基于足够病例数的回顾性研究似乎是合理的。皮质类固醇单一疗法以及皮质类固醇与硫唑嘌呤联合疗法已被证明对CAH的免疫抑制有效。虽然免疫抑制疗法在HBsAg阴性的CAH中的有效性是无可争议的，但在HBsAg阳性的CAH中则存在疑问。现在无可争议的事实是，类固醇治疗会增加HBsAg阳性CAH的死亡率，这明确表明在该疾病组中普遍应用免疫抑制疗法是禁忌的。然而，对于预后不良的HBsAg阳性CAH病例，不应仅仅基于理论原因而排除使用这种治疗方法。即使对于这类患者，治疗成功的效果也可能令人惊讶。在某些情况下，对于HBeAg阳性的CAH可以尝试间接免疫刺激，在很大比例的病例中至少部分成功。
