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2023年7月 第38卷 第7期11
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自身免疫性肝炎诊治进展

Advances in the diagnosis and treatment of autoimmune hepatitis

来源期刊: 广州医药 | 1-6 发布时间:2023-07-27 收稿时间:2025/11/13 18:33:09 阅读量:16
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关键词:
自身免疫性肝炎应答欠佳诊断治疗
autoimmune hepatitispoor responsediagnosistreatment
DOI:
10.3969/j.issn.1000-8535.2023.06.001
收稿时间:
2023-02-21 
修订日期:
 
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引用总数:
6  
自身免疫性肝炎(AIH)是由不明原因免疫异常引起的急性或慢性肝脏炎症性疾病,不分年龄或性别,影响所有种族群体。AIH如果没有得到及时的治疗,可能会发展为肝硬化、肝衰竭,甚至导致死亡。目前一些诊断评分系统和肝活组织病理检查已成为诊断的标准,然而由于疾病表现的高度异质性,AIH诊断仍很有挑战性。大多数患者最初对一线治疗(糖皮质激素与硫唑嘌呤的联合治疗)有应答,然而,应答欠佳和因不良反应引起的不耐受也不少见,需要二线和(或)三线治疗。本文总结阐述诊断困难、一线药物治疗应答欠佳或不耐受的疑难AIH诊断和管理的最新进展,并归纳了目前国内外关于AIH治疗的新方法,为AIH的临床诊疗提供参考。
Autoimmune hepatitis(AIH)is an acute or chronic inflammatory disease of liver caused by unclear immune response that affects people from all ethnic groups irrespective of age or sex.If left untreated,AIH will lead to cirrhosis,liver failure,or death.A number of diagnostic scoring systems and histopathological examination of liver biopsies are now the standard for diagnosis.However,due to the high heterogeneity of the disease presentation,AIH diagnosing remains challenging.Most patients initially respond to first-line treatment,which is corticosteroids combined with azathioprine.However,insufficient response and intolerance due to side effects are also common,so some patients requires second-and/or third-line therapies.Here we summarized the latest progress in diagnosis and management of AIH with difficult diagnosis,poor response to first-line drug treatment or intolerance,as well as the new methods of AIH treatment worldwide,to provide reference for the clinical diagnosis and treatment of AIH.
1、 KANZLER S,LOHR H,GERKEN G,et al.Long-term management and prognosis of autoimmune hepatitis(AIH):a single center experience[J].Z Gastroenterol,2001,39(5):339-341,344-348. KANZLER S,LOHR H,GERKEN G,et al.Long-term management and prognosis of autoimmune hepatitis(AIH):a single center experience[J].Z Gastroenterol,2001,39(5):339-341,344-348.
2、 FERRI S,LONGHI M S,DE MOLO C,et al.A multifaceted imbalance of T cells with regulatory function characterizes type 1 autoimmune hepatitis[J].Hepatology,2010,52(3):999-1007. FERRI S,LONGHI M S,DE MOLO C,et al.A multifaceted imbalance of T cells with regulatory function characterizes type 1 autoimmune hepatitis[J].Hepatology,2010,52(3):999-1007.
3、 JOAO M,CARVALHANA S,MOURA M,et al.Severe acute autoimmune hepatitis:How to early predict who will not respond to corticosteroids and needs urgent liver transplantation?[J].Dig Liver Dis,2022,54(12):1681-1685. JOAO M,CARVALHANA S,MOURA M,et al.Severe acute autoimmune hepatitis:How to early predict who will not respond to corticosteroids and needs urgent liver transplantation?[J].Dig Liver Dis,2022,54(12):1681-1685.
4、 WEBB G J,RANA A,HODSON J,et al.Twenty-year comparative analysis of patients with autoimmune liver diseases on transplant waitlists[J].Clin Gastroenterol Hepatol,2018,16(2):278-287.e277. WEBB G J,RANA A,HODSON J,et al.Twenty-year comparative analysis of patients with autoimmune liver diseases on transplant waitlists[J].Clin Gastroenterol Hepatol,2018,16(2):278-287.e277.
5、 WANG H,BANERJEE N,LIANG Y,et al.Gut microbiome-host interactions in driving environmental pollutant trichloroethene-mediated autoimmunity[J].Toxicol Appl Pharmacol,2021(424):115597. WANG H,BANERJEE N,LIANG Y,et al.Gut microbiome-host interactions in driving environmental pollutant trichloroethene-mediated autoimmunity[J].Toxicol Appl Pharmacol,2021(424):115597.
6、 LIANG M,LIWEN Z,JIANGUO S,et al.Fecal microbiota transplantation controls progression of experimental autoimmune hepatitis in mice by modulating the TFR/TFH immune imbalance and intestinal microbiota composition[J].Front Immunol,2021(12):728723. LIANG M,LIWEN Z,JIANGUO S,et al.Fecal microbiota transplantation controls progression of experimental autoimmune hepatitis in mice by modulating the TFR/TFH immune imbalance and intestinal microbiota composition[J].Front Immunol,2021(12):728723.
7、 ZHANG H,LIU M,LIU X,et al.Bifidobacterium animalis ssp.Lactis 420 mitigates autoimmune hepatitis through regulating intestinal barrier and liver immune cells[J].Front Immunol,2020(11):569104. ZHANG H,LIU M,LIU X,et al.Bifidobacterium animalis ssp.Lactis 420 mitigates autoimmune hepatitis through regulating intestinal barrier and liver immune cells[J].Front Immunol,2020(11):569104.
8、 LIU Q,TIAN H,KANG Y,et al.Probiotics alleviate autoimmune hepatitis in mice through modulation of gut microbiota and intestinal permeability[J].J Nutr Biochem,2021(98):108863. LIU Q,TIAN H,KANG Y,et al.Probiotics alleviate autoimmune hepatitis in mice through modulation of gut microbiota and intestinal permeability[J].J Nutr Biochem,2021(98):108863.
9、 ARVANITI P,GIANNOULIS G,GABETA S,et al.Belimumab is a promising third-line treatment option for refractory autoimmune hepatitis[J].JHEP Rep,2020,2(4):100123. ARVANITI P,GIANNOULIS G,GABETA S,et al.Belimumab is a promising third-line treatment option for refractory autoimmune hepatitis[J].JHEP Rep,2020,2(4):100123.
10、 THAN N N,HODSON J,SCHMIDT-MARTIN D,et al.Efficacy of rituximab in difficult-to-manage autoimmune hepatitis:Results from the international autoimmune hepatitis group[J].JHEP Rep,2019,1(6):437-445. THAN N N,HODSON J,SCHMIDT-MARTIN D,et al.Efficacy of rituximab in difficult-to-manage autoimmune hepatitis:Results from the international autoimmune hepatitis group[J].JHEP Rep,2019,1(6):437-445.
11、 HUBENER S,OO Y H,THAN N N,et al.Efficacy of 6-mercaptopurine as second-line treatment for patients with autoimmune hepatitis and azathioprine intolerance[J].Clin Gastroenterol Hepatol,2016,14(3):445-453. HUBENER S,OO Y H,THAN N N,et al.Efficacy of 6-mercaptopurine as second-line treatment for patients with autoimmune hepatitis and azathioprine intolerance[J].Clin Gastroenterol Hepatol,2016,14(3):445-453.
12、 HARIDY J,NICOLL A,SOOD S.Methotrexate therapy for autoimmune hepatitis[J].Clin Gastroenterol Hepatol,2018,16(2):288-289. HARIDY J,NICOLL A,SOOD S.Methotrexate therapy for autoimmune hepatitis[J].Clin Gastroenterol Hepatol,2018,16(2):288-289.
13、 BAVEN-PRONK M A,HEW J M Jr,BIEWENGA M,et al.Calcineurin inhibitors in the treatment of adult autoimmune hepatitis:A systematic review[J].J Clin Transl Hepatol,2022,10(6):1155-1166. BAVEN-PRONK M A,HEW J M Jr,BIEWENGA M,et al.Calcineurin inhibitors in the treatment of adult autoimmune hepatitis:A systematic review[J].J Clin Transl Hepatol,2022,10(6):1155-1166.
14、 SANTIAGO P,SCHWARTZ I,TAMARIZ L,et al.Systematic review with meta-analysis:mycophenolate mofetil as a second-line therapy for autoimmune hepatitis[J].Aliment Pharmacol Ther,2019,49(7):830-839. SANTIAGO P,SCHWARTZ I,TAMARIZ L,et al.Systematic review with meta-analysis:mycophenolate mofetil as a second-line therapy for autoimmune hepatitis[J].Aliment Pharmacol Ther,2019,49(7):830-839.
15、 de LEMOS-BONOTTO M,VALLE-TOVO C,COSTABEBER A M,et al.A systematic review and meta-analysis of second-line immunosuppressants for autoimmune hepatitis treatment[J].Eur J Gastroenterol Hepatol,2018,30(2):212-216. de LEMOS-BONOTTO M,VALLE-TOVO C,COSTABEBER A M,et al.A systematic review and meta-analysis of second-line immunosuppressants for autoimmune hepatitis treatment[J].Eur J Gastroenterol Hepatol,2018,30(2):212-216.
16、 MANNS M P,WOYNAROWSKI M,KREISEL W,et al.Budesonide induces remission more effectively than prednisone in a controlled trial of patients with autoimmune hepatitis[J].Gastroenterology,2010,139(4):1198-1206. MANNS M P,WOYNAROWSKI M,KREISEL W,et al.Budesonide induces remission more effectively than prednisone in a controlled trial of patients with autoimmune hepatitis[J].Gastroenterology,2010,139(4):1198-1206.
17、 BJORNSSON H K,GUDBJORNSSON B,BJORNSSON E S.Infliximab-induced liver injury:Clinical phenotypes,autoimmunity and the role of corticosteroid treatment[J].J Hepatol,2022,76(1):86-92. BJORNSSON H K,GUDBJORNSSON B,BJORNSSON E S.Infliximab-induced liver injury:Clinical phenotypes,autoimmunity and the role of corticosteroid treatment[J].J Hepatol,2022,76(1):86-92.
18、 VOLLMER O,FELTEN R,MERTZ P,et al.Characterization of auto-immune hepatitis associated with the use of anti-TNFalpha agents:An analysis of 389 cases in VigiBase[J].Autoimmun Rev,2020,19(3):102460. VOLLMER O,FELTEN R,MERTZ P,et al.Characterization of auto-immune hepatitis associated with the use of anti-TNFalpha agents:An analysis of 389 cases in VigiBase[J].Autoimmun Rev,2020,19(3):102460.
19、 LIN R,ZHOU L,ZHANG J,et al.Abnormal intestinal permeability and microbiota in patients with autoimmune hepatitis[J].Int J Clin Exp Pathol,2015,8(5):5153-5160. LIN R,ZHOU L,ZHANG J,et al.Abnormal intestinal permeability and microbiota in patients with autoimmune hepatitis[J].Int J Clin Exp Pathol,2015,8(5):5153-5160.
20、 LIWINSKI T,CASAR C,RUEHLEMANN M C,et al.A disease-specific decline of the relative abundance of Bifidobacterium in patients with autoimmune hepatitis[J].Aliment Pharmacol Ther,2020,51(12):1417-1428. LIWINSKI T,CASAR C,RUEHLEMANN M C,et al.A disease-specific decline of the relative abundance of Bifidobacterium in patients with autoimmune hepatitis[J].Aliment Pharmacol Ther,2020,51(12):1417-1428.
21、 WEI Y,LI Y,YAN L,et al.Alterations of gut microbiome in autoimmune hepatitis[J].Gut,2020,69(3):569-577. WEI Y,LI Y,YAN L,et al.Alterations of gut microbiome in autoimmune hepatitis[J].Gut,2020,69(3):569-577.
22、 ELSHERBINY N M,RAMMADAN M,HASSAN E A,et al.Autoimmune hepatitis:shifts in gut microbiota and metabolic pathways among Egyptian patients[J].Microorganisms,2020,8(7):1011. ELSHERBINY N M,RAMMADAN M,HASSAN E A,et al.Autoimmune hepatitis:shifts in gut microbiota and metabolic pathways among Egyptian patients[J].Microorganisms,2020,8(7):1011.
23、 LOU J,JIANG Y,RAO B,et al.Fecal microbiomes distinguish patients with autoimmune hepatitis from healthy individuals[J].Front Cell Infect Microbiol,2020(10):342. LOU J,JIANG Y,RAO B,et al.Fecal microbiomes distinguish patients with autoimmune hepatitis from healthy individuals[J].Front Cell Infect Microbiol,2020(10):342.
24、 LOHSE A W,SEBODE M,BHATHAL P S,et al.Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH pathology group:Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology[J].Liver Int,2022,42(5):1058-1069. LOHSE A W,SEBODE M,BHATHAL P S,et al.Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH pathology group:Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology[J].Liver Int,2022,42(5):1058-1069.
25、 MACK C L,ADAMS D,ASSIS D N,et al.Diagnosis and management of autoimmune hepatitis in adults and children:2019 practice guidance and guidelines from the American association for the study of liver diseases[J].Hepatology,2020,72(2):671-722. MACK C L,ADAMS D,ASSIS D N,et al.Diagnosis and management of autoimmune hepatitis in adults and children:2019 practice guidance and guidelines from the American association for the study of liver diseases[J].Hepatology,2020,72(2):671-722.
26、 MIELI-VERGANI G,VERGANI D,BAUMANN U,et al.Diagnosis and management of pediatric autoimmune liver disease:ESPGHAN Hepatology Committee Position Statement[J].J Pediatr Gastroenterol Nutr,2018,66(2):345-360. MIELI-VERGANI G,VERGANI D,BAUMANN U,et al.Diagnosis and management of pediatric autoimmune liver disease:ESPGHAN Hepatology Committee Position Statement[J].J Pediatr Gastroenterol Nutr,2018,66(2):345-360.
27、 GATSELIS N K,AZARIADIS K,LYBEROPOULOU A,et al.Programmed cell death-1 rs11568821 and interleukin-28B rs12979860 polymorphisms in autoimmune hepatitis[J].J Transl Autoimmun,2021(4):100126. GATSELIS N K,AZARIADIS K,LYBEROPOULOU A,et al.Programmed cell death-1 rs11568821 and interleukin-28B rs12979860 polymorphisms in autoimmune hepatitis[J].J Transl Autoimmun,2021(4):100126.
28、 de BOER Y S,van GERVEN N M,ZWIERS A,et al.Genome-wide association study identifies variants associated with autoimmune hepatitis type 1[J].Gastroenterology,2014,147(2):443-452.e5. de BOER Y S,van GERVEN N M,ZWIERS A,et al.Genome-wide association study identifies variants associated with autoimmune hepatitis type 1[J].Gastroenterology,2014,147(2):443-452.e5.
29、 TAUBERT R,ENGEL B,DIESTELHORST J,et al.Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis[J].Hepatology,2022,75(1):13-27. TAUBERT R,ENGEL B,DIESTELHORST J,et al.Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis[J].Hepatology,2022,75(1):13-27.
30、 中华医学会肝病学分会.自身免疫性肝炎诊断和治疗指南(2021)[J].中华肝脏病杂志,2022,30(5):482-492. 中华医学会肝病学分会.自身免疫性肝炎诊断和治疗指南(2021)[J].中华肝脏病杂志,2022,30(5):482-492.
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