自身免疫性肝炎的鉴别与诊断

崔娜娜; 王绮夏

doi:10.3969/j.issn.1001-5256.2020.04.002

自身免疫性肝炎的鉴别与诊断

DOI: 10.3969/j.issn.1001-5256.2020.04.002

上海交通大学医学院附属仁济医院消化内科上海市消化疾病研究所

基金项目:

国家自然科学基金项目(81770564,81790634,81620108002,81771732,81830016)；上海市卫生计生系统优秀青年医学人才培养计划(2017YQ037)；上海市青年科技启明星计划(18QA1402700)；

详细信息

中图分类号: R575.1
计量
- 文章访问数: 1526
- HTML全文浏览量: 28
- PDF下载量: 477
- 被引次数: 0
出版历程
- 出版日期: 2020-04-20

Diagnosis and differential diagnosis of autoimmune hepatitis

Department of Gastroenterology, Shanghai Institute of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine

Research funding:

摘要

摘要: 自身免疫性肝炎（AIH）是一种与自身免疫反应相关的慢性持续性肝脏炎症性疾病。该病女性多发,未经干预者有进展为肝硬化、肝癌的可能。组织学特征性表现为中重度界面性肝炎伴淋巴-浆细胞浸润。AIH临床表现具有明显的异质性,与具有相似临床、生化、血清学和组织学特征的其他肝脏疾病存在鉴别难点,误诊者可严重影响预后。综述了AIH鉴别和诊断的要点,希望有利于临床诊疗工作。
- 肝炎,自身免疫性 /
- 诊断,鉴别 /
- 诊断
Abstract: Autoimmune hepatitis( AIH) is a chronic persistent liver inflammatory disease associated with autoimmune response. AIH is commonly seen in women,and those without intervention may progress to liver cirrhosis and liver cancer. The main histological feature of AIH is moderate to severe interfacial hepatitis with lymphocyte-plasma cell infiltration. The clinical manifestations of AIH have obvious heterogeneity,and it is difficult to differentiate AIH from other liver diseases with similar clinical,biochemical,serological,and histological features. Misdiagnosis may seriously affect the prognosis of patients. This article reviews the key points in the diagnosis and differential diagnosis of AIH,hoping to provide help for clinical diagnosis and treatment.
- hepatitis,autoimmune /
- diagnosis,differential /
- diagnosis

HTML全文

参考文献(38)

[1] WALDENSTROM J. Liver,blood proteins and food proteins[J]. Dtsch Z Verdau Stoffwechselkr,1952,12(Spec No):113-121.

[2] MANNS MP,LOHSE AW,VERGANI D. Autoimmune hepatitis—update 2015[J]. J Hepatol,2015,62(1 Suppl):s100-s111.

[3] HENEGHAN MA,YEOMAN AD,VERMA S,et al. Autoimmune hepatitis[J]. Lancet,2013,382(9902):1433-1444.

[4] ALVAREZ F,BERG PA,BIANCHI FB,et al. International Autoimmune Hepatitis Group Report:Review of criteria for diagnosis of autoimmune hepatitis[J]. J Hepatol,1999,31(5):929-938.

[5] HENNES EM,ZENIYA M,CZAJA AJ,et al. Simplified criteria for the diagnosis of autoimmune hepatitis[J]. Hepatology,2008,48(1):169-176.

[6] MACK CL,ADAMS D,ASSIS DN,et al. Diagnosis and management of autoimmune hepatitis in adults and children:2019practice guidance and guidelines from the American Association for the study of liver diseases[J]. Hepatology,2019.[Epub ahead of print]

[7] LIBERAL R,KRAWITT EL,VIERLING JM,et al. Cutting edge issues in autoimmune hepatitis[J]. J Autoimmun,2016,75:6-19.

[8] FLOREANI A,de MARTIN S,SECCHI MF,et al. Extrahepatic autoimmunity in autoimmune liver disease[J]. Eur J Intern Med,2019,59:1-7.

[9] MIELI-VERGANI G,VERGANI D,CZAJA AJ,et al. Autoimmune hepatitis[J]. Nat Rev Dis Primers,2018,4:18017.

[10] European Association for the Study of the Liver. EASL clinical practice guidelines:Autoimmune hepatitis[J]. J Hepatol,2015,63(4):971-1004.

[11] LIBERAL R,GRANT CR,LONGHI MS,et al. Diagnostic criteria of autoimmune hepatitis[J]. Autoimmun Rev,2014,13(4-5):435-440.

[12] VERGANI D,ALVAREZ F,BIANCHI FB,et al. Liver autoimmune serology:A consensus statement from the committee for autoimmune serology of the International Autoimmune Hepatitis Group[J]. J Hepatol,2004,41(4):677-683.

[13] WASHINGTON MK. Autoimmune liver disease:Overlap and outliers[J]. Mod Pathol,2007,20(Suppl 1):s15-s30.

[14] GLEESON D,HENEGHAN MA,British Society of Gastroenterology. British Society of Gastroenterology(BSG)guidelines for management of autoimmune hepatitis[J]. Gut,2011,60(12):1611-1629.

[15] MIAO Q,BIAN Z,TANG R,et al. Emperipolesis mediated by CD8 T cells is a characteristic histopathologic feature of autoimmune hepatitis[J]. Clin Rev Allergy Immunol,2015,48(2-3):226-235.

[16] GUINDI M. Histology of autoimmune hepatitis and its variants[J]. Clin Liver Dis,2010,14(4):577-590.

[17] HOFER H,OESTERREICHER C,WRBA F,et al. Centrilobular necrosis in autoimmune hepatitis:A histological feature associated with acute clinical presentation[J]. J Clin Pathol,2006,59(3):246-249.

[18] ZENG T,YU J,TAN L,et al. Noninvasive indices for monitoring disease course in Chinese patients with autoimmune hepatitis[J]. Clin Chim Acta,2018,486:135-141.

[19] MUSADDAQ G,SHAHZAD N,ASHRAF MA,et al. Circulating liver-specific microRNAs as noninvasive diagnostic biomarkers of hepatic diseases in human[J]. Biomarkers,2019,24(2):103-109.

[20] EFE C,CENGIZ M,KAHRAMANOGˇLU-AKSOY E,et al. Angiotensin-converting enzyme for noninvasive assessment of liver fibrosis in autoimmune hepatitis[J]. Eur J Gastroenterol Hepatol,2015,27(6):649-654.

[21] KULLAK-UBLICK GA,ANDRADE RJ,MERZ M,et al. Drug-induced liver injury:Recent advances in diagnosis and risk assessment[J]. Gut,2017,66(6):1154-1164.

[22] HOOFNAGLE JH,BJORNSSON ES. Drug-induced liver injury-types and phenotypes. Reply[J]. N Engl J Med,2019,381(14):1396.

[23] WEILER-NORMANN C,SCHRAMM C. Drug induced liver injury and its relationship to autoimmune hepatitis[J]. J Hepatol,2011,55(4):747-749.

[24] CZAJA AJ. Drug-induced autoimmune-like hepatitis[J].Dig Dis Sci,2011,56(4):958-976.

[25] FONTANA RJ,SEEFF LB,ANDRADE RJ,et al. Standardization of nomenclature and causality assessment in drug-induced liver injury:Summary of a clinical research workshop[J]. Hepatology,2010,52(2):730-742.

[26] SUZUKI A,BRUNT EM,KLEINER DE,et al. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury[J]. Hepatology,2011,54(3):931-939.

[27] FEBRES-ALDANA CA,ALGHAMDI S,KRISHNAMURTHY K,et al. Liver fibrosis helps to distinguish autoimmune hepatitis from DILI with autoimmune features:A review of twenty cases[J]. J Clin Transl Hepatol,2019,7(1):21-26.

[28] BALA S,PETRASEK J,MUNDKUR S,et al. Circulating microRNAs in exosomes indicate hepatocyte injury and inflammation in alcoholic,drug-induced,and inflammatory liver diseases[J]. Hepatology,2012,56(5):1946-1957.

[29] WANG Y,TANG N,HUI T,et al. Identification of endogenous reference genes for RT-qPCR analysis of plasma microRNAs levels in rats with acetaminophen-induced hepatotoxicity[J].J Appl Toxicol,2013,33(11):1330-1336.

[30] CHALASANI N,YOUNOSSI Z,LAVINE JE,et al. The diagnosis and management of nonalcoholic fatty liver disease:Practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology,2018,67(1):328-357.

[31] CHALASANI N,YOUNOSSI Z,LAVINE JE,et al. The diagnosis and management of non-alcoholic fatty liver disease:Practice guideline by the American Gastroenterological Association,American Association for the Study of Liver Diseases,and American College of Gastroenterology[J]. Gastroenterology,2012,142(7):1592-1609.

[32] YATSUJI S,HASHIMOTO E,KANEDA H,et al. Diagnosing autoimmune hepatitis in nonalcoholic fatty liver disease:Is the International Autoimmune Hepatitis Group scoring system useful?[J]. J Gastroenterol,2005,40(12):1130-1138.

[33] de LUCA-JOHNSON J,WANGENSTEEN KJ,HANSON J,et al. Natural history of patients presenting with autoimmune hepatitis and coincident nonalcoholic fatty liver disease[J]. Dig Dis Sci,2016,61(9):2710-2720.

[34] SUZUKI A,DIEHL AM. Nonalcoholic steatohepatitis[J]. Annu Rev Med,2017,68:85-98.

[35] TAO TY,GITLIN JD. Hepatic copper metabolism:Insights from genetic disease[J]. Hepatology,2003,37(6):1241-1247.

[36] GITLIN JD. Wilson disease[J]. Gastroenterology,2003,125(6):1868-1877.

[37] FERENCI P,CACA K,LOUDIANOS G,et al. Diagnosis and phenotypic classification of Wilson disease[J]. Liver Int,2003,23(3):139-142.

[38] WOIMANT F,DJEBRANI-OUSSEDIK N,POUJOIS A. New tools for Wilson’s disease diagnosis:Exchangeable copper fraction[J]. Ann Transl Med,2019,7(Suppl 2):s70.

施引文献

资源附件(0)

访问统计