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重视不典型自身免疫性肝病患者的早诊早治

黄春洋 刘燕敏

引用本文:
Citation:

重视不典型自身免疫性肝病患者的早诊早治

DOI: 10.3969/j.issn.1001-5256.2022.04.003
利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:黄春洋参与文章的撰写、修改;刘燕敏负责文章的思路框架设计、文章撰写校稿。
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    通信作者:

    刘燕敏,yanmin130@ccmu.edu.cn

The early diagnosis and treatment of atypical autoimmune liver disease should be taken seriously

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  • 摘要: 自身免疫性肝病是一组疾病,主要由于自身免疫异常引起,包括以肝细胞损伤为主的自身免疫性肝炎,以胆管损伤为主的原发性胆汁性胆管炎及原发性硬化性胆管炎,也包括具有上述两种疾病主要特征的重叠综合征,近来IgG4相关肝胆疾病也被列入此类,如不及时诊治,可发展至肝硬化,甚至肝衰竭。自身免疫性肝病均有各自特点,随着自身免疫性肝病知识普及,专业医生对此类疾病认识程度逐渐增加,多数较典型自身免疫性肝病能够早期诊断,使患者得到及时治疗。但也有一些患者表现或化验指标不典型,易被延误诊断,所以对于不典型自身免疫性肝病及早辨别,及时诊治非常重要。

     

  • [1] HENNES EM, ZENIYA M, CZAJA AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis[J]. Hepatology, 2008, 48(1): 169-176. DOI: 10.1002/hep.22322.
    [2] 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. DOI: 10.1016/s0168-8278(99)80297-9.
    [3] YEOMAN AD, WESTBROOK RH, ZEN Y, et al. Prognosis of acute severe autoimmune hepatitis (AS-AIH): The role of corticosteroids in modifying outcome[J]. J Hepatol, 2014, 61(4): 876-882. DOI: 10.1016/j.jhep.2014.05.021.
    [4] MACK CL, ADAMS D, ASSIS DN, 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. DOI: 10.1002/hep.31065.
    [5] YEOMAN AD, WESTBROOK RH, AL-CHALABI T, et al. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group (IAIHG) criteria in acute and chronic liver disease[J]. Hepatology, 2009, 50(2): 538-545. DOI: 10.1002/hep.23042.
    [6] MOENNE-LOCCOZ R, SEVERAC F, BAUMERT TF, et al. Usefulness of corticosteroids as first-line therapy in patients with acute severe autoimmune hepatitis[J]. J Hepatol, 2016, 65(2): 444-446. DOI: 10.1016/j.jhep.2016.03.023.
    [7] YASUI S, FUJIWARA K, YONEMITSU Y, et al. Clinicopathological features of severe and fulminant forms of autoimmune hepatitis[J]. J Gastroenterol, 2011, 46(3): 378-390. DOI: 10.1007/s00535-010-0316-3.
    [8] FUJIWARA K, FUKUDA Y, YOKOSUKA O. Precise histological evaluation of liver biopsy specimen is indispensable for diagnosis and treatment of acute-onset autoimmune hepatitis[J]. J Gastroenterol, 2008, 43(12): 951-958. DOI: 10.1007/s00535-008-2254-x.
    [9] YASUI S, FUJIWARA K, OKITSU K, et al. Importance of computed tomography imaging features for the diagnosis of autoimmune acute liver failure[J]. Hepatol Res, 2012, 42(1): 42-50. DOI: 10.1111/j.1872-034X.2011.00892.x.
    [10] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of autoimmune hepatitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796.

    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]. 临床肝胆病杂志, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796.
    [11] RAHIM MN, LIBERAL R, MIQUEL R, et al. Acute severe autoimmune hepatitis: Corticosteroids or liver transplantation?[J]. Liver Transpl, 2019, 25(6): 946-959. DOI: 10.1002/lt.25451.
    [12] CASTIELLA A, ZAPATA E, LUCENA MI, et al. Drug-induced autoimmune liver disease: A diagnostic dilemma of an increasingly reported disease[J]. World J Hepatol, 2014, 6(4): 160-168. DOI: 10.4254/wjh.v6.i4.160.
    [13] OHMOTO K, YAMAMOTO S. Drug-induced liver injury associated with antinuclear antibodies[J]. Scand J Gastroenterol, 2002, 37(11): 1345-1346. DOI: 10.1080/003655202761020687.
    [14] CHEN J, ESLICK GD, WELTMAN M. Systematic review with meta-analysis: Clinical manifestations and management of autoimmune hepatitis in the elderly[J]. Aliment Pharmacol Ther, 2014, 39(2): 117-124. DOI: 10.1111/apt.12563.
    [15] SUI M, WU R, HU X, et al. Low prevalence of hepatitis B virus infection in patients with autoimmune diseases in a Chinese patient population[J]. J Viral Hepat, 2014, 21(12): 925-929. DOI: 10.1111/jvh.12302.
    [16] LIN XQ, SHENG L, XIAO X, et al. Clinical diagnosis and treatment of chronic hepatitis B complicated with autoimmune hepatitis[J]. Chin J Hepatol, 2020, 28(4): 351-356. DOI: 10.3760/cma.j.cn501113-20190120-00020.

    林小钦, 盛黎, 肖潇, 等. 慢性乙型肝炎合并自身免疫性肝炎的临床诊治分析[J]. 中华肝脏病杂志, 2020, 28(4): 351-356. DOI: 10.3760/cma.j.cn501113-20190120-00020.
    [17] HAN X, LI J, ZHOU L, et al. Viral hepatitis with autoimmune hepatitis: A report of 3 cases and literature review[J]. J Clin Hepatol, 2018, 34(11): 2397-2400. DOI: 10.3969/j.issn.1001-5256.2018.11.026.

    韩旭, 李嘉, 周莉, 等. 病毒性肝炎合并自身免疫性肝炎3例报告并文献复习[J]. 临床肝胆病杂志, 2018, 34(11): 2397-2400. DOI: 10.3969/j.issn.1001-5256.2018.11.026.
    [18] RIGOPOULOU EI, ZACHOU K, GATSELIS N, et al. Autoimmune hepatitis in patients with chronic HBV and HCV infections: Patterns of clinical characteristics, disease progression and outcome[J]. Ann Hepatol, 2013, 13(1): 127-135. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM24378276
    [19] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of primary biliary cholangitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 35-41. DOI: 10.3760/cma.j.cn112138-20211112-00794.

    中华医学会肝病学分会. 原发性胆汁性胆管炎的诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 35-41. DOI: 10.3760/cma.j.cn112138-20211112-00794.
    [20] GRANITO A, MURATORI P, QUARNETI C, et al. Antinuclear antibodies as ancillary markers in primary biliary cirrhosis[J]. Expert Rev Mol Diagn, 2012, 12(1): 65-74. DOI: 10.1586/erm.11.82.
    [21] CHEN S, DUAN W, LI M, et al. Prognosis of 732 ursodeoxycholic acid-treated patients with primary biliary cholangitis: A single center follow-up study from China[J]. J Gastroenterol Hepatol, 2019, 34(7): 1236-1241. DOI: 10.1111/jgh.14521.
    [22] JULIUSSON G, IMAM M, BJÖRNSSON ES, et al. Long-term outcomes in antimitochondrial antibody negative primary biliary cirrhosis[J]. Scand J Gastroenterol, 2016, 51(6): 745-752. DOI: 10.3109/00365521.2015.1132337.
    [23] CHAZOUILLÈRES O, WENDUM D, SERFATY L, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: Clinical features and response to therapy[J]. Hepatology, 1998, 28(2): 296-301. DOI: 10.1002/hep.510280203.
    [24] BOBERG KM, CHAPMAN RW, HIRSCHFIELD GM, et al. Overlap syndromes: The International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue[J]. J Hepatol, 2011, 54(2): 374-385. DOI: 10.1016/j.jhep.2010.09.002.
    [25] KUIPER EM, ZONDERVAN PE, van BUUREN HR. Paris criteria are effective in diagnosis of primary biliary cirrhosis and autoimmune hepatitis overlap syndrome[J]. Clin Gastroenterol Hepatol, 2010, 8(6): 530-534. DOI: 10.1016/j.cgh.2010.03.004.
    [26] FAN X, WANG T, SHEN Y, et al. Underestimated male prevalence of primary biliary cholangitis in China: Results of a 16-yr cohort study involving 769 patients[J]. Sci Rep, 2017, 7(1): 6560. DOI: 10.1038/s41598-017-06807-7.
    [27] LIU YM, YAN HP, LIAO HY, et al. Clinical and laboratory characteristics of male patients with primary biliary cirrhosis[J]. J Clin Hepatol, 2010, 26(1): 54-56. http://lcgdbzz.org/article/id/LCGD201001023

    刘燕敏, 闫惠平, 廖慧钰, 等. 男性原发性胆汁性肝硬化患者临床与实验室特点分析[J]. 临床肝胆病杂志, 2010, 26(1): 54-56. http://lcgdbzz.org/article/id/LCGD201001023
    [28] MAYO MJ. Natural history of primary biliary cirrhosis[J]. Clin Liver Dis, 2008, 12(2): 277-288; viii. DOI: 10.1016/j.cld.2008.02.012.
    [29] MITCHISON HC, BASSENDINE MF, HENDRICK A, et al. Positive antimitochondrial antibody but normal alkaline phosphatase: Is this primary biliary cirrhosis?[J]. Hepatology, 1986, 6(6): 1279-1284. DOI: 10.1002/hep.1840060609.
    [30] SUN C, XIAO X, YAN L, et al. Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker?[J]. J Autoimmun, 2019, 99: 33-38. DOI: 10.1016/j.jaut.2019.01.005.
    [31] TERZIROLI BERETTA-PICCOLI B, STIRNIMANN G, MERTENS J, et al. Primary biliary cholangitis with normal alkaline phosphatase: A neglected clinical entity challenging current guidelines[J]. J Autoimmun, 2021, 116: 102578. DOI: 10.1016/j.jaut.2020.102578.
    [32] LIU YM, LIAO HY, YAN HP, et al. Clinical analysis of short-term rise of bilirubin in patients with primary biliary cirrhosis[J]. Chin J Hepatol, 2012, 20(8): 632-633. DOI: 10.3760/cma.j.issn.1007-3418.2012.08.019.

    刘燕敏, 廖慧钰, 闫惠平, 等. 原发性胆汁性肝硬化患者胆红素短期内上升临床分析[J]. 中华肝脏病杂志, 2012, 20(8): 632-633. DOI: 10.3760/cma.j.issn.1007-3418.2012.08.019.
    [33] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis[J]. J Hepatol, 2017, 67(1): 145-172. DOI: 10.1016/j.jhep.2017.03.022.
    [34] FRICKER ZP, LICHTENSTEIN DR. Primary sclerosing cholangitis: A concise review of diagnosis and management[J]. Dig Dis Sci, 2019, 64(3): 632-642. DOI: 10.1007/s10620-019-05484-y.
    [35] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of primary sclerosing cholangitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 50-61. DOI: 10.3760/cma.j.cn112138-20211109-00786.

    中华医学会肝病学分会. 原发性硬化性胆管炎诊断及治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 50-61. DOI: 10.3760/cma.j.cn112138-20211109-00786.
    [36] FLOREANI A, RIZZOTTO ER, FERRARA F, et al. Clinical course and outcome of autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome[J]. Am J Gastroenterol, 2005, 100(7): 1516-1522. DOI: 10.1111/j.1572-0241.2005.41841.x.
    [37] van BUUREN HR, van HOOGSTRATEN H, TERKIVATAN T, et al. High prevalence of autoimmune hepatitis among patients with primary sclerosing cholangitis[J]. J Hepatol, 2000, 33(4): 543-548. DOI: 10.1034/j.1600-0641.2000.033004543.x.
    [38] KAYA M, ANGULO P, LINDOR KD. Overlap of autoimmune hepatitis and primary sclerosing cholangitis: An evaluation of a modified scoring system[J]. J Hepatol, 2000, 33(4): 537-542. DOI: 10.1034/j.1600-0641.2000.033004537.x.
    [39] AL-CHALABI T, PORTMANN BC, BERNAL W, et al. Autoimmune hepatitis overlap syndromes: an evaluation of treatment response, long-term outcome and survival[J]. Aliment Pharmacol Ther, 2008, 28(2): 209-220. DOI: 10.1111/j.1365-2036.2008.03722.x.
    [40] WANG L, HAN Y. An excerpt of British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis (2019)[J]. J Clin Hepatol, 2019, 35(9): 1937-1941. DOI: 10.3969/j.issn.1001-5256.2019.09.010.

    王璐, 韩英. 《2019年英国胃肠病学会和英国原发性硬化性胆管炎协作组指南: 原发性硬化性胆管炎的诊断和治疗》摘译[J]. 临床肝胆病杂志, 2019, 35(9): 1937-1941. DOI: 10.3969/j.issn.1001-5256.2019.09.010.
    [41] DENEAU MR, MACK C, MOGUL D, et al. Oral vancomycin, ursodeoxycholic acid, or no therapy for pediatric primary sclerosing cholangitis: A matched analysis[J]. Hepatology, 2021, 73(3): 1061-1073. DOI: 10.1002/hep.31560.
    [42] TANAKA A, MORI M, KUBOTA K, et al. Epidemiological features of immunoglobulin G4-related sclerosing cholangitis in Japan[J]. J Hepatobiliary Pancreat Sci, 2020, 27(9): 598-603. DOI: 10.1002/jhbp.793.
    [43] OHARA H, NAKAZAWA T, KAWA S, et al. Establishment of a serum IgG4 cut-off value for the differential diagnosis of IgG4-related sclerosing cholangitis: A Japanese cohort[J]. J Gastroenterol Hepatol, 2013, 28(7): 1247-1251. DOI: 10.1111/jgh.12248.
    [44] ZEN Y, HARADA K, SASAKI M, et al. IgG4-related sclerosing cholangitis with and without hepatic inflammatory pseudotumor, and sclerosing pancreatitis-associated sclerosing cholangitis: Do they belong to a spectrum of sclerosing pancreatitis?[J]. Am J Surg Pathol, 2004, 28(9): 1193-1203. DOI: 10.1097/01.pas.0000136449.37936.6c.
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  • 收稿日期:  2022-01-07
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  • 出版日期:  2022-04-20
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