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自免疫性肝炎的急性呈现 - 从急性肝炎到ALF和ACLF
Atsushi Tanaka1, Kenichi Harada2
1Department of Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan. a-tanaka@med.teikyo-u.ac.jp.
Hepatology international
|August 11, 2024
概括
急性自身免疫性肝炎 (Acute Autoimmune Hepatitis,AIH) 是一种肝病谱,并不罕见,从轻度到急性肝衰竭呈现. 诊断可能具有挑战性,需要活检,治疗涉及皮质类固醇或肝移植.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 免疫学 免疫学 免疫学
- 胃肠病学 胃肠病学
背景情况:
- 急性自身免疫性肝炎 (AIH) 在22-43%的病例中出现,代表了临床谱,而不是单一实体.
- 该谱包括急性AIH,急性严重AIH,急性肝衰竭 (ALF) 和急性至慢性肝衰竭 (ACLF).
- 由于非典型的血清学,诊断具有挑战性,往往需要通过肝活检进行组织病理学检查.
研究的目的:
- 审查关于急性AIH的定义,诊断和管理的最新发现.
- 突出急性AIH的临床变异性和诊断挑战.
- 讨论包括皮质类固醇和肝移植在内的治疗策略.
主要方法:
- 关于急性自身免疫性肝炎的最新发现的文献综述.
- 对急性AIH诊断标准和挑战的分析.
- 对急性AIH及其严重形式的管理策略的评估.
主要成果:
- 急性AIH包括一系列严重程度,受到凝血病和脑病变等因素的影响.
- 当血清学标志物缺席或异常时,肝脏活检对于诊断至关重要.
- 皮质类固醇是急性AIH和严重的凝血病的第一线治疗,需要仔细监测.
- 建议在AIH呈现ALF或ACLF的情况下进行肝移植,尽管在特定的ALF/ACLF病例中可以考虑对皮质类固醇进行试验.
结论:
- 急性AIH是一个重要的临床谱,需要及时诊断和量身定制的管理.
- 有效的管理取决于准确的诊断,通常需要活检,及时考虑干预措施,如皮质类固醇或肝移植.
- 早期识别和适当的治疗对于改善急性AIH患者的治疗结果至关重要.
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