难以治疗和耐药的自身免疫性肝炎:近期药理管理方面的进展
Sayan Malakar1, Umair Shamsul Hoda2, Suprabhat Giri3
1Department of Gastroenterology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
World journal of hepatology
|September 30, 2025
概括
自身免疫性肝炎 (AIH) 的管理可能具有挑战性,特别是在难以治疗的病例中. 本综述探讨了对不耐药AIH患者的先进药理策略,这些患者对标准免疫抑制疗法没有反应.
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
- 内部医学 内部医学
背景情况:
- 自身免疫性肝炎 (AIH) 是一种罕见的慢性肝病,病理生理学不明,通常涉及自我耐受性的崩.
- 标准治疗依赖于免疫抑制,但10-25%的患者反应不佳,需要替代疗法.
- 识别和管理并发性肝病对于非响应性AIH病例的治疗成功至关重要.
研究的目的:
- 审查难以治疗的自身免疫性肝炎管理方面的挑战和最近的药理学进展.
- 定义耐火性AIH,并讨论对第一线免疫抑制疗法没有反应的患者的策略.
- 强调排除其他肝脏病因在非响应性AIH中的重要性.
主要方法:
- 对自身免疫性肝炎管理研究的文献综述.
- 对难以治疗和耐火AIH的药理选择的分析.
- 对AIH患者同时出现的肝病的诊断工作进行讨论.
主要成果:
- 难以治疗的AIH包括严重副作用,突发性疾病,怀孕或艾滋病毒同时感染的病例.
- 耐火性AIH被定义为对标准一线免疫抑制疗法的不响应.
- 第二和第三线药物,如mycophenolate mofetil,cyclosporine,tacrolimus,infliximab和rituximab用于救援疗法.
结论:
- 难以治疗的AIH的有效管理需要全面的方法,包括解决并发症.
- 药理管理方面的进步为耐火性自身免疫性肝炎患者提供了新的希望.
- 需要进一步的研究来完善对具有挑战性的AIH病例的治疗策略.
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