Otoimmün hepatit
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Maltepe Üniversitesi
Erişim Hakkı
CC0 1.0 Universal
info:eu-repo/semantics/openAccess
info:eu-repo/semantics/openAccess
Özet
Otoimmün hepatit, kadın cinsiyet dominansı, yükselmiş transaminaz ve immünglobulin G düzeyleri, otoantikor seropozitifliği ve histolojik düzeyde “interface” hepatit bulgularıyla karakterize, immün mekanizmalarla ortaya çıkan kronik bir karaciğer hastalığıdır. Asemptomatik transaminaz yüksekliğinden siroz ve portal hipertansiyon bulguları ve fulminan hepatite varan farklı klinik tablolarla kendini gösterebilir. Hastalığın erken tanısı konulursa başlanacak immünosüpresif tedavi ile progresyonun durduğu, histolojik düzeyde fibrozisin gerilediği ve siroza ilerlemesinin önlenebileceği gösterilmiştir. Karaciğerdeki otoimmün inflamasyonu başlatan ve sürdüren mekanizmalar ve hepatik toleransın neden kaybolduğu hala ortaya konulamamıştır. Ootoimmün hepatit için spesifik ve hedeflenmiş tedaviler yoktur ve tedavi hala non-selektif immünosüpresyona dayanmaktadır. Bu derlemede otoimmün hepatititin patogenez, tanı ve tedavisindeki yenilikler ele alınmakta, uluslarası otoimmün hepatit grubunun konsensus raporları irdelenmekte ve otoimmün hepatitle örtüşen primer sklerozan kolanjit, primer biliyer kolanjit sendromlarına ilişkin Paris kriterleri vurgulanmaktadır. Otoimmün hepatitin tedavisinde Hamburg 2016 konsensus raporları şu şekildedir. Steroidler remisyonun indüksiyonunda (normal transaminaz ve IgG) seçilecek ilaçlardır, ancak optimal doz şemaları tartışmalıdır. Azatiyopurin remisyonun sürdürülmesinde (idamesi) seçilecek ilaçtır. Azatiyopurin metabolit düzeyleri dozun ayarlanmasında ve ilaç alımına uyumsuzluğunun ortaya konulmasında yardımcı olur. İki yıldan uzun süren stabil biyokimyasal remisyon ilacın kesilme denemesi için ön koşuldur, çoğu yaşam boyu tedavi gerektirir.
Autoimmune hepatitis is a chronic liver disease caused by immune mechanisms, characterized by signs of female gender dominance, elevated transaminase and immunoglobulin G levels, autoantibody seropositivity and exist of interface hepatitis at histological level. Asymptomatic transaminase elevation may present with different clinical manifestations ranging from cirrhosis and portal hypertension to fulminant hepatitis. If the disease is diagnosed early, progression is stopped with the immunosuppressive treatment, fibrosis regresses at histological level and cirrhosis can be prevented. Mechanisms that initiate and maintain autoimmune inflammation in the liver and the absence of hepatic tolerance have yet to be revealed. There are no specific and targeted therapies for Autoimmune hepatitis and the treatment is still based on non-selective immunosuppression. In this review, the pathogenesis, diagnosis and treatment of autoimmune hepatitis is discussed, consensus reports of the international autoimmune hepatitis group are examined and primary sclerosing cholangitis overlapping with autoimmune hepatitis and the Paris criteria for primary biliary cholangitis syndromes are emphasized. Hamburg 2016 consensus reports on the treatment of autoimmune hepatitis are as follows. Steroids are drugs to be selected in the induction of remission (normal transaminase and IgG), but optimal dosing schemes are controversial. Azathioprine is the drug to be chosen for the maintenance of remission. Metabolite levels of Azathioprine help in the adjustment of the dose and to demonstrate its incompatibility with drug intake. Stable biochemical remission, which lasts more than two years, is a prerequisite for drug discontinuation, most of which require lifelong treatment.
Autoimmune hepatitis is a chronic liver disease caused by immune mechanisms, characterized by signs of female gender dominance, elevated transaminase and immunoglobulin G levels, autoantibody seropositivity and exist of interface hepatitis at histological level. Asymptomatic transaminase elevation may present with different clinical manifestations ranging from cirrhosis and portal hypertension to fulminant hepatitis. If the disease is diagnosed early, progression is stopped with the immunosuppressive treatment, fibrosis regresses at histological level and cirrhosis can be prevented. Mechanisms that initiate and maintain autoimmune inflammation in the liver and the absence of hepatic tolerance have yet to be revealed. There are no specific and targeted therapies for Autoimmune hepatitis and the treatment is still based on non-selective immunosuppression. In this review, the pathogenesis, diagnosis and treatment of autoimmune hepatitis is discussed, consensus reports of the international autoimmune hepatitis group are examined and primary sclerosing cholangitis overlapping with autoimmune hepatitis and the Paris criteria for primary biliary cholangitis syndromes are emphasized. Hamburg 2016 consensus reports on the treatment of autoimmune hepatitis are as follows. Steroids are drugs to be selected in the induction of remission (normal transaminase and IgG), but optimal dosing schemes are controversial. Azathioprine is the drug to be chosen for the maintenance of remission. Metabolite levels of Azathioprine help in the adjustment of the dose and to demonstrate its incompatibility with drug intake. Stable biochemical remission, which lasts more than two years, is a prerequisite for drug discontinuation, most of which require lifelong treatment.
Açıklama
Anahtar Kelimeler
Otoimmün hepatit, Gastroenteroloji, Skorlama, Autoimmune hepatitis, Gastroenterology, Scoring
Kaynak
Maltepe Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
11
Sayı
2
Künye
Akbayır, N. (2019). Otoimmün hepatit / Autoimmun hepatitis. Maltepe Tıp Dergisi. 11(2), s. 55-67.
