Autoimmune Hepatitis
Last reviewed: 23.04.2024
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Autoimmune hepatitis is a chronic hepatitis of unknown etiology, in the pathogenesis of which the leading role is played by autoimmune mechanisms.
The disease is more common in women (ratio of men and women with autoimmune hepatitis 1: 3), the most commonly affected age is 10-30 years.
Etiology
The etiology is unknown. Immune changes are evident. Levels of y-globulin in the serum are extremely high. Positive results of LE-cell test in about 15% of patients led to the emergence of the term "lupoid hepatitis". Tissue antibodies are found in a significant proportion of patients.
Chronic ("lupoid") hepatitis and classical systemic lupus erythematosus are not identical diseases, as in classical lupus in the liver, there are rarely any changes. Moreover, in the blood of patients with systemic lupus erythematosus there are no antibodies to smooth muscles and mitochondria.
In the pathogenesis of autoimmune hepatitis, immunoregulation defects, in particular, a decrease in T-suppressor function of lymphocytes and the appearance of various autoantibodies, are of great importance. These antibodies are fixed on the membrane of hepatocytes, which creates conditions for the development of antibody-dependent cytotoxic reactions damaging the liver and causing the development of immune inflammation.
Causes and pathogenesis of autoimmune hepatitis
Clinical picture
The disease occurs mainly in young people; the age of half of patients is from 10 to 20 years. The second peak of the disease is observed in the menopause period. Three quarters are women.
In most cases, the picture of liver damage does not match the established duration of the symptomatology. Chronic hepatitis can remain asymptomatic for several months (and possibly even years) until the moment when jaundice becomes obvious and a diagnosis can be made. The disease can be recognized earlier if a routine study reveals the stigma of a liver disease or the results of a biochemical study of liver function differ from the norm.
Symptoms of autoimmune hepatitis
Laboratory data
- General blood test: normocytic, normochromic anemia, indistinctly expressed leukopenia, thrombocytopenia, increased ESR. Due to expressed autoimmune hemolysis, a high degree of anemia is possible.
- The general analysis of urine: there may be the appearance of proteinuria, microhematuria (with the development of glomerulonephritis); when jaundice develops, bilirubin appears in the urine.
Diagnosis of autoimmune hepatitis
Treatment
Controlled clinical studies have shown that therapy with corticosteroids prolongs life in the case of severe chronic hepatitis type I.
The benefits of treatment are particularly evident in the first two years. Weakness decreases, appetite improves, fever and arthralgia give in to treatment. The menstrual cycle is restored. The levels of bilirubin, y-globulin and the activity of transaminases usually decrease. The changes are so pronounced that on their basis it is possible to establish a diagnosis of autoimmune chronic hepatitis. Histological examination of the liver against the background of treatment reveals a decrease in the activity of the inflammatory process. However, it is not possible to prevent the outcome of chronic hepatitis in cirrhosis.
Treatment of autoimmune hepatitis
The course and prognosis of autoimmune hepatitis is extremely variable. The course has a wavy character with episodes of deterioration, when jaundice and weakness develop. The outcome of the chronic hepatitis thus proceeding, with rare exception, is inevitably cirrhosis.
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