Autoimmune hepatitis - chronic inflammatory process in the liver of unknown nature, which is characterized by periportal or more extensive inflammation, and the presence of hypergammaglobulinemia and tissue autoantibodies.
Autoimmune hepatitis in children generally occurs between the ages of 10 years and older.Three-quarters of the total number of cases are women over the age of 40 years.
Chronic autoimmune hepatitis can last several months or years remain asymptomatic until the moment when manifest jaundice and can make an accurate diagnosis.Recognize the disease is possible before, if to conduct a study on the presence of stigma hepatic disease or the results of biochemical liver function will be different from the norm.
disease onset can be of different character.We can distinguish two variants of the beginning of the disease:
- In some patients the disease begins as an acute viral hepatitis: there is a weakness, lack of appetite, dark urine, jaundice occurs with severe hyperbilirubinemia, as well as high levels of transaminases in the blood.Second Embodiment
- start autoimmune hepatitis characterized by a predominance of extrahepatic manifestations and temperature increases, which leads to a false diagnosis of systemic lupus erythematosus, sepsis, rheumatoid arthritis or rheumatism.
reason of autoimmune hepatitis is still unknown.Due to changes in the level of immune globulin in serum are extremely high.Approximately 15% of patients with positive results due LE-cell test and the appearance of the term "lupoid hepatitis."We found a large number of patients with tissue antibodies.
Signs and symptoms of autoimmune hepatitis
Autoimmune hepatitis is characterized by the following symptoms:
- Marked general weakness, fatigue, decreased ability to work, appetite loss, pain and feeling of heaviness in the right upper quadrant, nausea, symptoms of jaundice, itching, and painin the joints, fever, skin rash, and menstrual disorders.
- When osmotrevyyavlyaetsya jaundice of varying severity, hemorrhagic exanthema of the skin in the form of dots or spots.
- In severe cases, the disease on the body there are spider veins and redness of palms.
- often occurs digestive organ system failure.
- hepatomegaly - the most characteristic feature of autoimmune hepatitis.The liver is painful, and its texture is moderately dense.It is also possible enlargement of the spleen, in some patients there is a transient ascites . Almost all patients present chronic gastritis with a reduced secretory function.
- Extrahepatic systemic manifestations.
Autoimmune hepatitis - a systemic disease in which amazed many organs and systems.Patients may pleurisy, myocarditis, pericarditis, ulcerative colitis, glomerulonephritis, autoimmune thyroiditis, iridocyclitis, Cushing's syndrome, diabetes, hemolytic anemia.
Autoimmune hepatitis - symptoms in severe cases may occur in the form of hyperthermia.This is accompanied by recurrent acute arthritis involving large joints without distortion.
One of the most important manifestations of systemic extrahepatic is glomerulonephritis, which often develops in the terminal stage.Kidney biopsy often reveals mild glomerulitis.
from the history of autoimmune hepatitis disease known that extrahepatic manifestations of the disease do not dominate the clinical picture and develop much later.However, systemic lupus erythematosus, which is often confused with autoimmune hepatitis, extrahepatic symptoms in the clinical picture is dominated by developing much earlier than the symptoms of autoimmune hepatitis.
in the diagnosis of autoimmune hepatitis is important to define the following markers:
- antinuclear antibodies (ANA);
- antibodies to liver and kidney microsomes (anti-LKM);
- SMA - antibodies to smooth muscle cells, soluble liver (SLA) and hepato-pancreatic (LP) antigens;
- asialo-glycoprotein receptor (hepatic lectin) and hepatocyte plasma membrane antigens (LM).
Treatment of autoimmune hepatitis
The most common pathogenetic therapy using corticosteroids, which reduce the activity of the pathological process in the liver.This is due to an immunosuppressive effect on the K-cell autoimmunity intensity decrease, increase in the activity of T-suppressors against hepatocytes.
main therapeutic drugs - prednisolone or methylprednisolone.The initial daily dose of prednisolone - 60 mg for 1 th week, 40 mg - 2nd week on the 3rd and 4th weeks - 30 mg and maintenance dose is 20 mg.Reduce the daily dose should be slowly (2.5 mg every 1-2 weeks), to maintenance, which make up a complete clinical, laboratory and histological remission.Treatment is carried out for a long time: from 6 months to 2 years, and in some patients - throughout life.
Autoimmune hepatitis - forecast mostly favorable.Everything depends on the stage of the disease and the measures taken in time.Indications for liver transplantation in the relevant cases, if not managed using corticosteroids to achieve remission or in advanced process, when it develops cirrhosis.Survival after transplantation of comparable patients in whom remission was achieved with corticosteroids.Repeated liver biopsy after transplantation did not reveal recurrence of autoimmune chronic hepatitis.