Autoimmune hepatitis is a chronic progressive inflammation of the liver tissue as a result of a congenital defect of the membrane receptors HLA II, characterized by the presence of antibodies in the blood serum, hypergammaglobulinemia and inflammatory process. In this hepatitis occurs the development of inflammation, fibrosis, cirrhosis and rarely – liver failure.
Most women are affected, almost 2/3 of the patients. Autoimmune hepatitis develops at any age, but is usually detected in patients under 40 years of age. Maybe sharp, even lightning fast. A third of patients have concomitant immune diseases.
The basic treatment of autoimmune hepatitis (AIG) is glucocorticoids, although it is possible to lower their dose simultaneously using azathioprine. In 80% of cases after the initial therapy, remission occurs. The prognosis depends on the severity of the histological changes, although almost 50% of patients after the suspension of treatment remain remission or moderate activity of the disease. However, most patients require prolonged maintenance treatment.
After discontinuation of treatment, it is rarely possible to maintain remission in persons with signs of cirrhosis according to a primary biopsy. Normalization of biochemical parameters (decrease in the activity of aminotransferases and globulin levels) occurs mainly within about two months from the start of treatment. In certain patients, remission can only be induced by long-term therapy.
The mechanism of action of glucocorticoids in AIG is a violation of the production of cytokines involved in the coordination of immunocompetent cells.
Indications for the appointment of glucocorticoids in AIG:
- Pronounced clinical symptoms;
- Continuous progression;
- AsAT is more than 10 norms;
- AsAt more than 5 norms + y-globulins more than 2 norms;
- Bridge or multilobular necrosis.
- Symptoms are moderate or nonexistent;
- AsAT is more than 3-9 norms;
- Γ-globulins are less than 2 norms;
- Periportal hepatitis.
The drugs of choice are prednisolone or methylprednisolone (there are practically no side effects and no mineral corticoid activity). Halogenated glucocorticoids (triamcinolone, dexamethasone), despite the high enough activity, are poorly tolerated by patients due to severe myopathy, formed with prolonged admission.
The use of prednisolone in a dose of twenty-five mg is possible in all patients with histological signs of severe hepatitis c, fibrotic or cirrhotic changes. If a biopsy shows signs of moderate hepatitis, the decision to use medicines is based on the symptoms of the patient. Patients with asymptomatic disease and moderate inflammatory changes do not require treatment. The condition of such patients is carefully monitored (repeated biopsies are performed) in order to detect the progression of the disease in time.
Indications for combined treatment (prednisolone + azathioprine):
- Increase in transaminase activity by one and a half times;
- Increase in the level of y-globulins by a factor of 2;
- Histological picture of moderate or high degree of activity.
The prognosis of the development of the disease depends on the activity of the inflammatory process, which is determined by means of biochemical and histological studies.