gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1321Research ArticleГЕПАТОЛОГИЯHEPATOLOGYАутоиммунный гепатит: новое в диагностике, патогенезе и леченииAutoimmune hepatitis: new in diagnostics, a pathogenesis and treatmentШироковаЕ. Н.ShirokovaYe. N.ИвашкинК. В.IvashkinK. V.ИвашкинВ. Т.IvashkinV. T.ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздравсоцразвития РФRussian Federation2012300920122253745Copyright © Широкова Е.Н., Ивашкин К.В., Ивашкин В.Т., 20122012Широкова Е.Н., Ивашкин К.В., Ивашкин В.Т.Shirokova Y.N., Ivashkin K.V., Ivashkin V.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1321

Цель обзора. Обобщить новые данные о диагностике, патогенезе и лечении аутоиммунного гепатита (АИГ).Основные положения. АИГ– хроническое воспалительное заболевание печени, которое характеризуется разрушением пограничной пластинки инфильтратом мононуклеаров (interface hepatitis) по данным гистологического исследования, гипергаммаглобулинемией и продукцией аутоантител. Генетические факторы риска развития АИГ – наличие аллелей DRB1*0301 и DRB1*0401. Уменьшение числа и функциональной активности CD4+ CD25+ (регуляторных) Т-клеток ведет к нарушению иммунного гомеостаза.Улучшение результатов лечения АИГ возможно при продолжении кортикостероидной терапии до нормализации печеночных проб и гистологической картины, при раннем выявлении «трудных» пациентов и проведении длительной поддерживающей терапии после первого рецидива заболевания. Альтернативные лечебные препараты – ингибиторы кальцинейрина и микофенолата мофетил, а также рекомбинантный интерлейкин-10, абатацепт и CD-3 специфичные антитела. Трансплантация печени – эффективный метод лечения.Заключение. Оптимизация кортикостероидной терапии позволит выявить кандидатов для альтернативного лечения. Будесонид – препарат выбора для больных, ранее не получавших терапию. Разработка новых стратегий лечения возможна на основе определения ключевых дефектов иммунного гомеостаза и антигенных мишеней.

The aim of review

The aim of review. To generalize new data on diagnostics, pathogenesis and treatment of autoimmune hepatitis (AIH).

Original positions

Original positions. AIH is a chronic inflammatory liver disease which is characterized by destruction of terminal plate by mononuclear infiltrate (interface hepatitis) according to histological investigation, hypergammaglobulinemia and production of autoantibodies. Genetic risk factors of AIH development is the presence of DRB1*0301 and DRB1*0401 alleles. Decrease of number and functional activity of CD4+CD25 + (regulatory) Т-cells leads to disorder of immunological homeostasis. Improvement of AIH treatment results is possible at continuation of corticosteroid treatment before normalization of liver tests and histological pattern, at early detection of «difficult» patients and carrying out of long-term maintenance therapy after the first relapse of disease. Alternative medical agents include calcineurin inhibitors, mycophenolate mofetil, and recombinant interleukin-10, abatacept and CD-3 specific antibodies. Liver transplantation is effictive treatment method.

Conclusion

Conclusion. Improvement of corticosteroid treatment allows to determine candidates for alternative treatment. Budesonide is a drug of choice for the patients who were not receiving treatment before. Development of new treatment strategy is possible on the basis of assessment of key defects of immunological homeostasis and antigenic targets.

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The authors declare that there are no conflicts of interest present.