gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1634Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSСовременные терапевтические схемы лечения аутоиммунного гепатитаполучавших лечение. При этом наблюдается значительно меньшая частота развития побочных эффекModern therapeutic modes of treatment of autoimmune hepatitisИвашкинВ. Т.IvashkinV. T.МорозоваМ. А.MorozovaM. A.МаевскаяМ. В.MayevskayaM. V.БуеверовА. О.BuyeverovA. O.Московская медицинская академия им. И.М. СеченоваRussian Federation200905082009194412Copyright © Ивашкин В.Т., Морозова М.А., Маевская М.В., Буеверов А.О., 20092009Ивашкин В.Т., Морозова М.А., Маевская М.В., Буеверов А.О.Ivashkin V.T., Morozova M.A., Mayevskaya M.V., Buyeverov A.O.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/1634

Цель обзора. Представить стандартные и альтернативные терапевтические схемы, применяемые при лечении аутоиммунного гепатита (АИГ).Основные положения. Аутоиммунный гепатит – хроническое воспалительное заболевание печени неизвестной этиологии, сопровождающееся повышением уровня сывороточных трансаминаз, гипергаммаглобулинемией и циркуляцией в крови определенного спектра аутоантител. В большинстве случаев заболевание поддается лечению комбинацией преднизолона и азатиоприна. Однако, по современным сведениям, 20% пациентов остаются невосприимчивы к указанным препаратам или плохо их переносят, 10% вынуждены прекратить лечение в связи с развитием серьезных побочных эффектов.Будесонид представляет собой синтетический глюкокортикостероид, характеризующийся быстрым метаболизмом в печени и не обладающий системным действием. В мире опубликованы результаты ряда исследований по изучению эффективности и безопасности применения будесонида у пациентов с АИГ на различных стадиях заболевания. В обзоре освещены данные литературы, касающиеся эпидемиологии, клиники, диагностики и основных терапевтических стратегий при АИГ.Заключение. В настоящее время классической схемой, применяемой для лечения АИГ служит комбинация преднизолона и азатиоприна. Результаты проведенных исследований показали, что назначение будесонида может быть целесообразно в качестве препарата 1­-й линии у пациентов, ранее не получавших лечение. При этом наблюдается значительно меньшая частота развития побочных эффектов, чем при приеме комбинации преднизолона и азатиоприна. Однако применение будесонида для лечения больных с уже сформировавшимся циррозом печени связано с достаточно высоким риском развития стероид-­обусловленных побочных эффектов и меньшей частотой индукции ремиссии.

The aim of review

The aim of review. To present the standard and alternative therapeutic modes used at treatment of autoimmune hepatitis (AIH).

Original positions

Original positions. Autoimmune hepatitis is a chronic inflammatory disease of the liver of the unknown etiology, accompanied by elevation of serum transaminase level, hypergammaglobulinemia and circulation of the fixed spectrum of autoantibodies in the blood. In most of the cases disease can be treated by combination of prednisolon and azathioprin. However, according to current data, 20% of the patients remain resistant to these agents or have low tolerability, 10 % have to discontinue treatment due to development of serious side effects. Budesonide is a synthetic glucocorticosteroid which is characterized by rapid metabolism in the liver, having no systemic action. Results of some studies on efficacy and safety of application of budesonide at patients with AIH at various stages of disease are published in the world literature. In the review the data on epidemiology, clinical, diagnostics and main therapeutic strategy at autoimmune hepatitis are covered.

Conclusion

Conclusion. Now the combination of prednisolon and azathioprin serves as the classical mode for AIH treatment. Results of original studies demonstrated, that budesonide can be a drug of the 1-st line in patients who received no previous treatment. So, considerably less frequency of side effects development, than at intake of prednisolon and azathioprin combination is observed. However application of budesonide for treatment of liver cirrhosis patients is related to quite high risk of development steroid-related side effects and lower frequency of remission induction.

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