儿童自身免疫性肝炎的诊治进展

Advances in the diagnosis and treatment of pediatric autoimmune hepatitis

自身免疫性肝炎(AIH)是一种进行性炎症性肝病,儿童AIH发病率近年来逐步上升。AIH可分为两种类型:抗核抗体和(或)平滑肌抗体和(或)抗可溶性肝抗原抗体阳性的AIH-1、抗肝-肾微粒体1型和(或)抗肝细胞溶质1型抗体阳性的AIH-2,AIH-2主要见于儿童。正常儿童少见自身抗体阳性,因此儿童AIH诊断时对自身抗体滴度的要求低于成人标准,但儿童AIH疾病进展比成人期更快,因此确诊后应该立即开始治疗。成人AIH诊断评分系统不适用于儿科患者,尤其不适于区分AIH和自身免疫性硬化性胆管炎。

Autoimmune hepatitis(AIH)is a progressive inflammatory liver disease,and the incidence rate of pediatric AIH is gradually increasing in recent years.AIH can be classified into AIH-1(with positive antinuclear antibody and/or smooth muscle antibody and/or anti-soluble liver antigen antibody)and AIH-2(with positive liver-kidney microsomal type 1 antibody and/or anti-liver cytosol type 1 antibody),among which AIH-2 is mainly seen in children.Positive autoantibodies are rare in healthy children,and thus the requirements for autoantibody titer in the diagnosis of pediatric AIH are lower than the criteria for adults.Pediatric AIH progresses more rapidly than adult AIH,and treatment should be started immediately after confirmed diagnosis.Scoring systems for the diagnosis of AIH in adults are not applicable to pediatric patients and cannot be used to differentiate AIH from autoimmune sclerosing cholangitis.