原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征的诊治进展

doi:10.3969/j.issn.1004-583X.2024.01.016

摘要/Abstract

摘要：

自身免疫性肝病主要包括自身免疫性肝炎(autoimmune hepatitis,AIH)、原发性胆汁性胆管炎(primary biliary cholangitis,PBC)、原发性硬化性胆管炎。临床上部分患者出现两种或两种以上自身免疫性肝病的临床、生化及病理特征,称为重叠综合征,其中PBC-AIH重叠综合征最常见。与独立诊断的PBC或AIH患者相比,PBC-AIH重叠综合征的肝脏相关不良事件发生率更高,疾病进展速度更快,预后更差。本文就PBC-AIH重叠综合征的诊治进展作一综述,以期提高临床医师对该病的认识。

关键词: 肝炎,自身免疫性, 胆管炎, 诊断, 治疗

中图分类号:

R575.1

游琪琪, 霍丽娟. 原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征的诊治进展[J]. 临床荟萃, 2024, 39(1): 84-87.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.01.016

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I1/84

参考文献 38

[1]	Montano-Loza AJ, Allegretti JR, Cheung A, et al. Single topic conference on autoimmune liver disease from the Canadian Association for the study of the liver[J]. Can Liver J, 2021, 4(4): 401-425. doi: 10.3138/canlivj-2021-0006 URL
[2]	The Committee of the Autoantibodies Detection of Rheumatology and Immunology Physicians Committee of Chinese Medical Doctor Association. Expert consensus on clinical application of autoantibodies detection in patients with autoimmune liver disease[J]. Chin J Intern Med, 2021, 60(7): 619-625.
[3]	中华医学会肝病学分会. 原发性胆汁性胆管炎的诊断和治疗指南(2021)[J]. 中华肝脏病杂志, 2022, 30(3): 264-275.
[4]	Schulz L, Sebode M, Weidemann SA, et al. Variant syndromes of primary biliary cholangitis[J]. Best Pract Res Clin Gastroenterol, 2018, 34-35:55-61. doi: S1521-6918(18)30027-1 pmid: 30343711
[5]	Li Z, Liu Y, Yang F, et al. Dysregulation of circulating FGF19 and bile acids in primary biliary cholangitis-autoimmune hepatitis overlap syndrome[J]. Biomed Res Int, 2020, 2020:1934541.
[6]	To U, Silveira M. Overlap syndrome of autoimmune hepatitis and primary biliary cholangitis[J]. Clin Liver Dis, 2018, 22(3): 603-611. doi: S1089-3261(18)30035-7 pmid: 30259856
[7]	Yan YL, Xing X, Wang Y, et al. Clinical utility of two-dimensional shear-wave elastography in monitoring disease course in autoimmune hepatitis-primary biliary cholangitis overlap syndrome[J]. World J Gastroenterol, 2022, 28(18): 2021-2033. doi: 10.3748/wjg.v28.i18.2021 URL
[8]	European Association for the Study of the Liver. EASL clinical practice guidelines: The diagnosis and management of patients with primary biliary cholangitis[J]. J Hepatol, 2017, 67(1): 145-172. doi: S0168-8278(17)30186-1 pmid: 28427765
[9]	Chazouillères O, Wendum D, Serfaty L, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: Clinical features and response to therapy[J]. Hepatology, 1998, 28(2):296-301. doi: 10.1002/hep.510280203 pmid: 9695990
[10]	倪萍, 凡小丽, 杨丽. 自身免疫性肝病重叠综合征的研究现状[J]. 临床肝胆病杂志, 2020, 36(4): 743-748.
[11]	Kuiper EM, Zondervan PE, Van Buuren HR. Paris criteria are effective in diagnosis of primary biliary cirrhosis and autoimmune hepatitis overlap syndrome[J]. Clin Gastroenterol Hepatol, 2010, 8(6): 530-534. doi: 10.1016/j.cgh.2010.03.004 URL
[12]	Liu F, Pan ZG, Ye J, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: Simplified criteria may be effective in the diagnosis in Chinese patients[J]. J Dig Dis, 2014, 15(12): 660-668. doi: 10.1111/cdd.2014.15.issue-12 URL
[13]	张骏飞, 许何明, 宋海燕, 等. 自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征:巴黎标准诊断中国患者灵敏度低[J]. 实用肝脏病杂志, 2019, 22(4): 537-540.
[14]	杨宁, 刘雁声, 韩英. 原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征的诊治[J]. 临床肝胆病杂志, 2020, 36(3): 697-700.
[15]	Boberg KM, Chapman RW, Hirschfield GM, et al. Overlap syndromes: the International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue[J]. J Hepatol, 2011, 54(2): 374-385. doi: 10.1016/j.jhep.2010.09.002 pmid: 21067838
[16]	Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group report: Review of criteria for diagnosis of autoimmune hepatitis[J]. J Hepatol, 1999, 31(5):929-538. doi: 10.1016/s0168-8278(99)80297-9 pmid: 10580593
[17]	Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis[J]. Hepatology, 2008, 48(1): 169-176. doi: 10.1002/hep.22322 pmid: 18537184
[18]	Neuhauser M, Bjornsson E, Treeprasertsuk S, et al. Autoimmune hepatitis-PBC overlap syndrome: A simplified scoring system may assist in the diagnosis[J]. Am J Gastroenterol, 2010, 105(2): 345-353. doi: 10.1038/ajg.2009.616 pmid: 19888204
[19]	Zhang W, De D, Mohammed KA, et al. New scoring classification for primary biliary cholangitis-autoimmune hepatitis overlap syndrome[J]. Hepatol Commun, 2018, 2(3): 245-253. doi: 10.1002/hep4.1148 pmid: 29507900
[20]	Harms MH, van Buuren HR, Corpechot C, et al. Ursodeoxycholic acid therapy and liver transplant-free survival in patients with primary biliary cholangitis[J]. J Hepatol, 2019, 71(2): 357-365. doi: S0168-8278(19)30228-4 pmid: 30980847
[21]	Gordon SC, Wu KH, Lindor K, et al. Ursodeoxycholic acid treatment preferentially improves overall survival among African Americans with primary biliary cholangitis[J]. Am J Gastroenterol, 2020, 115(2): 262-270. doi: 10.14309/ajg.0000000000000512 pmid: 31985529
[22]	中华医学会肝病学分会. 自身免疫性肝炎诊断和治疗指南(2021)[J]. 中华肝脏病杂志, 2022, 30(5): 482-492.
[23]	Chen RL, Wang QX, Ma X. Precision medicine for autoimmune hepatitis[J]. J Dig Dis, 2019, 20(7): 331-337. doi: 10.1111/cdd.2019.20.issue-7 URL
[24]	王绮夏, 马雄. 自身免疫性肝病重叠综合征诊治进展[J]. 胃肠病学, 2018, 23(5): 283-286.
[25]	张晓梅. 熊去氧胆酸单药治疗原发性胆汁性肝硬化肝炎重叠综合征的临床研究[J]. 现代消化及介入诊疗, 2017, 22(4): 487-489.
[26]	郭丽萍, 周璐, 李树倩, 等. 熊去氧胆酸单药或联合免疫抑制剂治疗原发性胆汁性肝硬化-自身免疫性肝炎重叠综合征的疗效分析[J]. 中华消化杂志, 2016, 36(3): 155-160.
[27]	Chazouillères O, Wendum D, Serfaty L, et al. Long term outcome and response to therapy of primary biliary cirrhosis-autoimmune hepatitis overlap syndrome[J]. J Hepatol, 2006, 44(2): 400-406. doi: 10.1016/j.jhep.2005.10.017 pmid: 16356577
[28]	Ozaslan E, Efe C, Heurgué-Berlot A, et al. Factors associated with response to therapy and outcome of patients with primary biliary cirrhosis with features of autoimmune hepatitis[J]. Clin Gastroenterol Hepatol, 2014, 12(5): 863-869. doi: 10.1016/j.cgh.2013.09.021 URL
[29]	Fan X, Zhu Y, Men R, et al. Efficacy and safety of immunosuppressive therapy for PBC-AIH overlap syndrome accompanied by decompensated cirrhosis: A real-world study[J]. Can J Gastroenterol Hepatol, 2018, 2018: 1965492.
[30]	Freedman BL, Danford CJ, Patwardhan V, et al. Treatment of overlap syndromes in autoimmune liver disease: A systematic review and meta-analysis[J]. J Clin Med, 2020, 9(5): 1449.
[31]	Baven-Pronk AM, Coenraad MJ, Van Buuren HR, et al. The role of mycophenolate mofetil in the management of autoimmune hepatitis and overlap syndromes[J]. Aliment Pharmacol Ther, 2011, 34(3): 335-343. doi: 10.1111/apt.2011.34.issue-3 URL
[32]	Efe C, Hagström H, Ytting H, et al. Efficacy and safety of mycophenolate mofetil and tacrolimus as second-line therapy for patients with autoimmune hepatitis[J]. Clin Gastroenterol Hepatol, 2017, 15(12): 1950-1956. doi: 10.1016/j.cgh.2017.06.001 URL
[33]	Hanouneh M, Ritchie MM, Ascha M, et al. A review of the utility of tacrolimus in the management of adults with autoimmune hepatitis[J]. Scand J Gastroenterol, 2019, 54(1): 76-80. doi: 10.1080/00365521.2018.1551498 URL
[34]	Faisal N, Renner EL. Recurrence of autoimmune liver diseases after liver transplantation[J]. World J Hepatol, 2015, 7(29): 2896-2905. doi: 10.4254/wjh.v7.i29.2896 pmid: 26689244
[35]	Liberal R, Zen Y, Mieli-Vergani G, et al. Liver transplantation and autoimmune liver diseases[J]. Liver Transpl, 2013, 19(10): 1065-1077. doi: 10.1002/lt.v19.10 URL
[36]	Silveira MG, Talwalkar JA, Angulo P, et al. Overlap of autoimmune hepatitis and primary biliary cirrhosis: Long-term outcomes[J]. Am J Gastroenterol, 2007, 102(6): 1244-1250. pmid: 17319931
[37]	Park Y, Cho Y, Cho EJ, et al. Retrospective analysis of autoimmune hepatitis-primary biliary cirrhosis overlap syndrome in Korea: Characteristics, treatments, and outcomes[J]. Clin Mol Hepatol, 2015, 21(2): 150-157. doi: 10.3350/cmh.2015.21.2.150 pmid: 26157752
[38]	Yang F, Wang Q, Wang Z, et al. The natural history and prognosis of primary biliary cirrhosis with clinical features of autoimmune hepatitis[J]. Clin Rev Allergy Immunol, 2016, 50(1): 114-123. doi: 10.1007/s12016-015-8516-5 URL

原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征的诊治进展

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 38

相关文章 15

编辑推荐

Metrics

本文评价

[1]	王奕涵, 秦旭雁, 韩宣泽, 王樱洁, 高菲菲, 陈春红, 张岭楠, 张芳. 利伐沙班用于HASBLED评分≥3分的高龄非瓣膜性心房颤动患者的有效性和安全性[J]. 临床荟萃, 2024, 39(2): 121-124.
[2]	金鑫, 吴金玲, 尹丽丽. 持续性植物状态促醒机制及治疗研究进展[J]. 临床荟萃, 2024, 39(2): 172-176.
[3]	王琦, 陈宏. 维生素D在支气管哮喘和慢性阻塞性肺疾病治疗中的应用进展[J]. 临床荟萃, 2024, 39(1): 88-91.
[4]	崔兰丹, 杨春燕. 脓毒症患者甲状腺激素的变化特点及研究进展[J]. 临床荟萃, 2024, 39(1): 70-74.
[5]	邹子良, 余海, 王迪, 褚泰运, 李驹, 钱宝堂. 冠状动脉慢性完全闭塞病变介入治疗研究现状[J]. 临床荟萃, 2024, 39(1): 80-83.
[6]	赵浩天, 李丽. 肺超声在心脏急重症疾病合并肺水肿中应用的研究进展[J]. 临床荟萃, 2023, 38(9): 832-837.
[7]	王鑫, 张展, 刘铎, 谢萍. 铁缺乏与肺动脉高压相关性的研究进展[J]. 临床荟萃, 2023, 38(9): 838-844.
[8]	陈聪水, 李园, 陈淑芳. 重视儿童胆源性胰腺炎的中西医诊治(附1例分析)[J]. 临床荟萃, 2023, 38(8): 726-730.
[9]	武锐锋, 刘宇宏. PDZ结合激酶/T淋巴细胞因子激活的杀伤细胞源性蛋白激酶的作用机制及其在肿瘤治疗中的潜在价值[J]. 临床荟萃, 2023, 38(8): 763-768.
[10]	侯有玲, 李奕, 关红玉, 罗红霞. 目标导向液体治疗在脑肿瘤切除术中应用效果的meta分析[J]. 临床荟萃, 2023, 38(8): 686-693.
[11]	王玥, 陈辉, 岑奕, 张哲, 张欣, 李宗锡, 陈珍珍, 贾彤彤, 章美玲. 超声引导下侧入路颈脊神经后支三氧联合注射松解治疗颈脊神经后支源性慢性颈肩痛[J]. 临床荟萃, 2023, 38(8): 714-718.
[12]	张会, 丁东瑞, 金天然. 新型冠状病毒SARS-CoV-2的相关研究——过去与未来[J]. 临床荟萃, 2023, 38(7): 638-646.
[13]	郭文惠, 雷皓月, 潘友卓, 张琦. 质膜膜泡关联蛋白的生物学功能研究进展[J]. 临床荟萃, 2023, 38(7): 647-653.
[14]	陈瑾, 吕鸿雁, 刘晗, 刘建宁, 卢佳配, 张金巧. 靶向BCMA的嵌合抗原受体T细胞治疗三重难治性多发性骨髓瘤的研究进展[J]. 临床荟萃, 2023, 38(7): 654-658.
[15]	杨小雄, 杨帆, 魏小果. 肠-微生物群-肝轴与代谢相关脂肪性肝病的研究进展[J]. 临床荟萃, 2023, 38(6): 559-563.