自己免疫性肝炎について(特別講演,<特集>第68回東京女子医科大学学会総会)

概要

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We investigated many cases of autoimmune hepatitis depending on an acute phase or a chronic phase and proposed here the crucial points on diagnostic definition and treatment. In an acute phase, many cases lack positive auto-antibodies and hyper-γ-globulinemia which are typical feature in chronic phase of autoimmune hepatitis. Thus, the current diagnostic definition of autoimmune hepatitis is not sufficient to uncover acute phase of disease. Histologically, multi-lobular and diffuse hepatic degeneration and necrosis are initially observed and irreversible degeneration gave an atrophic change on some area, leading to wide and flat depression on a surface of liver which process brings out potato liver macroscopically. To suppress the progression of acute phase of autoimmune hepatitis we need the initial treatment of predonisolone within 1.5 month and basically with combination with Imuran. After treatment of acute phase, we control the disease with a maintaining dose of 7.5～2.5 mg/day of predonisolone. In a chronic phase autoimmune hepatitis repeatedly relapse and progress to liver cirrhosis consistent with positive auto-antibodies and prominent hyper-γ-globulinemia. The typical case of autoimmune hepatitis diagnosed with the current definition may show an exacerbated phase or a relapse phase of chronic autoimmune hepatitis.
東京女子医科大学の論文
2003-05-25