自身免疫性肝炎诊断与治疗PPT：2019年美国指南解读

2019年美国肝病学会（AASLD）发布的实践指引和指南是对2010年版自身免疫性肝炎（AIH）指南的更新，从而在现有证据和专家意见的基础上为AIH的诊疗提供指引，并在系统回顾文献和证据质量的基础上为相关临床问题提供指导。

该实践指引更新了成人和儿童AIH的流行病学、诊断、治疗和预后，包括两个部分：指导性建议和指引性声明。

指导性建议均基于对医学文献的系统回顾所获得的证据，并在适当时通过Meta分析予以支持。

指引性声明是指由专家小组在正式审查和分析已发表文献的基础上协商一致后达成的共识。

原版英文指南，在文末：

Diagnosis and Management of Autoimmune Hepatitis in Adults and Children:2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases

术语：

Abbreviations: 

AASLD, American Association for the Study of Liver Diseases; 

AIH, autoimmune hepatitis; 

ALF, acute liver failure; 

ALT, alanine aminotransferase; 

AMA, antimitochondrial antibodies; 

ANA, antinuclear antibodies; 

anti-α-actinin, antibody to alpha-actinin; 

anti-HBc, antibodies to hepatitis B core antigen; 

anti-LC1, antibodies to liver cytosol type 1; 

anti-LKM1, antibodies to LKM1; 

anti-PD-1, antibody to PD-1; 

anti-SLA, antibodies to SLA; 

ARFI, acoustic radiation force impulse imaging; 

ASC, autoimmune sclerosing cholangitis; 

AST, aspartate aminotransferase;

AZA, azathioprine; 

Breg, B regulatory cell; 

CD, cluster of differentiation; 

CI, confidence interval; 

CsA, cyclosporine; 

CTL, cytotoxic T lymphocyte;

CTLA-4, cytotoxic T lymphocyte antigen-4; 

GGT, gamma-glutamyltransferase; 

GRADE, Grading of Recommendations Assessment, Development,

and Evaluation; 

HAV, hepatitis A virus; 

HBsAg, hepatitis B surface antigen; 

HBV, hepatitis B virus; 

HCC, hepatocellular carcinoma; 

HLA, human

leukocyte antigen; 

IAIHG, International Autoimmune Hepatitis Group; 

IBD, inflammatory bowel disease; 

IgG, immunoglobulin G; 

IL, interleukin;

INR, international normalized ratio; 

iTreg, inducible T regulatory cell; 

LKM1, liver kidney microsome type 1; 

LT, liver transplantation; 

MAIT,mucosal invariant T; 

MMF, mycophenolate mofetil; 

6-MP, 6-mercaptopurine; 

MRE, magnetic resonance elastography; 

NAFLD, nonalcoholic fatty liver disease; 

NASH, nonalcoholic steatohepatitis; 

NK, natural killer; 

OR, odds ratio; 

pANCA, perinuclear antineutrophil cytoplasmic antibody; 

PBC,primary biliary cholangitis; 

PD-1, programmed death protein-1; 

PSC, primary sclerosing cholangitis; 

SLA, soluble liver antigen; 

SMA, smooth muscle

《2019年AASLD关于自身免疫性肝炎诊断与治疗的指南》解读

马雄

上海市消化疾病研究所

上海交通大学医学院附属仁济医院

指南共识，找到组织