Autoimmune enteropathy(AIE)is a rare immune mediated disorder primarily affecting children,characterized by chronic diarrhea,malabsorption,vomiting,weight loss and villous atrophy.It has also been observed in adults p...Autoimmune enteropathy(AIE)is a rare immune mediated disorder primarily affecting children,characterized by chronic diarrhea,malabsorption,vomiting,weight loss and villous atrophy.It has also been observed in adults presenting diagnostic and treatment challenges due to its overlap with other gastrointestinal disorders such as celiac disease.Initial diagnostic criteria for AIE include small bowel villous atrophy,lack of response to dietary restrictions,presence of anti-enterocyte antibodies,and predisposition to autoimmunity without severe immu-nodeficiency.Refined criteria emphasize characteristic histological findings and exclusion of other causes of villous atrophy.AIE is associated with various autoimmune disorders and can present with overlapping features with Celiac disease,including villous atrophy but without significant intraepithelial lympho-cytosis.Treatment primarily involves immunosuppression using corticosteroids,calcineurin inhibitors,and anti-tumor necrosis factor therapy,alongside nutri-tional support.Despite the challenges,understanding AIE’s diverse manifest-ations and improving diagnostic criteria are essential for effective management and improved patient outcome.Further research is needed to elucidate the pathogenesis,disease progression and long-term outcomes of AIE.展开更多
Chloroquine(CQ)and hydroxychloroquine(HCQ),originally developed as anti-malarial drugs,have found a new purpose in treating various autoimmune dis-eases due to their immunomodulatory properties.These drugs work throug...Chloroquine(CQ)and hydroxychloroquine(HCQ),originally developed as anti-malarial drugs,have found a new purpose in treating various autoimmune dis-eases due to their immunomodulatory properties.These drugs work through mu-ltiple mechanisms,including inhibiting Toll-like receptor signaling,suppressing antigen presentation,and modulating autophagy.This review article provides a comprehensive analysis of the immunomodulatory effects of CQ and HCQ in several autoimmune diseases such as systemic lupus erythematosus,rheumatoid arthritis,systemic sclerosis,and others.We delve into the intricate mechanisms of action,highlighting the key immune cells involved and discussing the clinical implications of these drugs in managing autoimmune conditions.Our review covers the latest research and clinical trials,offering a comprehensive under-standing of the therapeutic potential of CQ and HCQ in autoimmune diseases.We also discuss the challenges and controversies surrounding the use of these drugs,such as their long-term side effects and the need for personalized treatment approaches.By synthesizing current knowledge and identifying areas for future research,this review aims to provide a valuable resource for healthcare profes-sionals and researchers involved in the management of autoimmune diseases.展开更多
Background:Previous studies have highlighted the frequent occurrence of sarcopenia in patients with pancreatic diseases,including chronic pancreatitis.We aimed to clarify the prevalence of skeletal muscle(SM)loss and ...Background:Previous studies have highlighted the frequent occurrence of sarcopenia in patients with pancreatic diseases,including chronic pancreatitis.We aimed to clarify the prevalence of skeletal muscle(SM)loss and sarcopenia,and their associations with clinical characteristics,bone mineral density,and pancreatic imaging findings in patients with autoimmune pancreatitis(AIP).Methods:This study included 114 patients with AIP treated at Tohoku University Hospital.The SM index was assessed using a bioelectrical impedance analysis device,grip strength was measured using a hand dynamometer,and bone mineral density was evaluated using dual-energy X-ray absorptiometry.Univari-ate and multivariate logistic regression analyses were used to analyze factors associated with SM loss and sarcopenia.Results:Among 114 patients,57(50.0%)had SM loss,31(27.2%)had reduced grip strength,and 27(23.7%)had both.Patients with SM loss were older and had a lower body mass index,weaker grip strength,higher Controlling Nutritional Status scores,and lower serum lipase and albumin levels compared to those without SM loss.Computed tomography scans revealed a higher prevalence of pancreatic parenchy-mal atrophy in patients with SM loss.Similar differences were observed between patients with sarcopenia and those without.Osteopathy was observed in 35.6%of patients with SM loss and 38.1%of those with sarcopenia,whereas only 4.1%of patients without SM loss had osteopathy.Low BMI(<21.0 kg/m^(2))was also found to be an independent risk factor for SM loss in multivariate analysis.Age>72 years,low BMI(<20.0 kg/m^(2)),and low serum lipase levels(<13 U/L)were independent risk factors for sarcopenia in multivariate analysis.Conclusions:SM loss and sarcopenia are prevalent in patients with AIP and are associated with aging,poor nutritional status,low serum lipase levels,and pancreatic parenchymal atrophy.In addition to the high risk of osteopathy,careful attention should be paid to maintain muscle health in AIP patients.展开更多
Foot reflexology(FR)is a Chinese-originated and non-invasive complementary therapy increasingly used by functional,alternative and para-medical professionals.Enhance attempts are made to study FR in non-functional org...Foot reflexology(FR)is a Chinese-originated and non-invasive complementary therapy increasingly used by functional,alternative and para-medical professionals.Enhance attempts are made to study FR in non-functional organic conditions.The present invited Editorial discusses the application of FR in autoimmune diseases(AD),highlighting a few successful studies demonstrating symptomatic relief and objective improvements.Despite promising results,the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases,including AD,is highly recommended.展开更多
BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double c...BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.展开更多
BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High...BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High levels of anti-ganglionic nicotinic acetylcholine receptor(gAChR)serum antibodies are detected in approximately 50%of AAG cases,confirming the diagnosis.CASE SUMMARY We present the case of a 68-year-old man who developed autonomic failure gradually over a 2-year period.Recently,the patient was unable to stand upright for more than a few seconds before fainting.Additionally,he presented with decreased sweating,dry mouth,urinary retention,early satiety,weight loss,bloating,constipation,and erectile dysfunction.Neurological examination revealed dilated pupils that were unresponsive to light.Deep tendon reflexes were absent or diminished.Serologic evaluation revealed the presence of gAChR autoantibodies.An orthostatic hypotension test yielded a positive result.The patient did not respond to symptomatic therapy,including midodrine,fludrocortisone and atomoxetine.Second-line therapy with immunoadsorption produced a noticeable clinical improvement;however,orthostatic hypotension persisted.Sequential rituximab infusion therapy successfully led to a significant improvement in symptoms.CONCLUSION Our case report supports the benefit of combined immunomodulatory therapy for refractory AAG cases that are unresponsive to single-agent treatment.展开更多
Recently,Jayabalan et al published an important study.The authors defined the liver outcome score as a novel biomarker for predicting liver-related mortality in patients with autoimmune hepatitis-primary biliary chola...Recently,Jayabalan et al published an important study.The authors defined the liver outcome score as a novel biomarker for predicting liver-related mortality in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome.After thoroughly reviewing their work,we offer insights that primarily relate to their study design to enhance the medical community’s understanding of this complex disease.展开更多
This letter addresses the study by Jayabalan et al,which underscores the liver outcome score(LOS)and hemoglobin(Hb)as key prognostic markers for patients with autoimmune liver disease overlap syndromes(AILDOS),with pa...This letter addresses the study by Jayabalan et al,which underscores the liver outcome score(LOS)and hemoglobin(Hb)as key prognostic markers for patients with autoimmune liver disease overlap syndromes(AILDOS),with particular relevance to the autoimmune hepatitis-primary biliary cholangitis(AIH-PBC)subgroup.The findings indicate that an LOS threshold of 6 achieves high sensitivity and specificity in predicting liver-related mortality among AIH-PBC patients.Moreover,low Hb levels emerge as a significant mortality predictor across all AILDOS cases.These results contribute valuable perspectives on risk stratification in AILDOS,highlighting the promise of non-invasive prognostic tools.Future studies with larger cohorts are needed to substantiate LOS and Hb as robust markers for clinical application.展开更多
BACKGROUND Autoimmune hepatitis(AIH)is typically treated with immunomodulators and steroids.However,some patients are refractory to these treatments,necessitating alternative approaches.Biological therapies have recen...BACKGROUND Autoimmune hepatitis(AIH)is typically treated with immunomodulators and steroids.However,some patients are refractory to these treatments,necessitating alternative approaches.Biological therapies have recently been explored for these difficult cases.AIM To assess the efficacy and safety of biologics in AIH,focusing on patients unresponsive to standard treatments and evaluating outcomes such as serological markers and histological remission.METHODS A case-based systematic review was performed following the PRISMA protocol to evaluate the efficacy and safety of biological therapies in AIH.The primary focus was on serological improvement and histological remission.The secondary focus was on assessing therapy safety and additional outcomes.A standardized search command was applied to MEDLINE,EMBASE,and Cochrane Library databases to identify relevant studies.Inclusion criteria encompassed adult AIH patients treated with biologics.Data were analyzed based on demographics,prior treatments,and therapy-related outcomes.A narrative synthesis was employed to address biases and provide a comprehensive overview of the evidence.RESULTS A total of 352 studies were reviewed,with 30 selected for detailed analysis.Key findings revealed that Belimumab led to a favourable response in five out of eight AIH patients across two studies.Rituximab demonstrated high efficacy,with 41 out of 45 patients showing significant improvement across six studies.Basiliximab was assessed in a single study,where the sole patient treated experienced a beneficial outcome.Additionally,a notable number of AIH cases were induced by anti-tumor necrosis factor(TNF)medications,including 16 cases associated with infliximab and four cases with adalimumab.All these cases showed improvement upon withdrawal of the biologic agent.CONCLUSION Belimumab and Rituximab show promise as effective alternatives for managing refractory AIH,demonstrating significant improvements in clinical outcomes and liver function.However,the variability in patient responses to different therapies highlights the need for personalized treatment strategies.The risk of AIH induced by anti-TNF therapies underscores the need for vigilant monitoring and prompt symptom recognition.These findings support the incorporation of biologic agents into AIH treatment protocols,particularly for patients who do not respond to conventional therapies.展开更多
Objective:To explore the application effect of bundle management in the safe nursing of patients with autoimmune encephalitis.Methods:Seventy-five patients with autoimmune encephalitis who met the inclusion criteria i...Objective:To explore the application effect of bundle management in the safe nursing of patients with autoimmune encephalitis.Methods:Seventy-five patients with autoimmune encephalitis who met the inclusion criteria in our hospital from January 2024 to June 2024 were randomly divided into two groups:an observation group of 39 patients and a control group of 36 patients.The control group received routine nursing care,while the observation group implemented a bundle management strategy based on routine nursing care.Safety nursing outcomes,clinical symptom improvement time,hospital stay,and neurologic function recovery were observed in both groups.Results:The incidence of adverse events in the observation group was 12.82%,significantly lower than the 33.33%in the control group,with a statistically significant difference(P<0.05).There was no statistically significant difference in restraint usage and ICU transfer rates between the two groups(P>0.05).The clinical symptom improvement time,hospital stay,and neurologic function recovery in the observation group were significantly better than those in the control group,with a statistically significant difference(P<0.05).Conclusion:Through the bundle management model,effective connections can be ensured in various aspects of treatment and rehabilitation for patients with autoimmune encephalitis,providing patients with comprehensive and multi-level nursing services and improving their overall satisfaction and treatment effectiveness.展开更多
Addressing the challenges of difficult early diagnosis and the incomplete prognosis evaluation system for Autoimmune Encephalitis(AE),this study comprehensively reviews the relevant indicators for early diagnosis and ...Addressing the challenges of difficult early diagnosis and the incomplete prognosis evaluation system for Autoimmune Encephalitis(AE),this study comprehensively reviews the relevant indicators for early diagnosis and prognosis evaluation of AE.The analysis reveals that multiple indicators currently exhibit unique value in the diagnosis and treatment of AE,but each has its limitations.This article aims to systematically review these indicators and clarify their current application in clinical practice,to help improve the accuracy of early diagnosis and prognosis evaluation of AE,and provide a theoretical basis for clinicians to develop more effective treatment strategies.展开更多
The autoimmune response directed against pancreatic β cells is the most essential pathogenic process in type 1 diabetes(T1D)in humans.Spontaneous animal models of T1D greatly contribute to our understanding of the di...The autoimmune response directed against pancreatic β cells is the most essential pathogenic process in type 1 diabetes(T1D)in humans.Spontaneous animal models of T1D greatly contribute to our understanding of the disease pathogenesis and therapeutic options.Amongst many disease models,a significant proportion of T1D research is performed on multiple low dose streptozotocin induced diabetes in experimental animals,in parallel.Here,we discuss advantages of this model for contemporary T1D research.Additionally,challenges and perspectives for further improvement of the model are presented.展开更多
Current diagnosis of autoimmune pancreatitis(AIP)is challenging and often requires combining multiple dimensions.There is a need to explore new methods for diagnosing AIP.The development of artificial intelligence(AI)...Current diagnosis of autoimmune pancreatitis(AIP)is challenging and often requires combining multiple dimensions.There is a need to explore new methods for diagnosing AIP.The development of artificial intelligence(AI)is evident,and it is believed to have potential in the clinical diagnosis of AIP.This article aims to list the current diagnostic difficulties of AIP,describe existing AI applications,and suggest directions for future AI usages in AIP diagnosis.展开更多
BACKGROUND Autoimmune gastritis(AIG)is frequently associated with one or more comorbid conditions,among which type I gastric neuroendocrine tumors(gNETs)warrant significant clinical concern.However,risk factors for th...BACKGROUND Autoimmune gastritis(AIG)is frequently associated with one or more comorbid conditions,among which type I gastric neuroendocrine tumors(gNETs)warrant significant clinical concern.However,risk factors for the development of gNETs in AIG populations remain poorly defined.AIM To characterize the clinical and endoscopic profiles of AIG and identify potential risk factors for gNETs development.METHODS In this single-center cross-sectional study carried out at a tertiary hospital,303 patients with AIG over an 8-year period were retrospectively categorized into gNETs(n=116)and non-gNETs(n=187)groups.Endoscopic and clinical pa-rameters were analyzed.Endoscopic features were systematically reevaluated according to the 2023 Japanese diagnostic criteria for AIG.Feature selection was performed using the Boruta algorithm,and the model discriminative ability was evaluated via receiver operating characteristic curve analysis.RESULTS Among the 303 patients with AIG,116 had gNETs and 187 did not.Compared with the non-gNETs group,patients in the gNETs group were younger(54.3 years vs 60.6 years,P<0.001),had higher rate of vitamin B12 deficiency(77.2%vs 55.8%,P<0.001),lower pepsinogen I(4.3 ng/mL vs 7.4 ng/mL,P<0.001)and pepsinogen I/II ratios(0.7 vs.1.1,P<0.001),and lower prior Helicobacter pylori infection rate(3.4%vs 21.4%,P<0.001).Endoscopically,the gNETs group showed a lower incidence of oxyntic mucosal remnants,hyperplastic polyps,and patchy antral redness.The predictive model incorporating age,prior Helicobacter pylori infection,vitamin B12 level,gastric hy-perplastic polyps,and patchy antral redness showed an area under the curve of 0.830.CONCLUSION Patients with AIG or gNETs exhibit specific clinical and endoscopic features.The predictive model demonstrated favorable discriminative ability and may facilitate risk stratification of gNETs in patients with AIG.展开更多
BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performanc...BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performance of three fibrosis noninvasive tests[FibroTest,vibration-controlled transient elastography(VCTE),and the fibrosis-4 index(FIB-4)and two activity biomarkers(alanine aminotransferase(ALT)and ActiTest].METHODS This study enrolled 103 patients for whom liver biopsy,hepatic elastography results,and laboratory markers were available.Diagnostic performance was assessed with receiver operating characteristic(ROC)curves,the Obuchowski measure(OM),and the Bayesian latent class model.RESULTS FibroTest and VCTE outperformed FIB-4 in cases of significant fibrosis(≥F2),with areas under the ROC curve of 0.83[95%confidence interval(CI):0.73-0.90],0.86(95%CI:0.77-0.92),and 0.71(95%CI:0.60-0.80),respectively.The mean(standard error)OM values were 0.92(0.01),0.93(0.01),and 0.88(0.02)for FibroTest,VCTE,and FIB-4,respectively;FibroTest and VCTE performed comparably,and both were superior to FIB-4(P=0.03 and P=0.005).The areas under the ROC curve values for activity biomarkers were 0.86(95%CI:0.76-0.92)for ActiTest and 0.84(95%CI:0.73-0.90)for ALT(P=0.06).The OM values for ActiTest and ALT were 0.92(0.02)and 0.90(0.02),respectively(P=0.005).CONCLUSION FibroTest and VCTE outperformed FIB-4 according to the OM.FibroTest-ActiTest facilitated the evaluation of both fibrosis and activity.展开更多
Although Helicobacter pylori(H.pylori)is implicated in the development of most cases of gastric cancer with autoimmune gastritis,cases of gastric cancer have been reported in patients testing negative for H.pylori.Her...Although Helicobacter pylori(H.pylori)is implicated in the development of most cases of gastric cancer with autoimmune gastritis,cases of gastric cancer have been reported in patients testing negative for H.pylori.Here,we aimed to outline the current research status of the factors involved in the development of gastric cancer in H.pylori-negative autoimmune gastritis.Predictive pathological con-ditions for the development of gastric cancer in H.pylori-negative autoimmune gastritis are postulated to be:(1)Severe atrophy;(2)Hypergastrinemia;(3)Bile reflux;and(4)Low acidity,which are directly related to the pathophysiology of autoimmune gastritis,as well as smoking and family history,which are not re-lated to autoimmune gastritis.In autoimmune gastritis,where there is a possi-bility of spontaneous disappearance of H.pylori in advanced atrophy,it is diffi-cult to assess H.pylori.Since H.pylori infection begins in the antrum and subse-quently progresses to the proximal stomach,it is interpreted as H.pylori-negative autoimmune gastritis if histologically consistent with autoimmune gastritis in the body with spared antrum,and negative for other H.pylori tests.However,it is essential to examine whether the currently prevailing histological interpretation used to evaluate H.pylori infection status is appropriate.展开更多
In this article,we comment on the article by Peta et al.This study evaluates the diagnostic performance of FibroTest-Actitest,transient elastography,and the fibrosis-4 index against a histological reference.Using the ...In this article,we comment on the article by Peta et al.This study evaluates the diagnostic performance of FibroTest-Actitest,transient elastography,and the fibrosis-4 index against a histological reference.Using the Obuchowski measure,the authors demonstrate that FibroTest and vibration-controlled transient elastography outperform the fibrosis-4 index in detecting fibrosis.Additionally,Actitest offers superior estimation of inflammatory activity compared to conventional biomarkers.Assessing liver fibrosis is crucial for managing autoimmune hepatitis(AIH),yet reliance on invasive liver biopsy remains higher than in other liver diseases.This is partly due to more complex diagnostic criteria for AIH,the lack of standardized scoring for non-invasive testing,and the presence of inflammation,which can lead to falsely elevated results with non-invasive tests.A Bayesian latent class model further supports the reliability of these non-invasive tests,highlighting their potential to complement biopsy,particularly for longterm disease monitoring.These findings underscore the importance of noninvasive diagnostics in optimizing AIH management.展开更多
BACKGROUND Autoimmune liver disease(AILD)recurrence is common after liver transplantation(LT).While several risk factors for recurrence have been identified,their combined predictive value has yet to be thoroughly inv...BACKGROUND Autoimmune liver disease(AILD)recurrence is common after liver transplantation(LT).While several risk factors for recurrence have been identified,their combined predictive value has yet to be thoroughly investigated.AIM To evaluate the combined predictive value of clinical and laboratory risk factors for AILD recurrence after LT.METHODS This retrospective cohort study included 79 patients with AILD who underwent LT at a single liver transplant center.We compared clinical and laboratory variables between patients with and without recurrent disease and assessed the predictive performance of these factors using four logistic regression models and their corresponding area underthe receiver operating characteristic curve (AUC).RESULTSRecurrent AILD occurred in 26.58% of patients (95%CI: 17-38), the median time to recurrence was 28 months(interquartile range: 16-38). Patients with recurrent AILD had significantly higher pre-transplant Child-Pugh scores[11.61 ± 1.16 vs 10.58 ± 1.96 points;odds ratio (OR) = 1.43, 95%CI: 1.03-2.00;P = 0.032] and model for end-stage liverdisease score (MELD) (22.76 ± 5.47 vs 18.81 ± 7.24 points;OR = 1.08, 95%CI: 1.01-1.16;P = 0.032), compared to thosewithout recurrence. Additionally, baseline alanine aminotransferase (ALT) > 2 times the upper limit of normal(ULN) was significantly associated with recurrence (31% vs 57.1%;OR = 2.96, 95%CI: 1.06-8.28;P = 0.038). Ourmodels, incorporating several risk variables, demonstrated moderate predictive ability for AILD recurrence. TheAUCs were as follows: (1) Model 1 (AUC = 0.75, 95%CI: 0.58-0.87);(2) Model 2 (AUC = 0.74, 95%CI: 0.59-0.90);(3)Model 3 (AUC = 0.72, 95%CI: 0.58-0.88);and (4) Model 4 (AUC = 0.63, 95%CI: 0.40-0.76), with no statisticallysignificant difference between the models (P = 0.488).CONCLUSIONHigher pre-transplant Child-Pugh and MELD scores, as well as ALT > 2 ULN, were associated with an increasedrisk of AILD recurrence.展开更多
BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with a...BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with autoimmune hepatitis(AIH)has not been clarified.This study reveals for the first time that HDV may induce AIH through abnormalities in immunoregulation in two specific cases.This is the first report of HDV-HBV co-infected patients who did not receive interferon therapy and achieved serological conversion and histological remission by combining antiviral(entecavir)with immunosuppression(prednisone+azathioprine)therapy,providing new evidence of the mechanism of this complex disease.CASE SUMMARY A 40-year-old female developed malaise and jaundice with an alanine aminotransferase/aspartate aminotransferase>20 upper limit of normal(ULN),total bilirubin:97.20μmol/L,immunoglobulin G(IgG)47.1 g/L(>3×ULN),HDV RNA 1.6×10^(7)copies/mL and liver biopsy showed G3S4.Tenofovir alafenamide combined with prednisone and azathioprine was administered,and three months later the Child-Turcotte-Pugh class C was reduced to class B and IgG decreased to 13.62 g/L.Another 58-year-old male complained of pain in the liver area,antinuclear antibody was 1:320,IgG 22.6 g/L(>1.3×ULN),and liver biopsy showed G2S3.Entecavir was administered in combination with prednisone and azathioprine,and after 3 months,liver function returned to normal,and IgG reduced to 14.22 g/L.CONCLUSION Patients with HDV-HBV co-infection combined with AIH can achieve clinical remission following combination therapy,and the study of immunomodulatory mechanisms should be emphasized.展开更多
To the Editor:Autoimmune hepatitis(AIH)is an immune-mediated chronic liver disease that can progress to cirrhosis and even liver failure.The standard treatment approach for AIH involves the adminis-tration of immunosu...To the Editor:Autoimmune hepatitis(AIH)is an immune-mediated chronic liver disease that can progress to cirrhosis and even liver failure.The standard treatment approach for AIH involves the adminis-tration of immunosuppressive therapy,utilizing corticosteroids and azathioprine(Imuran),which result in clinical and histological im-provement among 60%AIH patients[1,2].The diagnosis of AIH requires a combination of clinical,bio-chemical,and histological findings.The first diagnostic system was established in 1993[3],revised in 1999[4],and then a simplified criterion was proposed[5].Liver histology plays an important role in the scoring systems of AIH diagnosis and is essential to make an accurate diagnosis.Due to the lack of obvious symptoms in the early stage,about 30%patients have already progressed to cirrho-sis by the time of diagnosis[6].展开更多
文摘Autoimmune enteropathy(AIE)is a rare immune mediated disorder primarily affecting children,characterized by chronic diarrhea,malabsorption,vomiting,weight loss and villous atrophy.It has also been observed in adults presenting diagnostic and treatment challenges due to its overlap with other gastrointestinal disorders such as celiac disease.Initial diagnostic criteria for AIE include small bowel villous atrophy,lack of response to dietary restrictions,presence of anti-enterocyte antibodies,and predisposition to autoimmunity without severe immu-nodeficiency.Refined criteria emphasize characteristic histological findings and exclusion of other causes of villous atrophy.AIE is associated with various autoimmune disorders and can present with overlapping features with Celiac disease,including villous atrophy but without significant intraepithelial lympho-cytosis.Treatment primarily involves immunosuppression using corticosteroids,calcineurin inhibitors,and anti-tumor necrosis factor therapy,alongside nutri-tional support.Despite the challenges,understanding AIE’s diverse manifest-ations and improving diagnostic criteria are essential for effective management and improved patient outcome.Further research is needed to elucidate the pathogenesis,disease progression and long-term outcomes of AIE.
基金Supported by the Oman Ministry of Higher Education,Research,and Innovation,No.BFP/RGP/HSS/24/015.
文摘Chloroquine(CQ)and hydroxychloroquine(HCQ),originally developed as anti-malarial drugs,have found a new purpose in treating various autoimmune dis-eases due to their immunomodulatory properties.These drugs work through mu-ltiple mechanisms,including inhibiting Toll-like receptor signaling,suppressing antigen presentation,and modulating autophagy.This review article provides a comprehensive analysis of the immunomodulatory effects of CQ and HCQ in several autoimmune diseases such as systemic lupus erythematosus,rheumatoid arthritis,systemic sclerosis,and others.We delve into the intricate mechanisms of action,highlighting the key immune cells involved and discussing the clinical implications of these drugs in managing autoimmune conditions.Our review covers the latest research and clinical trials,offering a comprehensive under-standing of the therapeutic potential of CQ and HCQ in autoimmune diseases.We also discuss the challenges and controversies surrounding the use of these drugs,such as their long-term side effects and the need for personalized treatment approaches.By synthesizing current knowledge and identifying areas for future research,this review aims to provide a valuable resource for healthcare profes-sionals and researchers involved in the management of autoimmune diseases.
基金supported in part by the Japan Pancreas Soci-ety and the MHLW Research Program on Rare and Intractable Dis-eases(Grant Number 23FC1015,Principal investigator:Mitsuhiro Kawano).
文摘Background:Previous studies have highlighted the frequent occurrence of sarcopenia in patients with pancreatic diseases,including chronic pancreatitis.We aimed to clarify the prevalence of skeletal muscle(SM)loss and sarcopenia,and their associations with clinical characteristics,bone mineral density,and pancreatic imaging findings in patients with autoimmune pancreatitis(AIP).Methods:This study included 114 patients with AIP treated at Tohoku University Hospital.The SM index was assessed using a bioelectrical impedance analysis device,grip strength was measured using a hand dynamometer,and bone mineral density was evaluated using dual-energy X-ray absorptiometry.Univari-ate and multivariate logistic regression analyses were used to analyze factors associated with SM loss and sarcopenia.Results:Among 114 patients,57(50.0%)had SM loss,31(27.2%)had reduced grip strength,and 27(23.7%)had both.Patients with SM loss were older and had a lower body mass index,weaker grip strength,higher Controlling Nutritional Status scores,and lower serum lipase and albumin levels compared to those without SM loss.Computed tomography scans revealed a higher prevalence of pancreatic parenchy-mal atrophy in patients with SM loss.Similar differences were observed between patients with sarcopenia and those without.Osteopathy was observed in 35.6%of patients with SM loss and 38.1%of those with sarcopenia,whereas only 4.1%of patients without SM loss had osteopathy.Low BMI(<21.0 kg/m^(2))was also found to be an independent risk factor for SM loss in multivariate analysis.Age>72 years,low BMI(<20.0 kg/m^(2)),and low serum lipase levels(<13 U/L)were independent risk factors for sarcopenia in multivariate analysis.Conclusions:SM loss and sarcopenia are prevalent in patients with AIP and are associated with aging,poor nutritional status,low serum lipase levels,and pancreatic parenchymal atrophy.In addition to the high risk of osteopathy,careful attention should be paid to maintain muscle health in AIP patients.
文摘Foot reflexology(FR)is a Chinese-originated and non-invasive complementary therapy increasingly used by functional,alternative and para-medical professionals.Enhance attempts are made to study FR in non-functional organic conditions.The present invited Editorial discusses the application of FR in autoimmune diseases(AD),highlighting a few successful studies demonstrating symptomatic relief and objective improvements.Despite promising results,the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases,including AD,is highly recommended.
基金Supported by the Health Technology Project of Pudong New District Health Commission,No.PW2020D-12.
文摘BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.
文摘BACKGROUND Autoimmune autonomic ganglionopathy(AAG),formerly known as acute pandysautonomia,is a rare,acquired,antibody-mediated,potentially curable autonomic disorder that presents with diffuse autonomic failure.High levels of anti-ganglionic nicotinic acetylcholine receptor(gAChR)serum antibodies are detected in approximately 50%of AAG cases,confirming the diagnosis.CASE SUMMARY We present the case of a 68-year-old man who developed autonomic failure gradually over a 2-year period.Recently,the patient was unable to stand upright for more than a few seconds before fainting.Additionally,he presented with decreased sweating,dry mouth,urinary retention,early satiety,weight loss,bloating,constipation,and erectile dysfunction.Neurological examination revealed dilated pupils that were unresponsive to light.Deep tendon reflexes were absent or diminished.Serologic evaluation revealed the presence of gAChR autoantibodies.An orthostatic hypotension test yielded a positive result.The patient did not respond to symptomatic therapy,including midodrine,fludrocortisone and atomoxetine.Second-line therapy with immunoadsorption produced a noticeable clinical improvement;however,orthostatic hypotension persisted.Sequential rituximab infusion therapy successfully led to a significant improvement in symptoms.CONCLUSION Our case report supports the benefit of combined immunomodulatory therapy for refractory AAG cases that are unresponsive to single-agent treatment.
基金Supported by The Key Research and Development Project of the Science and Technology Department of Sichuan Province,China,No.2023YFS0280The High-Level Research Initiation Fund of The First Affiliated Hospital of Chengdu Medical College,China,No.CYFY-GQ43.
文摘Recently,Jayabalan et al published an important study.The authors defined the liver outcome score as a novel biomarker for predicting liver-related mortality in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome.After thoroughly reviewing their work,we offer insights that primarily relate to their study design to enhance the medical community’s understanding of this complex disease.
文摘This letter addresses the study by Jayabalan et al,which underscores the liver outcome score(LOS)and hemoglobin(Hb)as key prognostic markers for patients with autoimmune liver disease overlap syndromes(AILDOS),with particular relevance to the autoimmune hepatitis-primary biliary cholangitis(AIH-PBC)subgroup.The findings indicate that an LOS threshold of 6 achieves high sensitivity and specificity in predicting liver-related mortality among AIH-PBC patients.Moreover,low Hb levels emerge as a significant mortality predictor across all AILDOS cases.These results contribute valuable perspectives on risk stratification in AILDOS,highlighting the promise of non-invasive prognostic tools.Future studies with larger cohorts are needed to substantiate LOS and Hb as robust markers for clinical application.
文摘BACKGROUND Autoimmune hepatitis(AIH)is typically treated with immunomodulators and steroids.However,some patients are refractory to these treatments,necessitating alternative approaches.Biological therapies have recently been explored for these difficult cases.AIM To assess the efficacy and safety of biologics in AIH,focusing on patients unresponsive to standard treatments and evaluating outcomes such as serological markers and histological remission.METHODS A case-based systematic review was performed following the PRISMA protocol to evaluate the efficacy and safety of biological therapies in AIH.The primary focus was on serological improvement and histological remission.The secondary focus was on assessing therapy safety and additional outcomes.A standardized search command was applied to MEDLINE,EMBASE,and Cochrane Library databases to identify relevant studies.Inclusion criteria encompassed adult AIH patients treated with biologics.Data were analyzed based on demographics,prior treatments,and therapy-related outcomes.A narrative synthesis was employed to address biases and provide a comprehensive overview of the evidence.RESULTS A total of 352 studies were reviewed,with 30 selected for detailed analysis.Key findings revealed that Belimumab led to a favourable response in five out of eight AIH patients across two studies.Rituximab demonstrated high efficacy,with 41 out of 45 patients showing significant improvement across six studies.Basiliximab was assessed in a single study,where the sole patient treated experienced a beneficial outcome.Additionally,a notable number of AIH cases were induced by anti-tumor necrosis factor(TNF)medications,including 16 cases associated with infliximab and four cases with adalimumab.All these cases showed improvement upon withdrawal of the biologic agent.CONCLUSION Belimumab and Rituximab show promise as effective alternatives for managing refractory AIH,demonstrating significant improvements in clinical outcomes and liver function.However,the variability in patient responses to different therapies highlights the need for personalized treatment strategies.The risk of AIH induced by anti-TNF therapies underscores the need for vigilant monitoring and prompt symptom recognition.These findings support the incorporation of biologic agents into AIH treatment protocols,particularly for patients who do not respond to conventional therapies.
文摘Objective:To explore the application effect of bundle management in the safe nursing of patients with autoimmune encephalitis.Methods:Seventy-five patients with autoimmune encephalitis who met the inclusion criteria in our hospital from January 2024 to June 2024 were randomly divided into two groups:an observation group of 39 patients and a control group of 36 patients.The control group received routine nursing care,while the observation group implemented a bundle management strategy based on routine nursing care.Safety nursing outcomes,clinical symptom improvement time,hospital stay,and neurologic function recovery were observed in both groups.Results:The incidence of adverse events in the observation group was 12.82%,significantly lower than the 33.33%in the control group,with a statistically significant difference(P<0.05).There was no statistically significant difference in restraint usage and ICU transfer rates between the two groups(P>0.05).The clinical symptom improvement time,hospital stay,and neurologic function recovery in the observation group were significantly better than those in the control group,with a statistically significant difference(P<0.05).Conclusion:Through the bundle management model,effective connections can be ensured in various aspects of treatment and rehabilitation for patients with autoimmune encephalitis,providing patients with comprehensive and multi-level nursing services and improving their overall satisfaction and treatment effectiveness.
文摘Addressing the challenges of difficult early diagnosis and the incomplete prognosis evaluation system for Autoimmune Encephalitis(AE),this study comprehensively reviews the relevant indicators for early diagnosis and prognosis evaluation of AE.The analysis reveals that multiple indicators currently exhibit unique value in the diagnosis and treatment of AE,but each has its limitations.This article aims to systematically review these indicators and clarify their current application in clinical practice,to help improve the accuracy of early diagnosis and prognosis evaluation of AE,and provide a theoretical basis for clinicians to develop more effective treatment strategies.
基金Ministry of Science,Technological Development,and Innovation,Republic of Serbia,Grant/Award Number:451-03-66/2024-03/200007。
文摘The autoimmune response directed against pancreatic β cells is the most essential pathogenic process in type 1 diabetes(T1D)in humans.Spontaneous animal models of T1D greatly contribute to our understanding of the disease pathogenesis and therapeutic options.Amongst many disease models,a significant proportion of T1D research is performed on multiple low dose streptozotocin induced diabetes in experimental animals,in parallel.Here,we discuss advantages of this model for contemporary T1D research.Additionally,challenges and perspectives for further improvement of the model are presented.
基金Supported by Youth Start-up Fund of the Naval Medical University,No.2023QN052Basic Medical Research Project of the First Affiliated Hospital of Naval Medical University,No.2023QD16+2 种基金Simulated RCT Research Project of Shanghai Hospital Deveopment Center,No.SHDC2024CRI048Changhai Hospital Changfeng Talent PlanShanghai Public Health Key Discipline Project,No.GWVI-11.1-21.
文摘Current diagnosis of autoimmune pancreatitis(AIP)is challenging and often requires combining multiple dimensions.There is a need to explore new methods for diagnosing AIP.The development of artificial intelligence(AI)is evident,and it is believed to have potential in the clinical diagnosis of AIP.This article aims to list the current diagnostic difficulties of AIP,describe existing AI applications,and suggest directions for future AI usages in AIP diagnosis.
文摘BACKGROUND Autoimmune gastritis(AIG)is frequently associated with one or more comorbid conditions,among which type I gastric neuroendocrine tumors(gNETs)warrant significant clinical concern.However,risk factors for the development of gNETs in AIG populations remain poorly defined.AIM To characterize the clinical and endoscopic profiles of AIG and identify potential risk factors for gNETs development.METHODS In this single-center cross-sectional study carried out at a tertiary hospital,303 patients with AIG over an 8-year period were retrospectively categorized into gNETs(n=116)and non-gNETs(n=187)groups.Endoscopic and clinical pa-rameters were analyzed.Endoscopic features were systematically reevaluated according to the 2023 Japanese diagnostic criteria for AIG.Feature selection was performed using the Boruta algorithm,and the model discriminative ability was evaluated via receiver operating characteristic curve analysis.RESULTS Among the 303 patients with AIG,116 had gNETs and 187 did not.Compared with the non-gNETs group,patients in the gNETs group were younger(54.3 years vs 60.6 years,P<0.001),had higher rate of vitamin B12 deficiency(77.2%vs 55.8%,P<0.001),lower pepsinogen I(4.3 ng/mL vs 7.4 ng/mL,P<0.001)and pepsinogen I/II ratios(0.7 vs.1.1,P<0.001),and lower prior Helicobacter pylori infection rate(3.4%vs 21.4%,P<0.001).Endoscopically,the gNETs group showed a lower incidence of oxyntic mucosal remnants,hyperplastic polyps,and patchy antral redness.The predictive model incorporating age,prior Helicobacter pylori infection,vitamin B12 level,gastric hy-perplastic polyps,and patchy antral redness showed an area under the curve of 0.830.CONCLUSION Patients with AIG or gNETs exhibit specific clinical and endoscopic features.The predictive model demonstrated favorable discriminative ability and may facilitate risk stratification of gNETs in patients with AIG.
文摘BACKGROUND Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis,but their validation is limited because of insufficient data.AIM To investigate the diagnostic performance of three fibrosis noninvasive tests[FibroTest,vibration-controlled transient elastography(VCTE),and the fibrosis-4 index(FIB-4)and two activity biomarkers(alanine aminotransferase(ALT)and ActiTest].METHODS This study enrolled 103 patients for whom liver biopsy,hepatic elastography results,and laboratory markers were available.Diagnostic performance was assessed with receiver operating characteristic(ROC)curves,the Obuchowski measure(OM),and the Bayesian latent class model.RESULTS FibroTest and VCTE outperformed FIB-4 in cases of significant fibrosis(≥F2),with areas under the ROC curve of 0.83[95%confidence interval(CI):0.73-0.90],0.86(95%CI:0.77-0.92),and 0.71(95%CI:0.60-0.80),respectively.The mean(standard error)OM values were 0.92(0.01),0.93(0.01),and 0.88(0.02)for FibroTest,VCTE,and FIB-4,respectively;FibroTest and VCTE performed comparably,and both were superior to FIB-4(P=0.03 and P=0.005).The areas under the ROC curve values for activity biomarkers were 0.86(95%CI:0.76-0.92)for ActiTest and 0.84(95%CI:0.73-0.90)for ALT(P=0.06).The OM values for ActiTest and ALT were 0.92(0.02)and 0.90(0.02),respectively(P=0.005).CONCLUSION FibroTest and VCTE outperformed FIB-4 according to the OM.FibroTest-ActiTest facilitated the evaluation of both fibrosis and activity.
文摘Although Helicobacter pylori(H.pylori)is implicated in the development of most cases of gastric cancer with autoimmune gastritis,cases of gastric cancer have been reported in patients testing negative for H.pylori.Here,we aimed to outline the current research status of the factors involved in the development of gastric cancer in H.pylori-negative autoimmune gastritis.Predictive pathological con-ditions for the development of gastric cancer in H.pylori-negative autoimmune gastritis are postulated to be:(1)Severe atrophy;(2)Hypergastrinemia;(3)Bile reflux;and(4)Low acidity,which are directly related to the pathophysiology of autoimmune gastritis,as well as smoking and family history,which are not re-lated to autoimmune gastritis.In autoimmune gastritis,where there is a possi-bility of spontaneous disappearance of H.pylori in advanced atrophy,it is diffi-cult to assess H.pylori.Since H.pylori infection begins in the antrum and subse-quently progresses to the proximal stomach,it is interpreted as H.pylori-negative autoimmune gastritis if histologically consistent with autoimmune gastritis in the body with spared antrum,and negative for other H.pylori tests.However,it is essential to examine whether the currently prevailing histological interpretation used to evaluate H.pylori infection status is appropriate.
文摘In this article,we comment on the article by Peta et al.This study evaluates the diagnostic performance of FibroTest-Actitest,transient elastography,and the fibrosis-4 index against a histological reference.Using the Obuchowski measure,the authors demonstrate that FibroTest and vibration-controlled transient elastography outperform the fibrosis-4 index in detecting fibrosis.Additionally,Actitest offers superior estimation of inflammatory activity compared to conventional biomarkers.Assessing liver fibrosis is crucial for managing autoimmune hepatitis(AIH),yet reliance on invasive liver biopsy remains higher than in other liver diseases.This is partly due to more complex diagnostic criteria for AIH,the lack of standardized scoring for non-invasive testing,and the presence of inflammation,which can lead to falsely elevated results with non-invasive tests.A Bayesian latent class model further supports the reliability of these non-invasive tests,highlighting their potential to complement biopsy,particularly for longterm disease monitoring.These findings underscore the importance of noninvasive diagnostics in optimizing AIH management.
文摘BACKGROUND Autoimmune liver disease(AILD)recurrence is common after liver transplantation(LT).While several risk factors for recurrence have been identified,their combined predictive value has yet to be thoroughly investigated.AIM To evaluate the combined predictive value of clinical and laboratory risk factors for AILD recurrence after LT.METHODS This retrospective cohort study included 79 patients with AILD who underwent LT at a single liver transplant center.We compared clinical and laboratory variables between patients with and without recurrent disease and assessed the predictive performance of these factors using four logistic regression models and their corresponding area underthe receiver operating characteristic curve (AUC).RESULTSRecurrent AILD occurred in 26.58% of patients (95%CI: 17-38), the median time to recurrence was 28 months(interquartile range: 16-38). Patients with recurrent AILD had significantly higher pre-transplant Child-Pugh scores[11.61 ± 1.16 vs 10.58 ± 1.96 points;odds ratio (OR) = 1.43, 95%CI: 1.03-2.00;P = 0.032] and model for end-stage liverdisease score (MELD) (22.76 ± 5.47 vs 18.81 ± 7.24 points;OR = 1.08, 95%CI: 1.01-1.16;P = 0.032), compared to thosewithout recurrence. Additionally, baseline alanine aminotransferase (ALT) > 2 times the upper limit of normal(ULN) was significantly associated with recurrence (31% vs 57.1%;OR = 2.96, 95%CI: 1.06-8.28;P = 0.038). Ourmodels, incorporating several risk variables, demonstrated moderate predictive ability for AILD recurrence. TheAUCs were as follows: (1) Model 1 (AUC = 0.75, 95%CI: 0.58-0.87);(2) Model 2 (AUC = 0.74, 95%CI: 0.59-0.90);(3)Model 3 (AUC = 0.72, 95%CI: 0.58-0.88);and (4) Model 4 (AUC = 0.63, 95%CI: 0.40-0.76), with no statisticallysignificant difference between the models (P = 0.488).CONCLUSIONHigher pre-transplant Child-Pugh and MELD scores, as well as ALT > 2 ULN, were associated with an increasedrisk of AILD recurrence.
基金Supported by Xinjiang“Tianshan Talents”Medical and Health High-Level Talent Training Program-Young and Middle-Aged Backbone Medical Talents.
文摘BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with autoimmune hepatitis(AIH)has not been clarified.This study reveals for the first time that HDV may induce AIH through abnormalities in immunoregulation in two specific cases.This is the first report of HDV-HBV co-infected patients who did not receive interferon therapy and achieved serological conversion and histological remission by combining antiviral(entecavir)with immunosuppression(prednisone+azathioprine)therapy,providing new evidence of the mechanism of this complex disease.CASE SUMMARY A 40-year-old female developed malaise and jaundice with an alanine aminotransferase/aspartate aminotransferase>20 upper limit of normal(ULN),total bilirubin:97.20μmol/L,immunoglobulin G(IgG)47.1 g/L(>3×ULN),HDV RNA 1.6×10^(7)copies/mL and liver biopsy showed G3S4.Tenofovir alafenamide combined with prednisone and azathioprine was administered,and three months later the Child-Turcotte-Pugh class C was reduced to class B and IgG decreased to 13.62 g/L.Another 58-year-old male complained of pain in the liver area,antinuclear antibody was 1:320,IgG 22.6 g/L(>1.3×ULN),and liver biopsy showed G2S3.Entecavir was administered in combination with prednisone and azathioprine,and after 3 months,liver function returned to normal,and IgG reduced to 14.22 g/L.CONCLUSION Patients with HDV-HBV co-infection combined with AIH can achieve clinical remission following combination therapy,and the study of immunomodulatory mechanisms should be emphasized.
基金supported by a grant from the Key Project from Beijing Municipal Science and Technology Commission(D121100003912003).
文摘To the Editor:Autoimmune hepatitis(AIH)is an immune-mediated chronic liver disease that can progress to cirrhosis and even liver failure.The standard treatment approach for AIH involves the adminis-tration of immunosuppressive therapy,utilizing corticosteroids and azathioprine(Imuran),which result in clinical and histological im-provement among 60%AIH patients[1,2].The diagnosis of AIH requires a combination of clinical,bio-chemical,and histological findings.The first diagnostic system was established in 1993[3],revised in 1999[4],and then a simplified criterion was proposed[5].Liver histology plays an important role in the scoring systems of AIH diagnosis and is essential to make an accurate diagnosis.Due to the lack of obvious symptoms in the early stage,about 30%patients have already progressed to cirrho-sis by the time of diagnosis[6].
