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自身免疫性肝炎在孕前-妊娠-产后期的管理

李春燕 徐文娇 邵利梅 汤善宏

引用本文:
Citation:

自身免疫性肝炎在孕前-妊娠-产后期的管理

DOI: 10.3969/j.issn.1001-5256.2022.08.034
基金项目: 

四川省卫生健康委员会科研课题 (20PJ180)

利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:李春燕参与拟定写作思路,收集分析文献,论文撰写及修改;徐文娇、邵利梅参与指导撰写文章及文章修改;汤善宏负责拟定写作方向,指导撰写文章与最后定稿。
详细信息
    通信作者:

    汤善宏,15928956390@163.com

Management of autoimmune hepatitis during prepregnancey-pregnancy-postpartum

Research funding: 

Scientific Research Project of Health Commission of Sichuan Province (20PJ180)

More Information
  • 摘要: 自身免疫性肝炎是由自身免疫系统攻击肝细胞导致的慢性进行性肝脏炎症性疾病,以血清自身抗体阳性、高IgG和/或γ-球蛋白血症为特征。目前对自身免疫性肝炎患者妊娠的研究大多集中于分娩并发症,而对于孕前期、妊娠期、产后疾病的评估、治疗以及管理缺少系统的建议。虽然孕妇免疫会受到抑制,但如果在孕前1年疾病控制不佳或妊娠期自行停用药物会显著增加妊娠不良结局,故本文旨在叙述如何开展多学科协作及围绕妊娠期开展全周期的共同管理以提高母胎安全。

     

  • [1] LV T, LI M, ZENG N, et al. Systematic review and meta-analysis on the incidence and prevalence of autoimmune hepatitis in Asian, European, and American population[J]. J Gastroenterol Hepatol, 2019, 34(10): 1676-1684. DOI: 10.1111/jgh.14746.
    [2] MANNS MP, CZAJA AJ, GORHAM JD, et al. Diagnosis and management of autoimmune hepatitis[J]. Hepatology, 2010, 51(6): 2193-2213. DOI: 10.1002/hep.23584.
    [3] WANG CW, GRAB J, TANA MM, et al. Outcomes of pregnancy in autoimmune hepatitis: A population-based study[J]. Hepatology, 2022, 75(1): 5-12. DOI: 10.1002/hep.32132.
    [4] WESTBROOK RH, YEOMAN AD, KRIESE S, et al. Outcomes of pregnancy in women with autoimmune hepatitis[J]. J Autoimmun, 2012, 38(2-3): J239-J244. DOI: 10.1016/j.jaut.2011.12.002.
    [5] WANG QX, MA X. Current status and perspectives of autoimmune hepatitis[J]. J Clin Hepatol, 2020, 36(4): 721-723. DOI: 10.3969/j.i ssn.1001-5256.2020.04.001.

    王绮夏, 马雄. 自身免疫性肝炎的研究现状与展望[J]. 临床肝胆病杂志, 2020, 36(4): 721-723. DOI: 10.3969/j.issn.1001-5256.2020.04.001.
    [6] DONG WD, ZHANG HR, LI R, et al. Role of regulatory T/T helper 17 cells in the pathogenesis of autoimmune hepatitis and related therapeutic targets[J]. J Clin Hepatol, 2021, 37(10): 2456-2460. DOI: 10.3969/j.issn.1001-5256.2021.10.042.

    董雯迪, 张海蓉, 李瑞, 等. 调节性T淋巴细胞/辅助性T淋巴细胞17在自身免疫性肝炎发生发展中的作用机制及其相关治疗靶点[J]. 临床肝胆病杂志, 2021, 37(10): 2456-2460. DOI: 10.3969/j.issn.1001-5256.2021.10.042.
    [7] ZHANG H, LIU Y, BIAN Z, et al. The critical role of myeloid-derived suppressor cells and FXR activation in immune-mediated liver injury[J]. J Autoimmun, 2014, 53: 55-66. DOI: 10.1016/j.jaut.2014.02.010.
    [8] BOZWARD AG, WOOTTON GE, PODSTAWKA O, et al. Autoimmune hepatitis: Tolerogenic immunological state during pregnancy and immune escape in post-partum[J]. Front Immunol, 2020, 11: 591380. DOI: 10.3389/fimmu.2020.591380.
    [9] RAHIM MN, RAN S, SHAH S, et al. Safety and efficacy of budesonide during pregnancy in women with autoimmune hepatitis[J]. Hepatology, 2021, 73(6): 2601-2606. DOI: 10.1002/hep.31634.
    [10] AKBARI M, SHAH S, VELAYOS FS, et al. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease[J]. Inflamm Bowel Dis, 2013, 19(1): 15-22. DOI: 10.1002/ibd.22948.
    [11] MACK CL, ADAMS D, ASSIS DN, et al. 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[J]. Hepatology, 2020, 72(2): 671-722. DOI: 10.1002/hep.31065.
    [12] WANG G, TANAKA A, ZHAO H, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis[J]. Hepatol Int, 2021, 15(2): 223-257. DOI: 10.1007/s12072-021-10170-1.
    [13] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of autoimmune hepatitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796.

    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]. 临床肝胆病杂志, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796.
    [14] BIGGIOGGERO M, BORGHI MO, GEROSA M, et al. Immune function in children born to mothers with autoimmune diseases and exposed in utero to immunosuppressants[J]. Lupus, 2007, 16(8): 651-656. DOI: 10.1177/0961203307079569.
    [15] CLARIS O, PICAUD JC, BRAZIER JL, et al. Pharmacokinetics of cyclosporin A in 16 newborn infants of renal or cardiac transplant mothers[J]. Dev Pharmacol Ther, 1993, 20(3-4): 180-185. DOI: 10.1159/000457560.
    [16] FU JH. Analysis of the use of cyclosporin A to treat refractory immune recurrent spontaneous abortion[J]. Clin Exp Obstet Gynecol, 2015, 42(6): 739-742. https://pubmed.ncbi.nlm.nih.gov/26753475/
    [17] BITTENCOURT PL, FARIAS AQ, PORTA G, et al. Frequency of concurrent autoimmune disorders in patients with autoimmune hepatitis: effect of age, gender, and genetic background[J]. J Clin Gastroenterol, 2008, 42(3): 300-305. DOI: 10.1097/MCG.0b013e31802dbdfc.
    [18] DENG BR, GUO LP, ZHOU L, et al. Progress of pregnancy research in patients with autoimmune hepatitis[J]. Chin J Dig, 2017, 37(4): 285-286. DOI: 10.3760/cma.j.issn.0254-1432.2017.04.016.

    邓宝茹, 郭丽萍, 周璐, 等. 自身免疫性肝炎患者妊娠研究进展[J]. 中华消化杂志, 2017, 37(4): 285-286. DOI: 10.3760/cma.j.issn.0254-1432.2017.04.016.
    [19] LEE NM, BRADY CW. Liver disease in pregnancy[J]. World J Gastroenterol, 2009, 15(8): 897-906. DOI: 10.3748/wjg.15.897.
    [20] MIYAURA H, IWATA M. Direct and indirect inhibition of Th1 development by progesterone and glucocorticoids[J]. J Immunol, 2002, 168(3): 1087-1094. DOI: 10.4049/jimmunol.168.3.1087.
    [21] MAO G, WANG J, KANG Y, et al. Progesterone increases systemic and local uterine proportions of CD4+CD25+ Treg cells during midterm pregnancy in mice[J]. Endocrinology, 2010, 151(11): 5477-5488. DOI: 10.1210/en.2010-0426.
    [22] BUCHEL E, van STEENBERGEN W, NEVENS F, et al. Improvement of autoimmune hepatitis during pregnancy followed by flare-up after delivery[J]. Am J Gastroenterol, 2002, 97(12): 3160-3165. DOI: 10.1111/j.1572-0241.2002.07124.x.
    [23] PETERS MG. Management of autoimmune hepatitis in pregnant women[J]. Gastroenterol Hepatol (N Y), 2017, 13(8): 504-506. https://pubmed.ncbi.nlm.nih.gov/28867984/
    [24] OLSEN K, HODSON J, RONCA V, et al. Type 2 autoimmune hepatitis and nonadherence to medication correlate with premature birth and risk of postpartum flare[J]. Hepatol Commun, 2021, 5(7): 1252-1264. DOI: 10.1002/hep4.1714.
    [25] MANNS MP, LOHSE AW, VERGANI D. Autoimmune hepatitis— Update 2015[J]. J Hepatol, 2015, 62(1 Suppl): S100-S111. DOI: 10.1016/j.jhep.2015.03.005.
    [26] BRAGA A, VASCONCELOS C, BRAGA J. Autoimmune hepatitis and pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2020, 68: 23-31. DOI: 10.1016/j.bpobgyn.2020.03.007.
    [27] KOTHADIA JP, SHAH J. Autoimmune hepatitis and pregnancy[M]. Treasure Island (FL): StatPearls Publishing, 2022.
    [28] JANIK MK, WUNSCH E, RASZEJA-WYSZOMIRSKA J, et al. Autoimmune hepatitis exerts a profound, negative effect on health-related quality of life: A prospective, single-centre study[J]. Liver Int, 2019, 39(1): 215-221. DOI: 10.1111/liv.13960.
    [29] EL JAMALY H, ESLICK GD, WELTMAN M. Systematic review with meta-analysis: autoimmune hepatitis in pregnancy[J]. Scand J Gastroenterol, 2021, 56(10): 1194-1204. DOI: 10.1080/00365521.2021.1953127.
    [30] ALUVIHARE VR, KALLIKOURDIS M, BETZ AG. Regulatory T cells mediate maternal tolerance to the fetus[J]. Nat Immunol, 2004, 5(3): 266-271. DOI: 10.1038/ni1037.
    [31] SAMUEL D, RIORDAN S, STRASSER S, et al. Severe autoimmune hepatitis first presenting in the early post partum period[J]. Clin Gastroenterol Hepatol, 2004, 2(7): 622-624. DOI: 10.1016/s1542-3565(04)00245-9.
    [32] GONZÁLEZ DA, DÍAZ BB, RODRÍGUEZ PÉREZ MDEL C, et al. Sex hormones and autoimmunity[J]. Immunol Lett, 2010, 133(1): 6-13. DOI: 10.1016/j.imlet.2010.07.001.
    [33] LLOVET LP, HORTA D, ELIZ MG, et al. Presentation and outcomes of pregnancy in patients with autoimmune hepatitis[J]. Clin Gastroenterol Hepatol, 2019, 17(13): 2819-2821. DOI: 10.1016/j.cgh.2018.12.030.
    [34] CHRISTENSEN LA, DAHLERUP JF, NIELSEN MJ, et al. Azathioprine treatment during lactation[J]. Aliment Pharmacol Ther, 2008, 28(10): 1209-1213. DOI: 10.1111/j.1365-2036.2008.03843.x.
    [35] ANGELBERGER S, REINISCH W, MESSERSCHMIDT A, et al. Long-term follow-up of babies exposed to azathioprine in utero and via breastfeeding[J]. J Crohns Colitis, 2011, 5(2): 95-100. DOI: 10.1016/j.crohns.2010.10.005.
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  • 收稿日期:  2022-02-12
  • 录用日期:  2022-03-08
  • 出版日期:  2022-08-20
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