Autoimmune hepatitis is a dangerous disease that is accompanied by chronic inflammation and damage to the liver. This disease is more often diagnosed in people of young and mature age. In the absence of treatment or its too late start, the prognosis for patients is unfavorable. That is why it is worth reading more information.
So what is pathology? What are the reasons for its appearance? What are the signs to look out for? What tests for autoimmune hepatitis should be done? Are there really effective therapies? What are the prognosis for patients? Many readers are looking for answers to these questions.
What is pathology?
Autoimmune hepatitis (ICD - K73.2) is a disease that is accompanied by a chronic inflammatory process in the liver tissues. This is an immune-dependent pathology - for one reason or another, the human body begins to produce specific antibodies that attack cellsown liver.
This disease is considered rare - for every million of the population there are no more than 50-200 patients with this diagnosis. Most often, people aged 10 to 30 (autoimmune hepatitis in children is also possible) and from 50 to 70 years old get sick. Women are more prone to this disease.
By the way, for the first time the symptoms of progressive hepatitis, which invariably ended in cirrhosis, were described by D. Waldenström in 1950. In 1956, during research, antinuclear bodies were found in the blood of patients, which confirmed the autoimmune origin of the disease. At that time, the disease was given the name "lupoid hepatitis". The term "autoimmune hepatitis" was introduced into the international nomenclature in 1965.
The main causes of the development of the disease
Autoimmune hepatitis is associated with inadequate activity of the human immune system, which, in fact, is evidenced by the very name of the pathology. The attack of antibodies leads to inflammatory-necrotic changes in the structures of the liver.
During the research, several types of antibodies were found in the blood of patients. However, two compounds play a major role in the development of the disease:
- SMA-antibodies (anti-smooth muscle), which destroy the smallest structures of smooth muscle cells;
- ANA-antibodies (antinuclear) have a detrimental effect on the DNA and proteins of cell nuclei.
Unfortunately, to date, the exact causes of autoimmune reactions are unknown. There are suggestions that activatethis disease can be caused by viruses that enter the human body, in particular viruses of various forms of hepatitis, herpes simplex virus, HIV infection, Epstein-Barr virus.
Risk factors include the activity of Salmonella and yeast in the human body. There is a hereditary predisposition. Thanks to scientific research, it has been found that the onset of an autoimmune process is sometimes associated with taking drugs such as Oxyphenizatin, Monocycline, Isoniazid, Diclofenac.
Autoimmune hepatitis: symptoms
Unfortunately, there are no specific signs, the appearance of which could confirm the presence of an autoimmune form of hepatitis. The clinical picture is blurred. You may experience the following symptoms:
- general deterioration in the patient's well-being;
- constant sleepiness;
- fatigue, decreased performance;
- a person gets tired even from minimal physical exertion, which in the past the body endured quite normally;
- appearance of a feeling of fullness, constant heaviness in the area of the right hypochondrium;
- eye sclera and skin turns yellow (jaundice can be either permanent or transient);
- the patient's urine becomes much darker;
- periodic increases in body temperature are observed (fever disappears as quickly as it appears);
- joint pain, muscle aches;
- loss of appetite and associated weight loss;
- from violationsliver work affects the integument - patients complain of irritating skin itching, burning, redness;
- women may have menstrual irregularities (sometimes menstruation stops altogether);
- possible appearance of spider veins and small pinpoint hemorrhages;
- patients' palms often turn reddish;
- The list of symptoms includes spontaneous tachycardia attacks.
If you have these symptoms, it is extremely important to see a specialist. The earlier the disease is detected, the higher the likelihood of a favorable outcome. Unfortunately, the intensity of symptoms increases gradually, so patients often go to the doctor already at the stage of cirrhosis.
Extrahepatic manifestations
Autoimmune hepatitis is a systemic disease. Often, patients are diagnosed not only with inflammatory-necrotic changes in the liver, but also with other pathologies, including:
- systemic lupus erythematosus;
- rheumatoid arthritis of varying severity;
- some forms of thyroiditis;
- hemolytic anemia;
- vitiligo (disappearance of skin pigmentation);
- vasculitis;
- bronchial asthma;
- insulin-dependent form of diabetes mellitus;
- poliomyositis;
- baldness, both in men and women;
- scleroderma;
- Raynaud's syndrome;
- fibrosing alveolitis;
- an autoimmune form of thrombocytopenia.
In the process of diagnosis, it is extremely important to determine which other organs have suffered from auto-aggression of their ownantibodies.
Main types of disease
There are many classification systems for this pathology. Depending on which antibodies can be isolated from the patient's blood, there are three types of autoimmune hepatitis.
- The most common is the first type of the disease, which, by the way, is most often recorded in females. Both antinuclear and antismooth muscle antibodies are present in the blood. The disease is indolent and responds well to immunosuppressive therapy.
- Hepatitis 2 is most common in children between the ages of 2 and 14. The disease progresses rapidly, and the prognosis is poor. According to statistics, 40-70% of patients at the time of diagnosis already have cirrhosis at one stage or another. Extrahepatic manifestations of the disease are recorded more often than in type 1 hepatitis. The disease is more resistant to medical treatment.
- The third type of disease is characterized by the presence in the blood of antibodies to the liver antigen. The clinical picture is similar to type 1 hepatitis.
What complications can the disease lead to?
Autoimmune liver hepatitis is an extremely dangerous pathology. In the absence of treatment, the disease inevitably ends with complications. Their list is quite large:
- progressive liver failure, which can lead to the development of so-called hepatic encephalopathy (accompanied bytoxic damage to the nervous system, which leads to the development of depressive states, decreased intelligence, personality changes, etc.);
- ascites (a pathology in which fluid accumulates in the free abdominal cavity);
- varicose veins of the esophagus with further damage and massive bleeding;
- cirrhosis of the liver.
That is why the patient should regularly take tests and be observed by a doctor - this is the only way to notice the appearance of deterioration in time.
Diagnostic measures
If the patient has the above symptoms, the doctor will prescribe additional tests. You can talk about autoimmune hepatitis if:
- in the patient's history there is no information about alcohol abuse, blood transfusions, taking medications that adversely affect the liver;
- an elevated level of immunoglobulins in the blood (at least 1.5 times higher than normal);
- in the study of blood serum, no markers of active viral diseases (cytomegalovirus, hepatitis A, B and C) were found;
- detected increased blood levels of SMA and ANA antibodies.
Patients must be sent for ultrasound of internal organs, as well as magnetic resonance and computed tomography. These procedures provide the doctor with information about the size of the liver, changes in its structure. It is also possible to confirm the presence of Wilson's disease, chronic viral hepatitis, fattyliver dystrophy, cirrhosis, cholangitis and some other diseases.
Conservative treatment
Depending on the results of the tests and the general condition of the patient, the doctor will draw up a treatment regimen. How is autoimmune hepatitis treated? Clinical guidelines are as follows.
- An obligatory part of the treatment is taking glucocorticosteroids. As a rule, "Prednisolone" is used. Depending on body weight, patients are administered from 40 to 80 mg of this drug. The course lasts two weeks, after which laboratory tests are carried out. If the patient's condition improves, then the dose of Prednisolone is gradually reduced to 10–20 mg per day.
- Patients are also taking cytostatic drugs that suppress the activity of the immune system. Azathioprine is effective. Patients take three tablets per day. Therapy lasts from 2 to 6 months.
- Urosdeoxycholic acid is also included in the treatment regimen. This substance has a beneficial effect on the liver, accelerates the regeneration of hepatocytes.
- Of course, symptomatic treatment is also carried out. For example, in the presence of ascites and edema, patients are prescribed Furosemide. This medication is for short term use as it depletes potassium from the body.
- If there is gum bleeding, petechial subcutaneous hemorrhages, the appearance of spider veins, then doctors recommend taking Vikasol tablets three times a day.
- Riabal helps with pain and discomfort.
It is worth notingthat anti-inflammatory and immunosuppressive therapy lasts at least 1-2 years. The patient regularly takes tests - so the doctor can evaluate the effect of the treatment, detect deterioration in time. If remission has been achieved, the regimen and schedule of taking the drugs can be slightly changed. According to statistics, in 80% of cases, after the complete withdrawal of drugs, patients develop a relapse. Only some patients with anti-inflammatory therapy can achieve a stable remission. But even if the therapy ended successfully, the person must still be constantly registered with the doctor.
Hepatitis Diet
Treatment of such a disease necessarily includes an appropriate diet. The right diet will help take the load off the liver. What does nutrition look like in a disease like autoimmune hepatitis? Recommendations look like this:
- the ideal option is fractional nutrition (divide the daily food intake into 5-7 meals);
- need to limit the amount of s alt to 5 g per day;
- doctors recommend drinking at least 1.5 liters of water a day;
- alcoholic beverages are strictly prohibited;
- you need to give up products that contain cocoa, as well as carbonated drinks, coffee, legumes, mushrooms, spices, nuts, citrus fruits, whole milk, honey;
- it is allowed to eat cereals, lean meats and fish, fruits and vegetables;
- spicy, fried, fatty and canned foods are contraindicated;
- dishes should be steamed, boiled or baked in the oven.
Surgicalinterference
Using conservative methods, you can stop the symptoms, slow down the inflammatory process and the further development of hepatitis. Nevertheless, surgical treatment of autoimmune hepatitis is currently the only effective way to eliminate this pathology. The essence of therapy in this case is the transplantation of a new liver to the patient.
Of course, the procedure involves a lot of difficulties. Finding a suitable donor is not so easy, sometimes this process drags on for several years. Moreover, the operation is expensive, and not every surgeon is qualified to perform a transplant.
This is the only way to get rid of a disease like autoimmune hepatitis. Cured patients must adhere to certain recommendations, eat right and take appropriate drugs.
Unfortunately, even after a transplant, difficulties may arise. In particular, there is a risk of organ rejection. A transplanted liver, for one reason or another, may not work properly, which leads to liver failure. In addition, medications taken by the patient suppress the activity of the immune system (this helps prevent rejection), so people are much more difficult to tolerate infectious diseases - a common cold can result in pneumonia, meningitis or sepsis.
Home remedy treatment
You already know what autoimmune hepatitis is. Causes, symptoms, conservative treatment - all these are important points. But many patientsare interested in questions about whether home remedies can be added to the treatment regimen. Traditional medicine offers various remedies to improve liver function.
- Oats are considered useful, as the extract of this plant helps to restore hepatocytes. To prepare the medicine, you will need 350 g of unpeeled grains, which must be poured with three liters of water. The mixture must be brought to a boil, then “simmer” over low heat for three hours. After the broth has cooled, it must be filtered. You need to take 150 ml twice a day (preferably 20-30 minutes before meals) for 2-3 weeks.
- Vegetable juices also have a positive effect on the state of the liver. For example, you can drink radish and beetroot juices mixed in equal amounts (no more than one glass of the mixture per day). Juice (or puree) from fresh pumpkin helps, as well as juice from fresh or sauerkraut.
- Bee products, in particular honey, propolis, royal jelly, are widely used in the treatment of hepatitis and other liver diseases.
It should be understood that autoimmune hepatitis is a serious disease, so you should not experiment with drugs. Please consult your he althcare professional before using any home remedy.
Autoimmune hepatitis: patient prognosis
In this case, much depends on the therapy. If the patient does not receive adequate medical care, then chronic autoimmune hepatitis will inevitably lead to cirrhosis, liver failure and death of the patient.
Correctly selected and timely started treatmentgives patients a chance - in 80% of cases, patients manage to at least partially recover and live for at least 20 more years. If the inflammatory process is associated with cirrhosis, then the prognosis, alas, is not so favorable - 80% of patients die within the next 2-5 years. Liver transplantation allows to achieve a stable remission (the prognosis for patients for the next five years is quite favorable).
