PROGRESOS Y PROBLEMAS EN LA HEPATITIS AUTOINMUNE

PROGRESOS Y PROBLEMAS EN LA HEPATITIS AUTOINMUNE

(especial para SIIC © Derechos reservados)
Los criterios diagnósticos para la hepatitis autoinmune están normatizados, los índices de pronóstico mejoraron, las indicaciones para el tratamiento han sido seleccionadas, se clarificaron los objetivos de la terapia y se evaluaron nuevas drogas. La ausencia de marcadores serológicos específicos, esquemas de dosificación personalizados, índices de predicción para la toxicidad de las drogas, la evaluación de síndromes alternativos y las intervenciones moleculares específicas son los problemas pendientes.
czaja9.jpg Autor:
Albert J. Czaja
Columnista Experto de SIIC

Institución:
Mayo Clinic College of Medicine


Artículos publicados por Albert J. Czaja
Recepción del artículo
27 de Abril, 2007
Aprobación
18 de Julio, 2007
Primera edición
26 de Agosto, 2008
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Los problemas previos en el diagnóstico y el tratamiento de la hepatitis autoinmune fueron resueltos a medida que se reconocían las diversas manifestaciones clínicas e histológicas de la enfermedad, se identificaban los factores serológicos y genéticos que reflejan el pronóstico, se definieron las indicaciones y los criterios de valoración de la terapia convencional y corticosteroidea, y se codificaron los criterios diagnósticos de la enfermedad. Existe una presentación aguda grave o fulminante; distintos grupos étnicos pueden tener diferentes fenotipos clínicos; es posible que los pacientes asintomáticos no justifiquen el tratamiento; los pacientes ancianos son candidatos importantes para la terapia y la necrosis centrolobulillar (zona 3) es una característica incipiente de la enfermedad. Los anticuerpos contra antígeno hepático/pancreático soluble identifican a los pacientes que sufren una recaída después de suspendidos los fármacos y el Modelo de Enfermedad Hepática en Estadio Terminal puede predecir el fracaso terapéutico antes de la terapia. La ciclosporina, el tacrolimus, el mofetil micofenolato y la budesonida brindan nuevas oportunidades terapéuticas, y es factible realizar intervenciones moleculares en vías patogénicas críticas. Los problemas restantes incluyen el diagnóstico de pacientes seronegativos, la incertidumbre acerca de los esquemas de dosificación apropiados, la prevención de efectos colaterales relacionados con los fármacos y la naturaleza de los síndromes variantes. La ciencia y la tecnología se hallan disponibles para resolver estas cuestiones. Los requisitos del progreso continuo son modelos animales confiables de la enfermedad humana y una red cooperativa de investigadores clínicos.

Palabras clave
hepatitis autoinmune, diagnóstico, tratamiento, corticoides


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Abstract
Previous problems in the diagnosis and treatment of autoimmune hepatitis have been resolved as the diverse clinical and histological manifestations of the disease have been recognized, serological and genetic factors reflective of prognosis have been identified, the indications and end points of conventional corticosteroid therapy have been defined, and the diagnostic criteria for the disease have been codified. A severe acute or fulminant presentation is possible; various ethnic groups can have different clinical phenotypes; asymptomatic patients may not warrant treatment; elderly patients are important candidates for therapy, and centrilobular (zone 3) necrosis is an early feature of the disease. Antibodies to soluble liver antigen/liver pancreas identify patients who relapse after drug withdrawal, and the Model for End Stage Liver Stage may predict treatment failure prior to therapy. Cyclosporine, tacrolimus, mycophenolate mofetil, and budesonide afford new treatment opportunities, and molecular interventions at critical pathogenic pathways are feasible. Remaining problems include the diagnosis of seronegative patients, uncertainties about proper dosing schedules, prevention of drug-related side effects, and the nature of variant syndromes. The science and technologies are available to resolve these issues. Confident animal models of the human disease and a collaborative network of clinical investigators are the requisites for continued progress.

Key words
autoimmune hepatitis, diagnosis, treatment, corticosteroids


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Especialidades
Principal: Infectología
Relacionadas: Diagnóstico por Laboratorio, Farmacología, Gastroenterología, Inmunología, Medicina Interna



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Albert J. Czaja, Mayo Clinic College of Medicine Division of Gastroenterology and Hepatology, MN 55905, 200 First Street S.W., Rochester, EE.UU.
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