Autoimmune diseases are the least studied by modern medicine. Autoimmune hepatitis is characterized by the destruction of the liver cells by the immune system. What are the causes of this pathology? What methods of diagnostics and treatment will help a person?
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Characteristics of the disease
Autoimmune hepatitis - what is it? With this pathology, an inflammatory process begins in the liver cells, which rapidly progresses. In the body, necrotic processes are triggered, which leads to the development of cirrhosis. Chronic immune hepatitis is a rare disease, a cause of development, which is not fully understood.
The most commonly diagnosed disease is between the ages of 10 and 30 years in both sexes, in women 8 times more often. Developed autoimmune hepatitis in women during menopause. In a third of patients, pathology is accompanied by other autoimmune diseases. The most difficult consequences of autoimmune hepatitis are cirrhosis and hepatic insufficiency. Women can develop amenorrhea, the disappearance of ovulation, infertility.
Often the disease develops against the background of a hepatitis A, B, C, herpes infection, the Epstein-Barr virus. To provoke the development of the disease may be medications on the basis of interferon. Pathology is not hereditary, scientists have not identified a gene that provokes the development of chronic immune hepatitis.
The prognosis of survival depends on how the inflammatory process proceeds. With the delayed development of 8 patients out of 10 live more than 15 years. In the absence of appropriate treatment, life expectancy does not exceed 5 years.
Important! In 20% of patients with autoimmune hepatitis, there are cases of self-healing.
The types of autoimmune hepatitis depend on the type of protein compounds that appear in the blood serum:
- AIG-1 develops at the age of 10-20 years, or after 50. It has a good response to immunosuppressive drugs, stable remission is noted in every 5 patientseven after the abolition of corticosteroids. If the therapy is not started in time, cirrhosis of the liver will develop in 3 years.
- AIG-2 - develops in every 10-12 patients with autoimmune hepatitis. Often diagnosed in children, the disease is characterized by relapses, cirrhosis develops 2 times more often than with the first type of immune hepatitis.
- AIG-3 - is accompanied by rheumatoid factors.
The main symptoms of the disease
Symptoms of autoimmune hepatitis are similar to the manifestation of lupus erythematosus. Sometimes the disease begins acutely, proceeds particularly hard - a severe form of hepatitis develops, in which a large number of liver cells die. Against the background of severe intoxication, damage occurs in the brain.
Important! In 25% of cases, autoimmune hepatitis occurs without any symptoms, it is often detected in the development of complications and irreversible consequences.
Possible symptoms of the disease:
- increased fatigue, unreasonable rise in temperature to 39 degrees;
- signs of jaundice;
- pain and discomfort in the right hypochondrium region;
- articular problems - pain, swelling, disruption of work;
- dermatological diseases - acne, inflammation in the sebaceous glands and hairs of the hair.
Sometimes, against the background of autoimmune hepatitis, there is an increase in the liver, spleen, lymph nodes. The disease can be accompanied by increased hairiness.
There may be signs of increased production of hormones by the adrenal cortex - obesity of the face and upper body, while the limbs become very thin, purple blush appears, striae, bubbles with pus.
With the development of cirrhosis, the pressure in the collar vein increases, varicose veins of the esophagus develop, and the peripodal region develops. There may be signs of food poisoning - nausea, vomiting, poor appetite, bloating.
The first signs of autoimmune hepatitis in children appear after 10 years. Sometimes the cause of the disease can serve as measles and other viral diseases. Virtually all children have autoimmune hepatitis manifested as symptoms of acute hepatitis.
Important! Diagnosis and treatment methods are the same for children and adults, but in children the disease occurs in a more acute form.
Diagnostic methods
Diagnosis begins with the collection of anamnesis, analysis of the patient's life, external examination. At the first stage the doctor reveals the presence of signs of jaundice, fever, palpating the liver, spleen, lymph nodes.
Laboratory test methods:
- general blood test - with immune hepatitis the results will show a low level of hemoglobin, high content of leukocytes;
- biochemical blood test - helps to see changes in the liver, pancreas;
- blood test for the presence of viruses that can trigger the development of liver disease;
- coagulogram - an analysis for determining blood coagulability, with cirrhosis the indices decrease;
- enzyme-linked immunosorbent assay - with cirrhosis it will show a high content of gamma globulins and IgG immunoglobulins;
- coprogram and analysis of feces for eggs of worms.
Be sure to make biochemical markers( PGA-indices), which show the presence of liver fibrosis. In severe liver pathologies, the clotting factor and plasma protein decrease. A PGA score of less than 2 indicates almost complete lack of probability of cirrhosis.
Important! If the PGA is above 9, then the probability of developing cirrhosis is 85% or more.
Additionally, ultrasound and computer tomography of the abdominal organs are performed to see the condition and pathological changes in the gallbladder, liver, pancreas. Be sure to conduct a study for the detection of dilated veins in the stomach and duodenum.
Biopsy and elastography are aimed at the study of liver cells, allow to exclude the presence of cancer, to study the extent of growth of scar tissue.
The final diagnosis is made with the coincidence of several indicators - a high content of antibodies, the level of antibodies in children above 1:80( in children 1:20).At the same time, a person did not receive blood transfusion in the recent past, he did not take drugs that have hematoxic activity, all studies for viral diseases showed a negative result.
Autoimmune hepatitis in pregnancy
The chances of becoming pregnant in the early stages of immune hepatitis are the same as in healthy women. The main danger - autoimmune hepatitis leads to intrauterine fetal death or miscarriage.
Important! Timely diagnosis and treatment increase the chance of a normal course of pregnancy with a natural delivery up to 80%.
When planning pregnancy in the treatment, only corticosteroids are used - the safety of Prednisolone for an embryo is proven and confirmed by various studies. Azathioprine should be excluded from the treatment regimen, since there are cases of fetal pathology development when taking the drug. During the lactation, it is safe to take glucocorticosteroids.
Traditional therapies
Therapy for autoimmune hepatitis aims to suppress immunity, decrease the activity of reactions that destroy liver cells. For this, glucocorticosteroids are used.
Combination therapy is based on the joint administration of drugs Prednisolone and Azathioprine. When monotherapy is prescribed Prednisolone in high doses. Both schemes have approximately the same effectiveness, help prevent the development of concomitant diseases. In a combined scheme, adverse reactions are noted in 10% of cases, with monotherapy, this indicator increases to 45%.
Combined therapy is used to treat elderly women, diabetics, with osteoporosis, obesity, increased nervous excitability. Monotherapy is prescribed in pregnancy, the presence of tumors of various origin, cytopenia.
Duration of treatment -6-24 months, the dose of prednisolone is gradually reduced. Sometimes it is necessary to take medicines continuously for life.
To treatment with steroids resorted to in the presence of necrosis, loss of ability to work. Corticosteroids are recommended for use if pathological changes develop rapidly.
Important! If for 4 years the therapy does not bring positive changes, the patient is diagnosed with permanent relapses - in this case only liver transplantation will help.
Recently, doctors have been treating autoimmune hepatitis with Budenofalk. This drug belongs to the group of glucocorticosteroids, for a long time it was used to treat exclusively Crohn's disease. But research and feedback from patients showed the effectiveness of using Bedofalcka in the treatment of immune hepatitis, it causes fewer side effects. It is especially effective in the period of remission.
Proper nutrition in autoimmune hepatitis
For chronic immune hepatitis, special diet No. 5.5a must be followed. All dishes should be at room temperature, it is forbidden to eat spicy, fried, salted, sour and marinated food.
Prohibited products:
- products that contain cocoa;
- coffee, carbonated drinks;
- mushrooms and legumes, cabbage, onion, garlic, leafy greens;
- ice cream, spices.
It is allowed to use only dietary dishes in boiled, baked, stewed and steam kind.
- If the disease worsens, it is necessary to increase the number of meals from 5 to 6, while the daily calorie content decreases from 3000 kcal to 2700.
- The amount of water is not less than 1.5 liters per day, salt can be consumed no more than 5 g per day. In the diet should not be more than 80 grams of fat per day.
- It is allowed to eat lean meats and fish, eggs in any form, dairy products, seasonal vegetables without coarse fibers, non-acid berries.
Important! Treatment of autoimmune hepatitis implies a complete refusal of alcoholic beverages. More than 70% of ethyl alcohol, which enters the body, is processed by the liver, which leads to fatty degeneration and cell death.
Treatment with folk remedies
Folk remedies are recommended to be used as maintenance therapy during remission. It is impossible to completely cure the disease with the help of alternative medicine.
Oats
Oats are one of the best tools for the treatment and recovery of liver cells. Pour 3 l of water 300-350 g of raw grains, allow the mixture to boil, simmer for minimum 3 hours. Decoction squeeze, filter, take 100-150 ml twice a day for half an hour before meals. The duration of therapy is 2-3 weeks.
Juices
Helps to clear the liver ducts of juices. You can mix in equal proportions the juice of beet and radish, drink 240 ml per day. Cabbage juice from fresh or sauerkraut should be drunk every day for 200 ml for 6 weeks. Fresh pumpkin juice should be consumed per day for 120 ml, you can replace 500 g of puree.
Beekeeping products
Beekeeping products help with many chronic liver diseases. Treatment with propolis helps to eliminate colic, to clear the hepatic ducts, to prevent the multiplication of hepatitis viruses. It is necessary 3 times a day to take 2 drops of propolis tincture, the medicine should be diluted in 120 ml of warm water.
Honey for cirrhosis and hepatitis should be taken daily. You can mix 15 ml of honey with 3 g of pollen, take the mixture twice a day after breakfast and lunch.
For cirrhosis, morning and evening, eat 45 ml of honey with 2 g of royal jelly. Well cleanses the liver mixture of honey and fresh black currant, each component will require 1 kg. Take 5 grams of medication half an hour before meals, continue treatment until the end of the mixture.
Autoimmune hepatitis is a complex, chronic disease of unclear etiology. A person with this diagnosis should be prepared for long-term admission of medications, adherence to a special diet, avoid overheating and hypothermia. Only if all the doctor's reactions are observed, long-term remission of the disease is possible.