Immunosuppressive therapy with corticosteroids has been for many years the mainstay of treatment for autoimmune hepatitis (AIH). UK and European guidelines recommend using high-dose oral prednisolone to induce remission in AIH, followed by the introduction of the immunosuppressant azathioprine, with tapering of the corticosteroid dose, continuing with azathioprine as long-term maintenance monotherapy or sometimes in combination with low-dose prednisolone. In contrast to the other autoimmune liver diseases, primary biliary cholangitis and primary sclerosing cholangitis, there is assumption from healthcare professionals in the UK, that AIH is a disease that can be easily and successfully managed by treatment with corticosteroids and immunosuppressants. Is this assumption justified by the evidence? In this journal, Gordon and colleagues report on the finding of an audit of service provision and care of patients with AIH in 28 UK hospitals between January 2014 and November 2015.1 The study can be criticised for the delay of 6 years in the publication of the results, but it is unlikely that the results of the audit would have significantly altered in the 6-year interim and it provides an important overview of current practices in the management of AIH in the UK. The study found that after 1 year of treatment, 82% of the patients had achieved normal serum ALT levels; and that the remission rate was higher in University Hospitals than District General Hospitals. The other significant findings were that one-third of hospitals lacked a specialist consultant hepatologist, and only 18% had the services of a specialist liver nurse involved in the management of AIH. Liver blood test monitoring was found to be performed less frequently …

中文翻译：

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自身免疫性肝炎 (AIH) 患者治疗和随访护理的规定和标准

多年来，使用皮质类固醇进行免疫抑制治疗一直是自身免疫性肝炎 (AIH) 的主要治疗方法。英国和欧洲指南建议使用大剂量口服强的松龙诱导 AIH 缓解，然后引入免疫抑制剂硫唑嘌呤，逐渐减少皮质类固醇剂量，继续使用硫唑嘌呤作为长期维持单药治疗，有时与低剂量联合治疗泼尼松龙。与其他自身免疫性肝病、原发性胆汁性胆管炎和原发性硬化性胆管炎相比，英国的医疗保健专业人员假设 AIH 是一种可以通过皮质类固醇和免疫抑制剂治疗轻松成功地控制的疾病。这个假设有证据证明吗？在本刊中，Gordon 及其同事报告了 2014 年 1 月至 2015 年 11 月期间在 28 家英国医院对 AIH 患者的服务提供和护理进行审计的结果1。该研究的结果发表延迟 6 年可能会受到批评，但它是审计结果不太可能在 6 年中期发生重大变化，它提供了对英国 AIH 管理当前实践的重要概述。研究发现，经过1年的治疗，82%的患者达到了正常的血清ALT水平；并且大学医院的缓解率高于地区综合医院。其他重要发现是，三分之一的医院缺乏肝病专家顾问，只有 18% 的医院有参与 AIH 管理的肝病专科护士的服务。