Autoimmune liver disease

　　Potential triggering factors

　　The pathogenesis of autoimmune liver disease (AIH) requires the activation of antigens. The pathogenesis of AIH induced by environmental factors has not been elucidated, and viruses (such as HBV, HCV, EB virus, measles virus, etc.) are relatively certain in triggering immune responses. Viral antigen epitopes cause cross-reactions through 'molecular mimicry' and have the same epitopes as certain liver antigens, leading to autoimmune liver disease. For example, multiple non-specific autoantibodies can be detected in the serum of some patients with HCV infection. It is speculated that the infection of HCV may stimulate the expression of HLA on the surface of liver cells, changing the protein composition of the liver cell membrane. Biological, physical, or chemical factors can also trigger changes in autoantigens. Drugs such as methyldopa, furazolidone, diclofenac acid, minocycline, interferon, etc., can cause liver injury similar to AIH.

　　Genetic susceptibility

　　The exploration of genetic susceptibility is mainly focused on the superfamily of immunoglobulins, including genes located in the MHC encoding HLA, as well as genes encoding immunoglobulins and T cell receptors (TCR) molecules.

　　Changes in autoimmune reactions

　　1.Hepatic encephalopathy (hepatic coma): A syndrome of central nervous system dysfunction caused by metabolic disorders in severe liver disease, mainly manifested as changes in consciousness and coma.

　　2.Hepatorenal syndrome (HRS): A severe complication of late-stage severe hepatitis. The pathogenesis of HRS is very complex, including renal hemodynamic changes, renal vascular spasm, and widespread renal cortical ischemia as the basic factors of HRS.

　　3.Hemorrhage: Severe hepatitis is a common and serious complication, and is one of the important causes of death in patients.

　　Clinical manifestations of various autoimmune diseases, such as jaundice, fever, rash, arthritis, and various symptoms, and high gamma-globulinemia, rapid erythrocyte sedimentation rate, positive autoantibodies in the blood. About 20%-25% of patients have an onset similar to acute viral hepatitis, manifested as jaundice, anorexia, abdominal distension, etc.

　　Susceptible population

　　Clinical manifestations are more common in women, mainly seen in adolescence. In addition, postmenopausal women are also more common. The onset is usually insidious or slow, and may include joint pain, low fever, fatigue, rash, amenorrhea, etc.

　　In daily life, it is necessary to advocate for a diet high in protein, high in vitamins, low in sugar, and low in fat. Avoid or eat less animal fat and sweets (including sugary drinks). Eat more vegetables, fruits, and foods rich in fiber, and appropriately increase exercise to promote fat consumption in the body.

　　1.Urine test: Urinary bilirubin and urobilinogen in patients with acute jaundice hepatitis are positive before the onset of jaundice.

　　2.Liver function tests:

　　(1)Blood picture: White blood cell count slightly lower than normal levels, neutrophils may decrease, and lymphocytes may increase relatively.

　　(2)Serum bilirubin: During the jaundice period, serum bilirubin levels increase, following the trend of daily increase, usually reaching a peak within 1-2 weeks.

　　(3)Serum enzyme determination:

　　3.Serum alanine aminotransferase (ALT): Jaundice begins to rise before the onset of jaundice, reaches its peak during the extreme stage of the disease, acute hepatitis can have extremely high enzyme activity, and the recovery period is accompanied by a slow decline in serum bilirubin. In chronic hepatitis, ALT can fluctuate repeatedly, and in severe hepatitis, ALT may decrease instead when bilirubin rises sharply, known as 'enzyme-jaundice dissociation', indicating a severe condition.

　　(1)Chicken bone herb, date, pork sandwich: 30 grams of chicken bone herb, 7.8 dates, 100 grams of lean pork. Boil with an appropriate amount of water, season with a small amount of salt, remove the dregs, drink the soup and eat the meat, one dose per day. This formula has the effects of clearing damp-heat, detoxifying, reducing jaundice, and strengthening the body and protecting the liver. It is suitable for patients with marked damp-heat in acute and chronic hepatitis.

　　(2)Mud perch tofu soup: Fresh tofu 100 grams, mud perch several pieces. Put the mud perch in a basin for 1-2 days, clean and kill it, cut it into 3.3-4 cm long sections, put it in a pot with tofu, add an appropriate amount of water, cook until soft, eat tofu and drink soup, once a day, each time a small bowl. Used for acute and chronic jaundice type hepatitis, has a lowering effect on transaminase.

　　(3)Scutellaria baicalensis and date pork liver stew: 30 grams of Scutellaria baicalensis, 7-8 dates, 100 grams of pork liver. Cut the pork liver into slices, boil with an appropriate amount of water, add a small amount of salt, remove the dregs and drink the soup, eat the pork liver, with the effect of clearing heat and removing dampness, dispersing blood stasis and detoxifying, and reinforcing the body and protecting the liver. Suitable for patients with obvious damp-heat syndrome in acute and chronic hepatitis.

　　(1) Immune regulatory drugs

　　Thymosin(Thymosin): Dosage 5-20mg/d; intramuscular or intravenous injection, course of treatment 2-3 months, the artificial synthesis 28 amino acid polypeptide alpha-thymosin in the United States (Jidaxian), dosage 1.6mg per time, twice a week, subcutaneous injection, course of treatment 6 months, can make a few patients HBeAg,

　　HBV DNA negative but expensive. China has also reported the use of high-dose thymosin in the treatment of severe liver disease (160mg, once or every other day, intravenous infusion).　

      (2) Liver-protecting and hypolipidemic drugs:

　　A)Potent Ning or Potent Xin: Dosage: 40-120ml dissolved in glucose solution for intravenous infusion, once a day, after ALT returns to normal, it is advisable to gradually reduce the dose and discontinue the drug to prevent rebound. Long-term and large-scale application may present steroidal-like side effects in some patients.

　　B)Ganlixin is diglycine of glycyrrhizin, the antienzyme effect is better than that of Potent Ning, 30ml (150mg) diluted for intravenous infusion; oral administration is 450mg per day, taken in divided doses. Precautions are the same as Potent Ning.

　　C)Hepatitis Remedy: Significant reduction in ALT, 4ml intramuscular injection daily. It is advisable to gradually reduce the dose and discontinue the drug to prevent rebound. No adverse reactions.

　　D)Potassium Aspartate Magnesium: Dosage: 10-20ml added to glucose solution for slow intravenous infusion, once a day. Effective for reducing serum bilirubin and improving liver function, helpful for the recovery of patients with hepatic encephalopathy.