Viêm gan tự miễn: Báo cáo ca bệnh và tổng quan y văn=Autoimmune hepatitis: A case report and literature review

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Tác giả: Văn Linh Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Khoa học Sức khỏe, 2024

Mô tả vật lý: tr.75

Bộ sưu tập: Metadata

ID: 480789

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Bối cảnh: Viêm gan tự miễn là bệnh tương đối hiếm gặp với biểu hiện đa dạng, xảy ra khi hệ thống miễn dịch tấn công, đưa tới tổn thương gan và các biến chứng. Chẩn đoán sớm bằng loại trừ các bệnh nguyên khác, hướng tới xác định viêm gan tự miễn để điều trị kịp thời làm chậm quá trình tiến triển, ngăn ngừa các hậu quả nguy hại và thay đổi tiên lượng bệnh có ý nghĩa quan trọng. Ca bệnh: Bệnh nhân nữ, 84 tuổi, không có tiền sử dụng các thuốc, rượu bia, không mắc viêm gan virus hay các bệnh mạn tính khác, vào viện được chẩn đoán ban đầu là xơ gan. Xét nghiệm miễn dịch ghi nhận kháng thể kháng nhân dương tính, kháng thể kháng cơ trơn âm tính. Người bệnh được chẩn đoán có khả năng cao mắc viêm gan tự miễn cấp mức nặng, được điều trị ức chế miễn dịch với corticosteroid và có đáp ứng thuận lợi, được xuất viện sau 8 ngày điều trị. Sau xuất viện một tuần bệnh nhân tự bỏ thuốc, tái nhập viện 7 ngày sau trong tình trạng xơ gan tái tiến triển kèm viêm phổi. Bệnh nhân được dùng corticosteroid trở lại kết hợp với điều trị tình trạng viêm phổi, được xuất viện sau 11 ngày điều trị. Kêt luận: Viêm gan tự miễn có thể được tiếp nhận và chẩn đoán lần đầu trên người cao tuổi. Trước bệnh cảnh lâm sàng gợi ý, bệnh cần được nghĩ đến để có thể chẩn đoán và điều trị kịp thời. Từ ca bệnh cụ thể này kết hợp với khuyến cáo AASLD2019, tác giả đề xuất một quy trình thực hành linh động và ít xâm lấn, cho phép chẩn đoán sớm và điều trị kịp thời hơn trong thực hành lâm sàng.Context: Autoimmune hepatitis (AIH) is an uncommon immune-mediated liver disease that leads to hepatocellular damage. The disease may has variable manifestations and severe consequences if left untreated. Early diagnosis made by excluding other etiological factors in targeting autoimmune hepatitis for timely treatment to prevent severe consequences and slow down the disease progression is a critical concern. Case report: A 84-year-old female patient without histories of using drugs, alcohol, or of viral hepatitis or other chronic diseases, was hospitalized and initially diagnosed with hepatic cirrhosis. Immunological testing showed antinuclear antibodies (ANA) positive, anti-smooth muscle antibody (SMA) negative. The patient was diagnosed, by law of likelihood, with acute severe autoimmune hepatitis, that responded favorably to corticosteroid therapy, and was discharged after 8 days of treatment. One week after discharge from the hospital, the patient quit the prescribed treatment on her own and was hospitalized again with progressive cirrhosis state associated with pneumonia. The patient was treated again with corticosteroids in conjunction with the medications prescribed for her pneumonia. Conclusion: Autoimmune hepatitis may be presented among elders. In the presence of suggested manifestations, the diagnosis of autoimmune hepatitis should be oriented and considered for rapid institution of treatment (if eligible). From this specific case combined with the 2019 AASLD Guidelines, the author proposes a flexible and less invasive practical diagnostic algorithm for the evaluation of suspected AIH that allows for early diagnosis and more timely treatment in clinical practice.

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