自身免疫性肝炎aih发病机制(马雄)

《自身免疫性肝炎aih发病机制(马雄)》由会员上传分享，免费在线阅读，更多相关内容在应用文档-天天文库。

1、自身免疫性肝炎发病机制研究进展马雄上海市消化疾病研究所上海交通大学医学院附属仁济医院AutoimmuneHepatitis（AIH）Autoantibodies自身免疫性肝炎的分型特征I型AIHII型AIH自身抗体ANA，SMA，肌动蛋白的抗体LKM-1，ALC-1(antiactin)，抗SLA/LP，pANCA地理分布全世界全世界，北美罕见年龄任何年龄大多为儿童及青少年性别75%为女性95%为女性伴发免疫性疾病常见常见临床严重程度多样性一般较严重组织学特征多样性多为进展性治疗失败少见常见停药后复发不定常见长期维持治

2、疗不定几乎100%需要5自身免疫性肝炎的发病机理•遗传易感性•Treg/Th17细胞平衡•体液免疫和细胞免疫6PositiveandnegativecostimulationofT-cellactivationAutoantigenAssociationofHLADRB1allelswithAIHHLAallelePopulationAdults/ChildrenRiskratioDRB1*0301ArgentinaChildren3.0DRB1*0301NorthAmerica,UK3.39DRB1*0301Indi

3、aAdults3.79DRB1*0404MexicoMixed7.71DRB1*0405ArgentinaAdults10.4DRB1*0405Japan,ChinaAdults4.97DRB1*1301ArgentinaChildren16.3DRB1*1301IndiaAdults6.47DRB1*1302ArgentinaChildren0.1DRB1*14IndiaAdults3.25DRB1*1501NorthAmerica,UK0.52DRB1*0301/0301NorthAmerica,UK7.618DR

4、B1*0301/04NorthAmerica,UK5.099自身免疫性肝炎的发病机理•遗传易感性•Treg/Th17细胞平衡•体液免疫和细胞免疫10NKAPCLivercellIL-17ClassIIPeptideClassIClassIIIL-1Co-stimuliCIL-12IFN-Th0TcTNF-YYTh1YIL-2YIL-4TGF-IFN-MPTregTh2IL-17IL-4IL-10BIL-13IL-6Th17Autoimmuneattack11tothelivercellsVerganiD,eta

5、l.SeminarsinLiverDisease2007RegulatoryTcellsandTcellimmuneresponseVieringJM.Hepatology2011,53:385-388MaX,etal.Heptology2007,46:1519-1529ExpansionandDeNovoGenerationofPotentiallyTherapeuticRegulatoryTCellsinPatientswithAIHFOXP3proteinexpressioninnewlygeneratedT-r

6、egs14LonghiMS，etal.Hepatology,2008,47Autoantigen-specificregulatoryTcells,apotentialtoolforimmune-tolerancereconstitutionintype-2AIHLonghiMS，etal.Hepatology,2011,53:536-547EvidenceofimpairedimmuneregulationinAIH-1•Impairedsuppressorcellfunctioncorrectedbyinvitro

7、exposuretosteroids•DefectinasubsetofT-cellscontrollingresponsestoaliver-specificmembraneautoantigen•NumericalandfunctionalimpairmentofCD4+CD25+Tregs•TregsdefectiveatregulatingCD4andCD8T-cellproliferationandIFN-production•Tregsdefectiveatpromotingsecretionofregu

8、latorycytokinesbytheirtargets•TregsunabletorestrainmonocyteactivationandfunctionEvidenceofimpairedimmuneregulationinAIH-2•NumericalandfunctionalimpairmentofCD4+CD25+T