Abstract：
Diagnostic histological criteria for autoimmune hepatitis (AIH) have not been clearly established. Previously published criteria focused mainly on chronic AIH, in which inflammatory changes mainly occur in portal/periportal regions and may not be applicable to acute presentation of AIH, in which inflammatory changes are typically predominantly lobular in location. International consensus criteria for the diagnosis and assessment of disease severity in both acute and chronic AIH are thus urgently needed.
Seventeen expert liver pathologists convened at an international workshop and subsequently used a modified Delphi panel approach to establish consensus criteria for the histopathological diagnosis of AIH.
The consensus view is that liver biopsy should remain standard for diagnosing AIH. AIH is considered likely, if there is a predominantly portal lymphoplasmacytic hepatitis with more than mild interface activity and/or more than mild lobular hepatitis in the absence of histological features suggestive of another liver disease. AIH is also considered likely if there is predominantly lobular hepatitis with or without centrilobular necroinflammation and at least one of the following features: portal lymphoplasmacytic hepatitis, interface hepatitis or portal-based fibrosis, in the absence of histological features suggestive of another liver disease. Emperipolesis and hepatocellular rosettes are not regarded as being specific for AIH.
The criteria proposed in this consensus statement provide a uniform approach to the histological diagnosis of AIH, which is relevant for patients with an acute as well as a chronic presentation and to more accurately reflect the current understanding of liver pathology in AIH.
Seventeen expert liver pathologists convened at an international workshop and subsequently used a modified Delphi panel approach to establish consensus criteria for the histopathological diagnosis of AIH.
The consensus view is that liver biopsy should remain standard for diagnosing AIH. AIH is considered likely, if there is a predominantly portal lymphoplasmacytic hepatitis with more than mild interface activity and/or more than mild lobular hepatitis in the absence of histological features suggestive of another liver disease. AIH is also considered likely if there is predominantly lobular hepatitis with or without centrilobular necroinflammation and at least one of the following features: portal lymphoplasmacytic hepatitis, interface hepatitis or portal-based fibrosis, in the absence of histological features suggestive of another liver disease. Emperipolesis and hepatocellular rosettes are not regarded as being specific for AIH.
The criteria proposed in this consensus statement provide a uniform approach to the histological diagnosis of AIH, which is relevant for patients with an acute as well as a chronic presentation and to more accurately reflect the current understanding of liver pathology in AIH.
摘要：
自身免疫性肝炎（AIH）的组织学诊断标准尚未明确建立。以前公布的标准主要集中在慢性AIH，其中炎症变化主要发生在门静脉/门静脉周围区域，可能不适用于AIH的急性表现，其中炎症变化通常主要是小叶的位置。因此，迫切需要国际共识标准来诊断和评估急性和慢性AIH的疾病严重程度。
17位专家肝病理学家在一个国际研讨会上召集，随后使用改良的Delphi小组方法建立AIH组织病理学诊断的共识标准。
一致的观点是肝活检应该仍然是诊断AIH的标准。AIH被认为是可能的，如果存在主要的门静脉淋巴浆细胞性肝炎，具有超过轻度的界面活动和/或超过轻度的小叶性肝炎，而没有组织学特征提示另一种肝病。AIH也被认为是可能的，如果有或没有小叶中心坏死性炎症和至少一个以下特征：门脉淋巴浆细胞性肝炎，界面性肝炎或门静脉纤维化，在没有组织学特征的情况下，提示另一种肝病。围手术期和肝细胞玫瑰花结不被认为是AIH的特异性。
本共识声明中提出的标准为AIH的组织学诊断提供了统一的方法，这与急性和慢性表现的患者相关，并更准确地反映目前对AIH肝脏病理的理解。
17位专家肝病理学家在一个国际研讨会上召集，随后使用改良的Delphi小组方法建立AIH组织病理学诊断的共识标准。
一致的观点是肝活检应该仍然是诊断AIH的标准。AIH被认为是可能的，如果存在主要的门静脉淋巴浆细胞性肝炎，具有超过轻度的界面活动和/或超过轻度的小叶性肝炎，而没有组织学特征提示另一种肝病。AIH也被认为是可能的，如果有或没有小叶中心坏死性炎症和至少一个以下特征：门脉淋巴浆细胞性肝炎，界面性肝炎或门静脉纤维化，在没有组织学特征的情况下，提示另一种肝病。围手术期和肝细胞玫瑰花结不被认为是AIH的特异性。
本共识声明中提出的标准为AIH的组织学诊断提供了统一的方法，这与急性和慢性表现的患者相关，并更准确地反映目前对AIH肝脏病理的理解。
