{"id":83,"date":"2009-02-28T14:34:41","date_gmt":"2009-02-28T14:34:41","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/reuautohep\/"},"modified":"2025-05-14T20:58:10","modified_gmt":"2025-05-14T20:58:10","slug":"reuautohep","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/es\/reuautohep\/","title":{"rendered":"Criterios Diagn\u00f3stico para Hepatitis Autoinmune (HAI)"},"content":{"rendered":"<div class=\"7ca9444b8380138fe077da07353677a4\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>La hepatitis autoinmune (HAI) se caracteriza por histolog\u00eda hep\u00e1tica inflamatoria, autoanticuerpos circulantes que no son espec\u00edficos de \u00f3rganos y niveles elevados de inmunoglobulina (Ig) G en ausencia de una etiolog\u00eda conocida.<br \/>\n<!--more--><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td rowspan=\"2\"><strong>Requisitos<\/strong><\/td>\n<td style=\"text-align: center;\" colspan=\"2\"><strong>Criterios diagn\u00f3sticos<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>Definitivo<\/strong><\/td>\n<td><strong>Probable<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Ausencia de enfermedad hep\u00e1tica gen\u00e9tica<\/td>\n<td>Fenotipo normal de alfa-1 antitripsina.<br \/>\nNiveles s\u00e9ricos normales de ceruloplasmina, hierro y ferritina.<\/td>\n<td>Deficiencia parcial de alfa-1 antitripsina.<br \/>\nAnormalidades s\u00e9ricas no espec\u00edficas de cobre, ceruloplasmina, hierro, y\/o ferritina.<\/td>\n<\/tr>\n<tr>\n<td>Ausencia de infecci\u00f3n viral activa<\/td>\n<td>Ausencia de marcadores de infecci\u00f3n activa para virus de hepatitis A, B, y C.<\/td>\n<td>Ausencia de marcadores de infecci\u00f3n activa para virus de hepatitis A, B, y C.<\/td>\n<\/tr>\n<tr>\n<td>Ausencia de lesi\u00f3n t\u00f3xica o por alcohol<\/td>\n<td>Consumo de alcohol diario &lt;25 g\/d y no uso reciente de drogas hepatot\u00f3xicas.<\/td>\n<td>Consumo de alcohol diario &lt;50 g\/d y no uso reciente de drogas hepatot\u00f3xicas.<\/td>\n<\/tr>\n<tr>\n<td>Caracter\u00edsticas de laboratorio<\/td>\n<td>Predominio de elevaci\u00f3n de transaminasas s\u00e9ricas.<br \/>\nNivel de globulinas, gamma-globulinas o inmunoglobulinas G &gt;\/= 1,5 veces del nivel normal.<\/td>\n<td>Predominio de elevaci\u00f3n de transaminasas s\u00e9ricas.<br \/>\nHipergammaglobulinemia de cualquier grado.<\/td>\n<\/tr>\n<tr>\n<td>Autoanticuerpos<\/td>\n<td>ANA, SMA, o anti-LKM1 &gt; o = 1:80 en adultos, y &gt; o = 1:20 en ni\u00f1os; no AMA.<\/td>\n<td>ANA, SMA, o anti-LKM1 &gt; o = 1:40 en adultos u otros autoanticuerpos.*<\/td>\n<\/tr>\n<tr>\n<td>Hallazgos histol\u00f3gicos<\/td>\n<td>Interfase de hepatitis.<br \/>\nNo lesiones biliares, granulomas, o cambios prominentes sugestivos de otra enfermedad.<\/td>\n<td>Interfase de hepatitis.<br \/>\nNo lesiones biliares, granulomas, o cambios prominentes sugestivos de otra enfermedad.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"font-weight: 400;\">*Incluye anticuerpos antineutr\u00f3filos citopl\u00e1smico perinuclear (pANCA) y anticuerpos generalmente no disponibles como ant\u00edgeno hep\u00e1tico soluble\/hep\u00e1tico pancre\u00e1tico (anti-SLA\/LP), actina, citosol hep\u00e1tico tipo 1 (anti-LC1), y receptor asialoglicoprote\u00edna (anti-ASGPR).<\/p>\n<p style=\"font-weight: 400;\">Abreviaturas: ANA, anticuerpos antinucleares; SMA, anticuerpos antim\u00fasculo liso; anti-LKM1, anticuerpos microsomal anti h\u00edgado\/ri\u00f1\u00f3n tipo 1; AMA, anticuerpos antimitocondriales.<\/p>\n<p style=\"font-weight: 400;\"><strong>Sistema de puntuaci\u00f3n para realizar diagn\u00f3stico de hepatitis autoinmunes at\u00edpicas en adultos<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td width=\"199\"><strong>Categor\u00eda<\/strong><\/td>\n<td style=\"text-align: center;\" width=\"199\"><strong>Factor<\/strong><\/td>\n<td style=\"text-align: center;\" width=\"199\"><strong>Score<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Sexo<\/td>\n<td style=\"text-align: center;\" width=\"199\">Femenino<\/td>\n<td style=\"text-align: center;\" width=\"199\">+2<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Relaci\u00f3n FAL\/GOT (o GPT)<\/td>\n<td style=\"text-align: center;\" width=\"199\">&gt;3<br \/>\n&lt;1,5<\/td>\n<td style=\"text-align: center;\" width=\"199\">-2<br \/>\n+2<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Gammaglobulina o IgG (veces sobre el l\u00edmite superior normal)<\/td>\n<td style=\"text-align: center;\" width=\"199\">&gt;2,0<br \/>\n1,5-2,0<br \/>\n1,0-1,5<br \/>\n&lt;1,0<\/td>\n<td style=\"text-align: center;\" width=\"199\">+3<br \/>\n+2<br \/>\n+1<br \/>\n0<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">T\u00edtulos de ANA, SMA, o anti-LKM1<\/td>\n<td style=\"text-align: center;\" width=\"199\">&gt;1:80<br \/>\n1:80<br \/>\n1:40<br \/>\n&lt;1:40<\/td>\n<td style=\"text-align: center;\" width=\"199\">+3<br \/>\n+2<br \/>\n+1<br \/>\n0<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">AMA<\/td>\n<td style=\"text-align: center;\" width=\"199\">Positivo<\/td>\n<td style=\"text-align: center;\" width=\"199\">-4<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Marcadores virales de infecci\u00f3n activa<\/td>\n<td style=\"text-align: center;\" width=\"199\">Positivo<br \/>\nNegativo<\/td>\n<td style=\"text-align: center;\" width=\"199\">-3<br \/>\n+3<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Drogas hepatot\u00f3xicas<\/td>\n<td style=\"text-align: center;\" width=\"199\">Si<br \/>\nNo<\/td>\n<td style=\"text-align: center;\" width=\"199\">-4<br \/>\n+1<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Alcohol<\/td>\n<td style=\"text-align: center;\" width=\"199\">&lt;25 g\/d<br \/>\n&gt;60 g\/d<\/td>\n<td style=\"text-align: center;\" width=\"199\">+2<br \/>\n-2<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Enfermedad autoinmune concurrente<\/td>\n<td style=\"text-align: center;\" width=\"199\">Cualquier enfermedad no-hep\u00e1tica de origen inmune<\/td>\n<td style=\"text-align: center;\" width=\"199\">+2<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Otros autoanticuerpos<\/td>\n<td style=\"text-align: center;\" width=\"199\">Anti-SLA\/LP, actina, LC1, pANCA<\/td>\n<td style=\"text-align: center;\" width=\"199\">+2<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Caracter\u00edsticas histol\u00f3gicas<\/td>\n<td style=\"text-align: center;\" width=\"199\">Interfase de hepatitis<br \/>\nC\u00e9lulas plasm\u00e1ticas<br \/>\nRosetas<br \/>\nNinguna de las de arriba<br \/>\nCambios biliares<br \/>\nCaracter\u00edsticas at\u00edpicas<\/td>\n<td style=\"text-align: center;\" width=\"199\">+3<br \/>\n+1<br \/>\n+1<br \/>\n-5<br \/>\n-3<br \/>\n-3<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">HLA<\/td>\n<td style=\"text-align: center;\" width=\"199\">DR3 o DR4<\/td>\n<td style=\"text-align: center;\" width=\"199\">+1<\/td>\n<\/tr>\n<tr>\n<td width=\"199\">Respuesta al tratamiento<\/td>\n<td style=\"text-align: center;\" width=\"199\">Remisi\u00f3n completa<br \/>\nRemisi\u00f3n con reca\u00edda<\/td>\n<td style=\"text-align: center;\" width=\"199\">+2<br \/>\n+3<\/td>\n<\/tr>\n<tr>\n<td width=\"199\"><strong>Score pretratamiento<\/strong><br \/>\nDiagn\u00f3stico definitivo<br \/>\nDiagn\u00f3stico probable<br \/>\n<strong>Score post-tratamiento<\/strong><br \/>\nDiagn\u00f3stico definitivo<br \/>\nDiagn\u00f3stico probable<\/td>\n<td width=\"199\"><\/td>\n<td style=\"text-align: center;\" width=\"199\">\n&gt;15<br \/>\n10-15<\/p>\n<p>&gt;17<br \/>\n12-17<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p style=\"font-weight: 400;\"><strong>Recomendaciones<\/strong><\/p>\n<p style=\"font-weight: 400;\">En base a la evidencia, las recomendaciones actuales con respecto al diagn\u00f3stico de la hepatitis autoinmune son las siguientes:<\/p>\n<ol style=\"font-weight: 400;\">\n<li>El diagn\u00f3stico de hepatitis autoinmune requiere la determinaci\u00f3n de niveles de aminotransferasas s\u00e9ricas y de gammaglobulinas; detecci\u00f3n de ANA y\/o SMA, o en su ausencia, anti-LKM1; y examen histol\u00f3gico de biopsia hep\u00e1tica.<\/li>\n<li>Los criterios diagn\u00f3sticos de hepatitis autoinmune deben ser aplicados a todos los pacientes.<\/li>\n<li>Si el diagn\u00f3stico de hepatitis autoinmune no est\u00e1 claro, se debe utilizar el m\u00e9todo de puntuaci\u00f3n o score.<\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p style=\"font-weight: 400;\"><strong>Bibliograf\u00eda:<\/strong><\/p>\n<ol style=\"font-weight: 400;\">\n<li>Czaja AJ, Freese DK; American Association for the Study of Liver Disease. Diagnosis and treatment of autoimmune hepatitis. Hepatology 2002 Aug;36(2):479-97 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12143059\/\">[Medline]<\/a><\/li>\n<li>Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Desmet VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathcote J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Buschenfelde KH, Zeniya M, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol\u00a0 1999 Nov;31(5):929-38 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/10580593\/\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p style=\"font-weight: 400;\">Creado: Feb 18, 2006<\/p>\n<p><\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>La hepatitis autoinmune (HAI) se caracteriza por histolog\u00eda hep\u00e1tica inflamatoria, autoanticuerpos circulantes que no son espec\u00edficos de \u00f3rganos y niveles elevados de inmunoglobulina (Ig) G en ausencia de una etiolog\u00eda conocida.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[45],"tags":[1746,250,251,16,15,14,1413,1144,1070],"class_list":["post-83","post","type-post","status-publish","format-standard","hentry","category-rheumatology","tag-aih","tag-autoimmune","tag-autoinmune","tag-criteria","tag-criterios","tag-diagnostic","tag-gastroenterology","tag-hepatitis","tag-rheumatology"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/83","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/comments?post=83"}],"version-history":[{"count":7,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/83\/revisions"}],"predecessor-version":[{"id":8838,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/posts\/83\/revisions\/8838"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/media?parent=83"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/categories?post=83"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/es\/wp-json\/wp\/v2\/tags?post=83"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}