1.What is autoimmune liver disease? Autoimmune liver disease is a chronic liver and biliary injury caused by the body’s immune system attacking its own liver components. Normally, the immune system is the body’s bodyguard, helping the body to fight and remove foreign substances. When the immune system is disturbed or the liver tissue components are abnormal, the immune system mistakes its own liver tissues for foreign substances, resulting in a situation where “one’s own people fight one’s own people”. Depending on the tissue components attacked, autoimmune liver diseases can be divided into those with predominantly hepatocellular damage, namely autoimmune hepatitis (AIH), and those with predominantly intrahepatic bile duct damage, namely primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). In addition, the simultaneous occurrence of any two of these three diseases is an overlapping syndrome, and there is another disease, IgG-4-associated hepatitis, which is sometimes found. Liu Guangwei, Department of Spleen, Gastrointestinal, Hepatobiliary Diseases, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine 2. How is autoimmune liver disease diagnosed? Diagnosis of autoimmune liver disease first needs to exclude hepatitis virus infection and liver damage caused by alcohol and drugs. Secondly, the diagnosis can be made only after a comprehensive analysis of clinical manifestations, liver biochemical tests, autoantibody and immunoglobulin tests, imaging tests and liver histopathological manifestations. It is important to identify which type of autoimmune liver disease the disease belongs to in order to select the right treatment drugs. 3.How is AIH treated? The standard treatment of AIH is based on glucocorticoids (prednisolone), and the dose of hormone is individualized. As AIH is prone to recurrent attacks, the treatment course usually needs to last for more than 3 years. In order to reduce recurrence and avoid side effects of glucocorticoids, azathioprine can be used as maintenance therapy after remission. Chinese medicine is more effective for the disease, especially for patients who are insensitive or intolerant to hormones and whose liver function fluctuates repeatedly, using internal and external methods. 4.How is PBC treated? The standard treatment of PBC is based on ursodeoxycholic acid (Ursodeoxycholic acid), and the treatment dose needs to reach 13-15mg/kg/day. Nowadays, there are also studies showing that some patients are not sensitive to the above mentioned drugs. Because PBC is a chronic disease, patients need to take adequate doses of ursodeoxycholic acid for a long time to maintain treatment. In addition, patients with PBC are prone to combined osteoporosis and ulcerative colitis, so they should take vitamin D and calcium supplements routinely. 5.How to treat AIH-PBC overlap syndrome? AIH-PBC overlap syndrome requires combined treatment with glucocorticoids and ursodeoxycholic acid due to the presence of both hepatocyte damage and cholestasis. 6.What is the prognosis of autoimmune liver disease? Autoimmune liver disease can be significantly improved after regular treatment. The survival of early stage patients and AIH patients who respond well to treatment is not different from normal people. With the development of testing technology and the experience of clinicians, most patients with PBC do not develop cirrhosis at the time of definitive diagnosis, and early and long-term adequate treatment of PBC patients can maintain disease stability, so the name “primary biliary cirrhosis” does not mean that cirrhosis is already present. 7.What are the side effects of glucocorticoid therapy? The long-term use of glucocorticosteroids may cause side effects such as increased blood pressure and blood sugar, osteoporosis and gastrointestinal bleeding. However, the dose of hormones used in the treatment of autoimmune liver disease is small, and only a few patients may experience these side effects. Pay attention to monitoring blood pressure and blood sugar and protecting gastric mucosa during hormone therapy, while supplementing with vitamin D, calcium and acid suppressants can reduce the occurrence of the above side effects. 8.What is liver biopsy? Liver biopsy is a test that can directly understand the pathological changes of the tissue and make a more accurate diagnosis, which is recognized as the “gold standard” and its diagnostic value is much higher than the diagnostic value of blood biochemistry and imaging. Liver biopsy is particularly important for the diagnosis of autoimmune liver disease with atypical blood biochemistry, and can detect fibrosis or early compensated cirrhosis, and has an irreplaceable role in determining the course of treatment and prognosis of the disease. 9.Is autoimmune liver disease contagious? Autoimmune liver disease is an autoimmune disease, not caused by hepatitis virus infection, so it is not contagious. 10.What should autoimmune liver disease patients pay attention to in terms of diet? Patients with autoimmune liver disease should not eat a high-fat diet, such as fatty meat, animal offal, etc., do not eat unknown ingredients of tonic drugs, local remedies, etc., and eat less mushrooms and celery, etc. It is advisable to eat high-protein foods such as fish, shrimp, lean meat and fresh fruits and vegetables.