未分化结缔组织病导致的肝损害  

Undifferentiated connective tissue disease-related hepatic injury

作　　者：张福奎[1] 贾继东[1] 张文胜[1] 张涛[1] 石晓燕[2] 王泰龄[3] 王宝恩[1] 

机构地区：[1]首都医科大学附属北京友谊医院肝病中心,北京100050 [2]首都医科大学附属北京友谊医院病理科 [3]中日友好医院病理科

出　　处：《肝脏》2007年第4期244-245,248,共3页Chinese Hepatology

基　　金：北京市科技新星计划资助项目(2006B54);北京友谊医院院内科研基金资助项目

摘　　要：目的研究未分化结缔组织病(undifferentiated connective tissue disease,UCTD)导致肝损害的临床特征及其诊断和治疗。方法对一例UCTD导致肝损害患者的病史、临床表现、实验室检查、诊断治疗经过以及近期疗效进行回顾性分析。结果患者为中年女性,临床表现为乏力、食欲减退、低热、皮疹,合并有间质性肺炎、心包积液等,有"骨关节炎"膝关节置换术等病史,血清转氨酶升高,血IgG、球蛋白升高,ESR增快,嗜酸粒细胞水平明显升高,血ANA1:320阳性,肝脏病理特点符合结缔组织病所致的小血管炎。经小剂量泼尼松治疗后,临床症状和实验室检查指标好转,近期疗效显著。结论对于结缔组织病患者肝功异常的鉴别诊断应该想到UCTD导致肝损害的可能,对于肝功能损害明显、常规保肝治疗无效的患者可应用小剂量糖皮质激素治疗。Objective To present the clinical features and management of a patiant with undifferentiated connective tissue disease （UCTD）-related hepatic injury, Methods Data of one case with UCTD-related hepatic injury, including the case history, clinical manifestations, laboratory findings, treatment and short-term effect were reviewed retrospectively. Results The patient was a middle-aged woman who presented with symptoms of fatigue, anorexia, low-grade fever and skin rashes, with a past history of left knee joint replacement. Imaging studies showed interstitial pneumonitis and hydropericardium. Laboratory findings showed elevated serum transaminases, IgG and globulin levels, accelerated erythrocyte sedimentation rate, eosinophilia and high titer of antinuclear antibodies （1：320）, Liver biopsy showed the features consistent with connective tissue diseases-related polyangitis. Both symptoms and laboratory tests improved significamtly after treatment with low-dose prednisone. Conclusion UCTD-related hepatic injury should be considered in the differential diagnosis of connective tissue diseases with abnormal liver function tests. Low-dose prednisone was effective to improve both symptoms and laboratory tests.

关 键 词：结缔组织病 肝损害 糖皮质激素 

分 类 号：R593.2[医药卫生—内科学]