52例自身免疫性肝炎的临床特点及其治疗  

The clinical characteristics and treatment of 52 cases of autoimmune hepatitis

作　　者：曹忆嵘[1] 郭津生[2] 彭利军[2] 欧阳阳阳[2] 王吉耀[2] 

机构地区：[1]上海复旦大学华东医院消化科,200032 [2]复旦大学中山医院消化科

出　　处：《肝脏》2012年第1期6-10,共5页Chinese Hepatology

摘　　要：目的研究自身免疫性肝炎(AIH)患者的临床特点和治疗。方法收集复旦大学附属中山医院2003至2010年之间收治入院并诊断AIH患者的临床资料,分析其特点。结果 8年间共收治AIH患者52例,平均年龄(55.5±12.9)岁,男、女之比为1∶6.4。入院时病程中位数6个月,最长者已达20年。入院时患者的临床分期如下:急性肝功能衰竭1例,失代偿性肝硬化6例,代偿性肝硬化6例,复发1例,症状期24例,缓解期2例,无症状期6例,不能明确6例。有肝活检病理诊断者30例,占57.7%,其余患者系综合临床症状、生化检查、自身抗体检查及激素疗效诊断。其中23例合并原发性胆汁性肝硬化(PBC),占44%。除PBC之外,合并桥本氏甲状腺炎4例,各类肾炎3例,类风湿性关节炎2例,干燥综合征1例,红斑狼疮1例。常见症状依次排列有乏力(48%),纳差(40%),中上腹不适(38%),黄疸(33%),恶心(27%),体质量下降(21%),皮肤瘙痒(13%),关节酸痛(13%),口干(12%),其他(<10%)。23例接受糖皮质激素治疗,其中14例同时接受熊去氧胆酸治疗。12例仅接受熊去氧胆酸治疗。2例因单用糖皮质激素2周反应不佳而加用硫唑嘌呤。另有1例单纯AIH失代偿性肝硬化患者同时接受这三种药物治疗。12例除"保肝药物"之外,不接受任何针对性治疗。这些患者随访7年,存活47例,1例死亡(死因为"急性粒细胞性白血病"),4例失访。结论本组AIH患者以中老年人居多,女性大大超过男性,临床表现多样,无特异性指标,但症状较为明显。对不愿接受病理活检者,综合临床表现、肝功能、自身免疫抗体,通过非典型AIH积分系统的计算和对激素治疗的反应也可获得诊断。AIH通常并发其他自身免疫性疾病。其中AIH-PBC重叠综合征较为多见。常用药物为糖皮质激素、硫唑嘌呤。当出现重叠综合征、肝损伤较重或出现毛细胆管受损征象时倾向于糖皮质激素和UDCA联合应用。部分患者不用激素Objective To investigate the clinical characteristics and treatment of autoimmune hepatitis （AIH） patients. Methods The clinical data of AIH patients that were admitted to Zhongshan Hospital Fudan University between 2003 and 2010 were collected and analyzed. Results A total of 52 patients with AIH were admitted to the hospital within 8 years. The average age of the patients was （55.5±12.9） years old. The male and female ratio was 1：6.4. The duration of disease when the patients were admitted was 6 months on average, with the longest course of 20 years. The clinical stages of the patients were in a wide range, from acute liver failure （n=1）, decompensate cirrhosis （n=6）, compensate cirrhosis （n=6）, recurrence （n=1）, symptomatic （n=24）, remission （n=2）, to asymptomatic （n=6） and undefined （n=6）. Thirty patients were diagnosed by liver biopsy（57.7%）. Others were diagnosed by a general judgment on clinical symptoms, biochemical function, profile of autoantibodies, and steroids response. Twenty-three AIH patients were complicated with primary biliary cirrhosis （44%）. Other complications included hashimoto’s thyroiditis （n=4）, various nephritis （n=3）, rheumatic arthritis （n=2）, Sjrens syndrome （n=1）, and systemic lupus erythematosus （SLE, n=1）. The common symptoms were ordinal listed as the following： fatigue （48%）,anorexia （40%）,upper abdominal discomfort （38%）,jaundice （33%）,anorexia （27%）,weight loss （21%）,pruritus （13%）,arthralgia （13%）,xerostomia （12%）, and other less common symptoms （less than 10%） including diarrhea, fever, rash, oral ulcer,dry eye and epistaxis. Six patients were asymptomatic （12%）. Twenty-three patients accepted steroids treatment, within which 14 patients were administrated with ursodeoxycholic acid （UDCA） simultaneously. Twelve patients obtained UDCA monotherapy. Twelve of the 14 patients that were treated by prednisone and UDCA were diagnosed as AIH-PBC overlap syndr

关 键 词：自身免疫性肝炎 临床特点 治疗 

分 类 号：R575.1[医药卫生—消化系统]