原发性胆汁性肝硬化-自身免疫性肝炎重叠综合征临床病理研究  

Clinical and pathological studies on the autoimmune hepatitis and primary biliary cirrhosis overlap syndrome

作　　者：欧阳石[1] 刘树人[1] 骆利敏[1] 

机构地区：[1]解放军第458医院全军肝病中心临床部,广东广州510602

出　　处：《中国现代医学杂志》2013年第36期74-76,共3页China Journal of Modern Medicine

基　　金：全军医学科技"十二五"科研项目(No:CWS11J279)

摘　　要：目的探讨并比较自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)及原发性胆汁性肝硬化-自身免疫性肝炎重叠综合征(AIH-PBC重叠综合征)的临床、生化及病理特征。方法对具有肝穿刺标本的14例AIH-PBC重叠综合征、26例Ⅰ型AIH和29例PBC(Scheuer分期Ⅰ、Ⅱ期)患者进行比较,重点分析AIH-PBC重叠综合征的临床表现、生化特点及病理特点。结果 3组患者的性别、年龄及临床特点无显著差异;AIH-PBC重叠综合征血清碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、抗线粒体抗体(AMA)、AMA-M2阳性率明显高于AIH组(P<0.05);而丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-球蛋白、免疫球蛋白IgG以及抗核抗体(ANA)或抗平滑肌抗体(SMA)阳性率明显高于PBC(P<0.05或P<0.01)。肝组织学示界面炎/碎屑样坏死、小叶内炎症及胆管病变。结论 AIH-PBC重叠综合征临床、血清学及组织病理学表现出AIH和PBC双重特征,不同于单纯的PBC和AIH。[ Objective ] To investigate and compare the clinical, biological, pathological features of patients with autoimmune hepatitis （AIH）, primary biliary cirrhosis （PBC） or AIH-PBC overlap syndrome. [Methods] Comparison was made between 14 patients with overlap syndrome, 26cases with AIH and 29 cases with PBC（Scheuer stage I and Ⅱ ）, and the emphases was laid upon the clinical manifestations, biological, pathological features. [Results] No significant differences were found in sex, age and clinical feature among the three groups. AIH-PBC overlap syndrome group, the serum levels of alkaline phosphatase （ALP）, γ-glutamyltranspeptidase （GTP）, IgM and the frequency of positive anti-mitochondrial antibodies （AMA） and AMA-M2 antibodies were significantly higher than those in the pure AIH group （P 〈0.05）; and the levels of alanine transaminase （ALT）, aspartate aminotransaminase （AST）, γ-globulin and IgG as well as the presence of positive antinuclear antibody （ANA） or anti-smooth muscle antibody （SMA） were markedly higher than those in PBC group （P 〈0.05 or P 〈0.01）. The liver biopsy specimens in the AIH-PBC group were characterized by interface hepatitis, piecemeal necrosis and bile duct lesion. [ Conclusions ] A combined features of both AIH and PBC existed in AIH-PBC overlap syndrome, differed from AIH or PBC alone.

关 键 词：肝炎 自身免疫性 肝硬化 胆汁性 重叠综合征 

分 类 号：R575.2[医药卫生—消化系统]