自身免疫性肝病41例临床特征分析  

Analysis on clinical features in 41 cases of autoimmune liver disease

作　　者：伍春霞[1] 曾爱中[1] 

机构地区：[1]重庆医科大学附属第一医院感染科,重庆400016

出　　处：《现代医药卫生》2015年第13期1929-1931,共3页Journal of Modern Medicine & Health

摘　　要：目的比较3种自身免疫性肝病(AILD)的临床表现、血清生化及免疫学检测指标等特征,增加对该类疾病的认识。方法选取2012年1月至2014年6月收治并诊断为AILD患者41例,根据疾病种类不同将其分为自身免疫性肝炎(AIH)17例(AIH组)、原发性胆汁性肝硬化(PBC)9例(PBC组)、AIH-PBC重叠综合征15例(AIH-PBC组),回顾性分析各组患者临床症状、体征、实验室检查等特点。结果 3种疾病均好发于中老年女性,AIH组患者主要表现为乏力、黄疸;PBC组患者临床表现以腹胀、黄疸为主;AIH-PBC组患者综合二者表现。三组患者清蛋白水平均下降,以PBC组下降较明显;三组患者总胆红素(TBIL)、总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、5-核苷酸酶(5-NT)水平均升高,AIH组患者ALT、GGT、5-NT水平升高明显,AIH-PBC组则以AST、ALP、TBIL、TBA水平升高为主。AIH、PBC、AIH-PBC组患者抗核抗体(ANA)阳性率分别为94.12%、77.78%、93.33%,线粒体抗体(AMA)阳性率分别为5.88%、55.56%、60.00%。PBC、AIH-PBC组ANA阳性患者ANA分型以胞浆型(均为42.86%)和混合型(28.57%、21.43%)为主,AIH组以胞浆型(31.25%)、颗粒型(25.00%)及均质型(25.00%)为主。三组ANA阳性患者ANA滴度水平比较,AIH-PBC组主要为高滴度(1∶320),而AIH组以低滴度(1∶100)为主,PBC组高、低滴度水平相当。结论 AILD患者临床表现多样,伴肝功能、免疫学检测等多项指标异常,同时可合并其他自身免疫性疾病。Objective To compare the clinical manifestations,serum biochemistry and immunological indicators in 3kinds of autoimmune liver disease（AILD） for increasing the cognition on these diseases. Methods 41 patients diagnosed as AILD and admitted in this hospital from January 2012 to June 2014 were selected and divided into the autoimmune hepatitis（AIH）group（n=17）,primary biliary cirrhosis（PBC） group（n=9）and overlap syndrome（AIH-PBC） group（n=15） according to different kinds of disease. The features of clinical symptoms,signs and laboratory examinations were retrospectively analyzed. Results These 3 kinds of disease often occurred in middle-aged and old women. The major symptoms in the AIH group were lacking in strength, icterus and splenauxe,which in the PBC group were abdominal distension,icterus and splenauxe,and which in the AIHPBC group combined the manifestations of other two groups. The albumin levels in 3 groups all were declined,especially the decrease in the PBC group was more obvious. The TBIL,TBA,ALT,AST,ALP,GGT and 5-NT levels in 3 groups all were increased.The ALT,GGT and 5-NT levels in the AIH group were significantly increased,while in the AIH-PBC group,the increase of AST,ALP,TBIL and TBA levels was predominant. The ANA positive rate was 94.12% for the AIH group,77.78% for the PBC group and 93.33% for AIH-PBC group. The AMA positive rates were 5.88%,55.56% and 60.00% respectively. The patients with positive ANA in the PBC and AIH-PBC group were mostly cytoplasm type（both were 42.86%） and mixed type（28.57%,21.43%）,while which in the AIH group was mostly cytoplasm type（31.25%）,particle type（25.00%）and homogeneity type（25.00%）. In the comparison of ANA titer levels,the AIH-PBC group showed high titer（1∶320）,the AIH group showed low titer（1∶100）,while in the PBC group,the high titer and low titer were equivalent. Conclusion AILD patients have multiple clinical symptoms accompanied by abnormal indexes in liver function and immunological detection,mea

关 键 词：肝疾病 自身免疫疾病 肝炎 自身免疫性 肝硬化 胆汁性 重叠综合征 

分 类 号：R575[医药卫生—消化系统]