自身免疫性肝病首诊临床特征的年代变迁  

Chronological changes in clinical features of autoimmune liver disease at initial diagnosis

作　　者：李燕妮[1] 周璐[1] 张洁[1] 邓宝茹[1] 郭丽萍[1] 张君[1] 王邦茂[1] LI Yanni ZHOU Lu ZHANG Jie et al(Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, Chin)

机构地区：[1]天津医科大学总医院消化科,天津300052

出　　处：《临床肝胆病杂志》2017年第1期141-145,共5页Journal of Clinical Hepatology

基　　金：国家自然科学基金青年项目(81200282);国家自然科学基金面上项目(81470834)

摘　　要：目的分析自身免疫性肝病(AILD)患者在不同年代中,首诊时临床特征的改变、首诊肝硬化及是否出现并发症的变化趋势,以及首诊途径和肝穿刺病理结果的变化情况,总结AILD患者首诊特征的年代变迁,为早期筛查和规范化诊治提供科学依据。方法回顾性分析2000年1月-2015年12月514例首诊于天津医科大学总医院消化科的AILD患者,根据时间划分为2个年度段,即2000年1月-2007年12月(n=86)、2008年1月-2015年12月(n=428),比较患者首诊年龄、疾病特征、诊断途径、首诊肝硬化及其并发症的比例、合并肝外自身免疫性疾病情况和肝穿刺病理特征。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,不满足χ2检验条件则采用校正χ2检验或Fisher确切概率法。结果 514例AILD患者中,326例自身免疫性肝炎(AIH)、106例原发性胆汁性胆管炎(PBC)、62例为PBC-AIH重叠综合征、2例为原发性硬化性胆管炎、18例为Ig G4相关胆胰疾病。以2007年12月31日为分界点,2个年度段的患者首诊为肝硬化的比例比较差异有统计学意义(83.72%vs 29.91%,χ2=84.996,P<0.05)。514例患者中204例(39.69%)因体检发现肝功能异常(首诊无症状),男女比例分别为6.4%(13例)、93.6%(191例),2007年后因体检发现转氨酶升高而就诊的无症状女性患者比例增多(22.4%vs 50.3%,χ2=16.525,P<0.01)。514例患者中97例(18.87%)为因合并其他疾病从相关科室(如风湿免疫科)转诊的患者,男女比例分别为32.0%(31例)、68.0%(66例),2007年前后相关科室转诊女性患者的比例比较差异有统计学意义(25.4%vs 14.0%,χ2=4.640,P=0.031)。2007年前后首诊消化道出血女性患者的比例比较差异有统计学意义(31.3%vs 4.0%,χ2=51.184,P<0.01)。171例合并其他肝外自身免疫性疾病的AILD患者中,自身免疫性甲状腺病比例为34.5%(59例)。在2006-2015年完成的244例AILD患者肝穿刺活组织检查中,每年肝纤维化/肝硬化患者Objective To investigate the chronological changes in the clinical features of autoimmune liver disease （AILD）at initial diag-nosis,presence or absence of complications of liver cirrhosis at initial diagnosis,initial diagnostic methods,and results of liver biopsy,to summarize the chronological changes in the clinical features of AILD at initial diagnosis,and to provide a basis for early screening and stand-ardized management.Methods A retrospective analysis was performed for the clinical data of 514 AILD patients who were initially diag-nosed at Department of Gastroenterology,Tianjin Medical University General Hospital,from January 2000 to December 2015.According to the time of diagnosis,they were divided into January 2000 to December 2007 group （86 patients）and January 2008 to December 2015 group （428 patients）.The patients′age at initial diagnosis,disease features,diagnostic methods,proportion of patients with liver cirrhosis and its complications at initial diagnosis,extrahepatic autoimmune diseases,and pathological features on liver biopsy were compared between the two groups.The t -test was used for comparison of continuous data between groups;the chi -square test was used for comparison of categor-ical data between groups,and the corrected chi -square test or Fisher′s exact text was used for the categorical data that cannot be analyzed by the chi -square test.Results Among the 514 patients with AILD,326 had autoimmune hepatitis （AIH）,106 had primary biliary cholangitis （PBC）,62 had PBC -AIH overlap syndrome,2 had primary sclerosing cholangitis,and 18 had IgG4 -associated pancreatico-biliary diseases.With December 31,2007 as the time dividing point,there was a significant difference in the proportion of patients with liver cirrhosis at initial diagnosis between the two groups （83.72% vs 29.91%,χ2 =84.996,P 〈0.05）.Of all patients,204 （39.69%）were＆nbsp;found to have abnormal liver function during physical examination （no symptoms at initial diagnosis）,among whom there w

关 键 词：肝疾病 自身免疫疾病 诊断 疾病特征 

分 类 号：R575[医药卫生—消化系统]